Acute airway obstruction in an infant with Pierre Robin syndrome after palatoplasty

Abstract

This report describes a complication of post-operative oedema of the palate, tongue and pharynx after a Perko-revised cleft palate repair, which resulted in a life-threatening airway obstruction in an infant with Pierre Robin syndrome. Although infants experiencing airway problems after Wardill-Kilner, von Langenbeck and Furlow palatoplasty have been described, airway complications in a group of Perko-revised repair children have not been previously reported. We speculate that this complication, which occurred in the absence of a history of previous airway problems, is due to prolonged operating time and excessive pressure exerted on the base of the tongue by the Kilner-Doughty retractor. Acknowledgments of this risk permits to identify those patients prior to surgery so that they can be managed appropriately.

Massive macroglossia after palatoplasty

“…First of all there is some evidence suggesting that the duration of the operation is related to the extent of postoperative swelling. The pressure applied by the tongue retractor used to obtain adequate exposure during surgery impairs the venous and lymphatic drainage resulting in edema [3,4,6,10,15]. Positioning of the patient during the operation seems to be another risk factor.…”

Avoiding airway obstruction after pediatric adenotonsillectomy

“…Less attention has been given to surgeon-related factors. Prolonged operative time and extended use of the tongue retractor are frequently mentioned as a contributing factor to postoperative upper airway edema [6,10,11]. Thermal devices seem to increase the risk of pharyngeal and uvular edema [12,13].…”

Lebensbedrohliche Makroglossie nach Gaumenspaltenverschluss

“…Die ange wandte Operationstechnik (häufiger bei Operationen nach WardillKilner, von Langenbeck und Furlow) sowie die Ein griffsdauer (>180 min) haben Einfluss auf die Inzidenz einer postoperativen Zun genschwellung [1,2,3,4,6,7,9,10]. Zum pathophysiologischen Hintergrund wird vermutet, der Sperrer könne eine Kom pression der Zunge verursachen, die über eine venöse Stase zur Abnahme der Per fusion führe.…”

“…Die Makroglossie tritt meist innerhalb der ersten 60 min nach der Operation auf, kann aber auch erst verzögert (inner halb 24 h) symptomatisch werden. Kin der mit kongenitalen Anomalien, insbe sondere der PierreRobinSequenz, sind besonders gefährdet [2,7,10]. Das Ödem der Zunge bildet sich innerhalb von 5 bis 14 Tagen spontan zurück; bleibende Funk tionsstörungen sind nicht beschrieben.…”