Effects of mandibular distraction osteogenesis on anesthetic implications in children with hemifacial microsomia

Abstract

Background: Hemifacial microsomia (HFM) is a congenital craniofacial malformation, and its features include hypoplasia and asymmetry in skeletal tissue and soft tissue.These features are usually associated with a difficult airway. Mandibular distraction osteogenesis can achieve mandibular advancement, but its effect on the subsequent laryngoscopic views has not been adequately documented. Aim:The aim of this study was to determine the change in laryngoscopic views after mandibular distraction osteogenesis (MDO) in children with HFM and to examine the radiological changes after MDO by using computed tomography (CT)-based threedimensional (3-D) airway reconstruction. Methods: An observational prospective study was carried out in children with HFM undergoing MDO. All children underwent 3-D airway reconstruction preoperatively before the placement and removal of the distractor. The temporomandibular joint lesions in children were classified by the Pruzansky-Kaban classification. The Cormack-Lehane grade was assessed after induction under direct laryngoscopy. The relationship between difficult laryngoscopy and the Pruzansky-Kaban classification was assessed. Changes in the upper pharyngeal airway parameters and laryngoscopic views were analyzed. Results: Forty children (ages ranging from 5 to 16 years, males = 26, females = 14)with HFM underwent 80 anesthesia for MDO. The incidence of difficult laryngoscopy before mandibular distraction was 5/12 (41.7%) in type IIa, 19/24 (79.2%) in type IIb and 1/4 (25%) in type III HFM. The mean difference in the incidence of difficult laryngoscopy before and after MDO was 33.3% (95% CI: À6.7% to 73.3%), 50.0% (95% CI: 8.4% to 91.6%), and 0% for type IIa, type IIb, and type III, respectively. In type IIb, 12/19 cases of difficult laryngoscopy became easy after mandibular distraction: this was associated with an increase in the palatopharyngeal and glossopharyngeal CT parameters (p < .05). In type IIa, 5/5 cases of difficult laryngoscopy became easy after mandibular distraction, and 1/7 cases of easy laryngoscopy became difficult laryngoscopy. However, there were no significant changes in the palatopharyngeal, glossopharyngeal, and hypopharyngeal CT parameters in type IIa and type III HFM (p > .05).Conclusions: MDO can improve the laryngoscopic views in children with HFM.According to the Pruzansky-Kaban classification, children with type IIb showed the highest incidence of difficult laryngoscopy before MDO. After MDO, the

Kaban–Pruzansky Grade Predicts Airway Severity in Hemifacial Microsomia

“…The clinical endpoints recorded were CL airway grade, difficult airway designation, frequency of airway emergencies, and number of airway procedures required. CL grades were also grouped by ease of laryngoscopic visualization as easy (grades I to IIB) or difficult (grades III to IV), as described in Xu et al 16 KP grade, Goldenhar syndrome diagnosis, bilateral disease, and age were analyzed as possible predictors. Continuous variables were assessed by means of Kruskal-Wallis tests, and categorical variables, with chi-square test.…”

“…Previous studies have either only assessed changes in CL grade following surgical manipulation of the mandible, or they did not use Kaban's modification of the Pruzansky scale in their assessments, introducing heterogeneity by grouping moderate grade IIA mandibles with the more severe grade IIB. [14][15][16] This study aims to perform a longitudinal assessment of perioperative airway status in an attempt to correlate mandibular dysmorphology with airway patency. This study tests the hypothesis that patients with higher KP grades have a higher difficult airway designation, a higher incidence of airway emergency, and higher CL grades.…”

“…Previous studies have either only assessed changes in CL grade following surgical manipulation of the mandible, or they did not use Kaban’s modification of the Pruzansky scale in their assessments, introducing heterogeneity by grouping moderate grade IIA mandibles with the more severe grade IIB. 14–16…”