Long-term effect of neonatal endotracheal intubation on palatal form and symmetry in 8-11-year-old children

Abstract

Premature and low birth weight infants often require neonatal oral intubation for resuscitation and to relieve respiratory distress. The endotracheal tube exerts pressure on the developing palate, which can result in palatal groove formation, a high-arched palate, and palatal asymmetry. The purpose of this investigation was to determine whether such intubation can have a long-term effect on palatal form and symmetry. Arch widths, palatal widths, and palatal depths were measured from the study casts of 43, 8-11-year-old previously intubated premature and low birth weight children using a reflex microscope, with a fixed rectangular Cartesian co-ordinate system, and compared with a group of non-intubated gender- and age-matched controls. Significant differences were found between the intubated and non-intubated children. The intubated children had significantly narrower palatal widths posteriorly (P < or = 0.001), steeper palatal vaults anteriorly (P < or = 0.01), and exhibited a directional palatal width asymmetry with the left side of the palate measuring consistently wider than the right. These differences did not, however, appear to be affected by the length of intubation. Therefore, it is concluded that an oral endotracheal tube might exert excess force on the developing alveolus anteriorly with the tube being displaced to the right of the palate posteriorly leading to a steep anterior palatal vault and a left-sided palatal asymmetry, which can persist until the age of 11 years of age.

Pulmonary Complications of Mechanical Ventilation in Neonates

“…The mortality associated with this complication is high (75% in one study) and is likely due to vascular, cardiac, and respiratory compromise secondary to air leak [52]. Palatal deformities such as palatal grooves, asymmetry, and a high-arched palate also occur after long-term mechanical ventilation [53]. Despite subsequent palatal growth and remodeling after extubation, abnormalities can persist for many years [53,54].…”

“…Palatal deformities such as palatal grooves, asymmetry, and a high-arched palate also occur after long-term mechanical ventilation [53]. Despite subsequent palatal growth and remodeling after extubation, abnormalities can persist for many years [53,54]. Tracheal trauma and endotracheal tube complications may be minimized by using smaller endotracheal tubes, by minimizing reintubation attempts, and by aggressively weaning preterm infants off of mechanical ventilator support.…”

Iatrogenic Disorders in Modern Neonatology: A Focus on Safety and Quality of Care

“…Because suctioning has been associated with several complications, adequate attention must be paid to the suction pressure, catheter length, and prevention of hypoxemia during suctioning. Palatal implants have been used to reduce the risk of palatal groves and subsequent dentition problems [56,57]. Air leak syndrome is not an uncommon occurrence in infants on assisted ventilation and often is attributed to barotraumas.…”

Acquired Oral Commissure Defect: A Complication of Prolonged Endotracheal Intubation

“…17 Some of these deformities may be transient and clinically insignificant, but others may persist into later life causing various degrees of anatomic and functional disability. 15,16 The advantage of the ETT holder used in this case is that it maintains the ETT securely in the desired position at the level of the lip and fastens securely to the face around the ETT. The risks of alveolar and palatal grooving may be reduced as this device minimizes rubbing of the ETT against the alveolar ridge or palate.…”

“…[11][12][13][14][15][16][17] We describe a rare case of an oral commissure defect acquired from prolonged endotracheal intubation in a preterm infant.…”