Une étude de cas d’assistance respiratoire dans un contexte de fissure palatine et de pharyngoplastie

Abstract

Preoperative determination of the type of pharyngoplasty is essential to understand the anatomy of the patent velopharyngeal port. A history of pharyngeal flap infection, hyponasal voice or upper airway obstruction suggests possible port stenosis. We describe a tactile guided technique that is useful and practical. Use of a flexible suction catheter of small external diameter minimizes the potential for trauma, bleeding and creation of false passages.

Pharyngeal flap damage caused by nasotracheal intubation in a patient who underwent palatoplasty and pharyngoplasty

“…The incidence of cleft lip and palate (CLP) was 1 per 554 births in the Republic of Korea. Up to 20% of patients with cleft palate will develop velopharyngeal dysfunction after primary palatoplasty, requiring further treatment with pharyngoplasty [ 2 ]. Many patients will undergo further orthognathic surgeries, and NTI is performed under general anesthesia during these surgeries.…”

Airway management for oral surgery in a patient with repaired cleft palate

“…[12] Since the defect is in midline in our case and nasal intubation was required, we opted for intubation using FOB. The alternate method of intubation is also described in the literature.…”

“…The alternate method of intubation is also described in the literature. [2] The anatomy of the nasopharynx as well as oropharynx usually gets altered after the cleft palate repair and increases the difficulty during nasotracheal intubation. [3] It also carries a risk of damage to the repaired palatal defect.…”

Prehospital airway management by paramedics

“…An observational study of tracheal intubation without anaesthetic agents in trauma patients in London showed one survivor from 286 patients over a 6-year period [1]. Furthermore, a recent US study of over 5000 trauma patients showed an increased mortality and prehospital times of those intubated, compared with management with bagvalve-mask ventilation alone, when corrected for mechanism and injury severity [2].…”