Masashi Fujii1, Kazuya Tachibana1, Muneyuki Takeuchi1, Juntaro Nishio2, Keiko Kinouchi1. 1. Department of Anesthesia and Intensive Care, Osaka Medical Center and Research Institute for Maternal and Child Health, Izumi, Japan. 2. Department of Oral and Maxillofacial Surgery, Osaka Medical Center and Research Institute for Maternal and Child Health, Izumi, Japan.
Abstract
BACKGROUND: Glossopexy (tongue-lip adhesion) is a procedure in which the tongue is anchored to the lower lip and mandible to relieve the upper airway obstruction mainly in infants with Pierre Robin sequence. Infants suffering from severe upper airway obstruction and feeding difficulties due to glossoptosis are the candidates for this procedure and are predicted to demonstrate difficult airway and difficult intubation. METHODS: We retrospectively examined the perioperative management of 19 infants undergoing glossopexy procedure at our institution from 1992 to 2010. RESULTS: Out of 19 patients, Pierre Robin sequence was diagnosed in 17, Treacher Collins syndrome in 1, and Stickler syndrome in 1. In all of them, inhalation anesthesia was induced with a nasopharyngeal tube in place. Nine patients underwent fiberoptic intubation. After surgery, 12 patients were extubated in the operating room and 11 of them required a nasopharyngeal tube to keep the airway open. Seven patients left the operating room with the trachea intubated. Two patients received tracheostomy at the age of 2 months. Seventeen patients underwent release of tongue-lip adhesion coincidentally with the palate repair at 7-14 months of age. For this surgery, no one required fiberoptic intubation. CONCLUSIONS: The airway of these patients should be managed carefully not only before but also after the operation. A nasopharyngeal tube was effective in maintaining the upper airway patency during anesthesia induction and before and after operation.
BACKGROUND: Glossopexy (tongue-lip adhesion) is a procedure in which the tongue is anchored to the lower lip and mandible to relieve the upper airway obstruction mainly in infants with Pierre Robin sequence. Infants suffering from severe upper airway obstruction and feeding difficulties due to glossoptosis are the candidates for this procedure and are predicted to demonstrate difficult airway and difficult intubation. METHODS: We retrospectively examined the perioperative management of 19 infants undergoing glossopexy procedure at our institution from 1992 to 2010. RESULTS: Out of 19 patients, Pierre Robin sequence was diagnosed in 17, Treacher Collins syndrome in 1, and Stickler syndrome in 1. In all of them, inhalation anesthesia was induced with a nasopharyngeal tube in place. Nine patients underwent fiberoptic intubation. After surgery, 12 patients were extubated in the operating room and 11 of them required a nasopharyngeal tube to keep the airway open. Seven patients left the operating room with the trachea intubated. Two patients received tracheostomy at the age of 2 months. Seventeen patients underwent release of tongue-lip adhesion coincidentally with the palate repair at 7-14 months of age. For this surgery, no one required fiberoptic intubation. CONCLUSIONS: The airway of these patients should be managed carefully not only before but also after the operation. A nasopharyngeal tube was effective in maintaining the upper airway patency during anesthesia induction and before and after operation.