BACKGROUND: The aims of this study were to evaluate the incidence of difficult laryngoscopy in infants with cleft lip and palate and to observe its relationships with age, sites, and degrees of deformities. METHODS: A total of 985 infants aged 1 month to 3 years, undergoing repair of cleft lip and palate were included in this study. The infants suffering from unilateral cleft lip, simple cleft palate, and combined bilateral cleft lip and palate were 465, 421, and 79 respectively. They were divided into three groups according to age; 1-6 months group, 6-12 months group and 1-3 years group. RESULTS: The total incidence of difficult laryngoscopy was 4.77%. The incidence of difficult laryngoscopy was closely related to age, sites and degrees of deformities, and micrognathia. The incidence of difficult laryngoscopy was 7.06% in 1-6 months group, 2.90% in 6-12 months group, and 3.13% in 1-3 years group, and was greatest for infants with combined bilateral cleft lip and palate, less for those with left cleft lip and least for those with right cleft lip and simple cleft palate. The incidences of difficult laryngoscopy in infants with and without micrognathia were 50% and 3.83% respectively. The incidences of moderately difficult, difficult, and failed intubations were 1.02%, 0.91%, and 0.102% respectively. CONCLUSIONS: Infants with cleft lip and palate, left cleft lip and alveolus, combined bilateral cleft lip and palate, micrognathia, and age <6 months were the important risk factors for difficult laryngoscopy. Difficult intubation occurred mainly in infants with laryngoscopic views of grade III and IV. 相似文献
Background: Children with orofacial cleft defects are expected to have difficult airways. Conventional midline laryngoscopic approach of oral intubation can lead to iatrogenic tissue trauma. In this study, we evaluated the feasibility of left paraglossal laryngoscopy as a primary technique for airway management in these children. Methods: After institutional ethical committee approval and informed consent, we enrolled 21 children with uncorrected bilateral lip and palate deformities (BL CL/P). Anesthesia was induced with halothane (0.5–4%) in 100% oxygen. After obtaining intravenous access, fentanyl 1.5 μg·kg?1 and atracurium 0.5 mg·kg?1 were administered. Endotracheal intubation was performed with Miller’s straight blade laryngoscope, introduced using left paraglossal approach. Difficulty of intubation was scored according to modified Intubation Difficulty Scale. Results: Data consists of 21 children (15 males and six females), mean age 1.31 ± 1.18 years and weight 9.27 ± 2.57 kg. Laryngoscopic view obtained was CL II (7[33.3%]) and CL I (14[66.6%]) respectively ( Figure 1 ). All the children could be easily intubated using left paraglossal approach, only 2/3 of them needed optimal external laryngeal manipulation to help achieving it. Though intubation could be done in the first attempt in 19 children, two infants (9½ and 11 months) required one size smaller endotracheal tube and were intubated in the second attempt using left paraglossal approach. Perioperative course was uneventful in all the children. Figure 1 Open in figure viewer PowerPoint Distribution of Intubation Difficulty scale (IDS) Score in BL CL/P patients. n (%) IDS: 0 (intubation without difficulty), IDS: 1 (slight difficulty; OELM applied/additional intubation attempt), IDS: >5 (Moderate to Major difficulty), IDS: = α (Impossible intubation). 相似文献
Background: Appropriate sizes (internal diameters) and insertion depths of uncuffed preformed endotracheal tubes in children with cleft lip and palate, who generally have delayed growth and development in early infancy have not been elucidated. Methods: The sizes and insertion depths of endotracheal tubes in patients who received primary cheiloplasty and/or palatoplasty in relation to age, height, and weight were retrospectively analyzed. Tube sizes were determined using an appropriate air leakage at an airway pressure of 15–20 cmH2O. Tube insertion depths were confirmed by auscultation of bilateral breathing sounds at several tube depths, placing the tip 1.5 cm above the carina. Obtained data sets were compared with previously published studies. Results: The number of cases analyzed was 236 in total. The mean age, height, and weight were 327.4 ± 199.2 days, 69.7 ± 7.5 cm, and 8.2 ± 1.8 kg, respectively (mean ± sd ). Neither the tube size nor tube depth in cleft lip and palate children was smaller or shorter than those of normal subjects. Discrepancies between the preformed bend and the tube insertion depth increased as the tube size increased. Conclusions: The current findings suggest that it is reasonable to apply the currently available standards for normal children, e.g. Motoyama's general guide, to predict the tube size and insertion depth for Japanese cleft lip and palate children, and that the use of the uncuffed preformed endotracheal tube is associated with a risk of endobronchial intubation, which appears to increase with age. 相似文献
Fifty patients with clefts (30 unilateral cleft lip and palate (UCLP), 9 bilateral cleft lip and palate (BCLP), and 11 cleft palate only (CP), mean age 25 years) treated with Le Fort I osteotomy were compared retrospectively from cephalograms taken shortly before operation, and at six months and one year postoperatively. Patients with bimaxillary surgery or previous velopharyngoplasty, or both, were excluded. Maxillary advancement was moderate in all groups. One year postoperatively there was a significant change (73%–90% of the surgical advancement) in the sagittal depth of the nasopharyngeal airway but not in the depth of the oropharyngeal airway, the length of the soft palate or the position of the hyoid bone. The nasopharyngeal airway was largest in the CP group both preoperatively and postoperatively. Eleven patients (7 CP, 4 UCLP) had a velopharyngoplasty after the osteotomy to improve their speech. There was no difference in the nasopharyngeal airway in the patients treated by velopharyngoplasty compared with those not so treated, but they seemed to have the shortest maxillas and the greatest surgical changes vertically. 相似文献
We describe our experience of working in plastic and reconstructive surgery in Uganda over the last 10 years. There is a high burden of disease, a health system that is under resourced, and few qualified physicians to provide healthcare for a principally rural population. Training the physicians of the future is essential. Prevention and early wound management needs to be emphasized for traumatic injuries including burns. Subsidized up-country visits by trained specialists with the appropriate equipment are required to provide a service for the rural poor. There appears to be a high mortality rate in babies with unrepaired cleft palate, probably due to feeding difficulties in an environment where intercurrent illness is common. We now offer nutritional support with early combined cleft lip and palate repair in these babies, a practice that has a high success rate and may be suited to other specialist units in the developing world. 相似文献
We describe the anesthetic management of a 5-year-old girl diagnosed with Seckel syndrome, for cleft lip surgery. The syndrome is characterized by severe intrauterine and postnatal growth retardation with proportional dwarfism, typical beak-like triangular nose, and mental retardation, accounting for its various synonyms such as bird-headed dwarfism, microcephalic primordial dwarfism, nanocephalic dwarfism and Seckel-type dwarfism. 相似文献
目的:探索唇腭裂患术后牙颌面畸形正畸-正颌外科的防治方法。方法:56例唇腭裂伴牙颌面畸形患者,男性30例,女性26例,年龄8~38岁。其中25例患者为替牙列期或恒牙列初期,31例为恒牙列期。所有患者均进行正畸治疗,替牙列或恒牙列初期采用唇挡或颅颌面架干预性诱导上颌骨前后位的发育,上牙弓扩弓器扩大上颌骨左右位的发育并行牙槽裂植骨术;恒牙列期患者在完成排挤牙列、矫正错位牙、去代偿、关闭间隙等正畸治疗,手术方法如下:①伴牙槽裂的患者前期行髂骨取骨植骨术;②上颌Le Fort I型截骨前徙术;③上颌多片段Le Fort I型截骨术;④上颌Le Fort I型截骨术+双侧下颌升支矢状劈开术(BSSRO);⑤BSSRO+颏成形术。所有病例骨间均用钛板钛钉坚强内固定,并辅以2~3周颌间牵引固定。术后应配合正畸治疗并定期随访12~49月。结果:青少年患者经唇挡、腭弓扩大矫正器和上颌前牵引面架干预性诱导上颌骨发育,伴牙槽裂患者行牙槽裂植骨术,其颜面形态及牙牙A关系明显改善;成人患者经正畸-正颌-正畸治疗模式后,面部比例协调,咬合关系及面型均较满意。结论:正畸-正颌外科联合防治唇腭裂术后牙颌面畸形的疗效确切;应以患者牙袷关系的具体情况、要求等因素,采用个体化的综合治疗方案宜于推崇。 相似文献
We aimed to evaluate retrospectively changes in the nasal appearance after secondary bone grafting in children with complete unilateral cleft lip and palate in 41 consecutive patients. Basal view photographs were analysed by a software program (ASYMNOS, for asymmetry of nostrils, available on simple request) that computes comparative functions between both nostrils and gives an objective score. These data were compared with those of a control group. The measurements and scores were calculated for each group, and then the global objective scores were correlated with the subjective scores that resulted from an independent external panel that ranked the aesthetic aspects of the nostrils. There was a significant improvement in the nasal symmetry postoperatively that resulted from a decrease in height between the nostrils, and a positive correlation between the objective and subjective scores. 相似文献
The purpose of this study was to compare facial growth in patients with unilateral complete cleft lip and palate (UCLP) in whom the palate was repaired with the von Langenbeck procedure at 8 months (L-8), or the Wardill procedure at 18 months (W-18). A total of 151 unaffected subjects were used as a reference series. Sixty-one adult patients, 34 in the L-8 group and 27 in the W-18 group, were investigated clinically and with lateral skull radiography and also filled out a questionnaire about their dental condition. Multiple linear regression was used to analyse the effects of the surgical strategy, sex, and the presence of a velopharyngeal flap on several dependent variables indicating sagittal jaw relations, vertical jaw relations, and inclination of incisors. The UCLP group was characterised by a short (n-sp) and retrusive maxilla (s-n-ss) and a retrusive mandible for women (s-n-sm), larger maxillary inclination (NSL/NL), more retroclined lower incisors (ILI/ML), shorter upper facial heights (n-sp) and normal total face height (n-gn) than the reference group. In the UCLP group there were significant differences between men and women in mandibular prognathism (s-n-sm), maxillary/mandibular relations (ss-n-sm), maxillary inclination (NSL/NL), total anterior facial height (n-gn), and upper anterior facial height (n-sp). Lateral crossbite was found in 20% of the UCLP group. The prevalence was similar in the L-8 and W-18 groups. Almost 80% of the patients in the UCLP group considered that their dental condition was good. The choice of surgical strategy had no significant influence on the variables measured on facial morphology. 相似文献
Objective/Aims: To assess current practices in the management of children undergoing craniofacial surgery and identify areas of significant practice variability with the intent to direct future research. Background: The perioperative management of infants and children undergoing craniofacial reconstruction surgery can be challenging because of the routine occurrence of significant blood loss with associated morbidity. A variety of techniques have been described to improve the care for these children. It is presently unknown to what extent these practices are currently employed. Methods: A web‐based survey was sent to representatives from 102 institutions. One individual per institution was surveyed to prevent larger institutions from being over‐represented in the results. Results: Requests to complete the survey were sent to 102 institutions; 48 surveys were completed. The survey was composed of two parts: management of infants undergoing strip craniectomies, and management of children undergoing major craniofacial reconstruction. Conclusions: Significant variability exists in the management of children undergoing these procedures; further study is required to determine the optimal management strategies. Clinical trials assessing the utility of central venous pressure and other hemodynamic monitoring modalities would enable evidence‐based decision‐making for monitoring in these children. The development of institutional transfusion thresholds should be encouraged, as there exists a body of evidence supporting their efficacy and safety. 相似文献