Nargozian C, Ririe D G, Bennun R D, Mulliken J B
Department of Anesthesia, Children's Hospital, Havard Medical School, Boston, MA 02115, USA.
Paediatr Anaesth. 1999;9(5):393-8. doi: 10.1046/j.1460-9592.1999.00374.x.
Hemifacial microsomia (HFM) is associated with a difficult airway. We hypothesized that a difficult intubation would be predicted by radiographic evaluation of the severity of mandibular hypoplasia. A retrospective review of anaesthetic and surgical records of 102 children with HFM from 1986 to 1996 was conducted for radiographic classification of mandibular hypoplasia and degree of difficulty with intubation. Intubation was classified as Grade A-easy, Grade B-difficult, or Grade C-very difficult. The mandibular anatomy was categorized as Type I-'mini-mandible', Type II-abnormal condylar size and shape, or Type III-absent ramus, condyle, and temporomandibular joint. In the 82 patients with HFM, 70% were classified as Grade A, 21% had Grade B and 9% had Grade C airways. No patients with Type I mandible had Grade C airway, while 25% of the patients with Type III mandible had Grade C airway. The correlation of the degree of airway difficulty with mandibular type was significant (P=0.001). In 20 patients with bilateral mandibular hypoplasia, 30% had Grade A, 35% had Grade B, and 35% had Grade C airways. We conclude that radiographic classification of mandibular deformity is a useful adjunct for preoperative prediction of airway difficulty in the management of children with unilateral HFM.
半侧颜面短小畸形（HFM）与困难气道相关。我们推测，下颌发育不全严重程度的影像学评估可预测困难插管情况。对1986年至1996年102例HFM患儿的麻醉和手术记录进行回顾性研究，以对下颌发育不全进行影像学分类并评估插管困难程度。插管分为A类 - 容易，B类 - 困难或C类 - 非常困难。下颌解剖结构分为I型 - “小下颌”，II型 - 髁突大小和形状异常，或III型 - 下颌支、髁突和颞下颌关节缺如。在82例HFM患者中，70%被分类为A类气道，21%为B类气道，9%为C类气道。I型下颌患者无C类气道，而III型下颌患者中有25%为C类气道。气道困难程度与下颌类型的相关性显著（P = 0.001）。在20例双侧下颌发育不全患者中，30%为A类气道，35%为B类气道，35%为C类气道。我们得出结论，下颌畸形的影像学分类是术前预测单侧HFM患儿气道困难的有用辅助手段。
