From the Division of Plastic, Reconstructive, and Oral Surgery, Children's Hospital of Philadelphia.
Perelman School of Medicine at the University of Pennsylvania.
Plast Reconstr Surg. 2024 Jun 1;153(6):1359-1366. doi: 10.1097/PRS.0000000000010785. Epub 2023 May 31.
Children born with hemifacial microsomia (HFM) can experience airway compromise. There is a paucity of data correlating degree of HFM severity with airway difficulty. This study aims to determine the relationship between the degree of micrognathia and airway insufficiency in the HFM population.
Patient demographics, airway function, Kaban-Pruzansky (KP) grade, and Cormack-Lehane (CL) grade were collected and compared with appropriate statistics for HFM patients treated between 2000 and 2022.
Seventy patients underwent 365 operations with KP grading as follows: 34% KP grade I, 23% KP grade IIA, 11% KP grade IIB, and 33% KP grade III. Goldenhar syndrome was present in 40% of patients and 16% had bilateral disease. KP grade ( P < 0.001) predicted mean number of airway-affecting procedures undergone and difficult airway status ( P < 0.001), with 75% of difficult airways in KP grade III patients. There was no association of airway compromise with Goldenhar syndrome, laterality, or age ( P > 0.05). Most CL grades were I (61%) or IIA (13%), with fewer grade IIB, grade III, and grade IV (4% to 7%). KP grade predicted CL grade ( P < 0.001), with 71% of grade IV views and 64% of grade III views seen in KP grade III patients.
KP grade correlated with airway severity in HFM. Patients do not appear to outgrow their CL grade, as previously hypothesized, suggesting that KP grade III patients remain at increased risk for airway insufficiency into the teen years. Given the potential significant morbidity associated with airway compromise, proper identification and preparation for a challenging airway is a critical part of caring for patients with HFM.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Risk, III.
患有先天性半侧颜面短小症（HFM）的儿童可能会出现气道阻塞。目前有关 HFM 严重程度与气道困难之间相关性的数据较少。本研究旨在确定 HFM 人群中下颌骨畸形程度与气道不足之间的关系。
收集患者的人口统计学资料、气道功能、Kaban-Pruzansky（KP）分级和 Cormack-Lehane（CL）分级，并与 2000 年至 2022 年间接受治疗的 HFM 患者的适当统计学数据进行比较。
70 例患者接受了 365 次手术，KP 分级如下：34%为 KP Ⅰ级，23%为 KP ⅡA 级，11%为 KP ⅡB 级，33%为 KP Ⅲ级。40%的患者为 Goldenhar 综合征，16%为双侧疾病。KP 分级（P<0.001）预测了气道受累手术的平均次数和困难气道状态（P<0.001），KP Ⅲ级患者中有 75%存在困难气道。气道阻塞与 Goldenhar 综合征、侧别或年龄无相关性（P>0.05）。大多数 CL 分级为Ⅰ级（61%）或ⅡA 级（13%），ⅡB、Ⅲ级和Ⅳ级（4%~7%）较少见。KP 分级与 CL 分级相关（P<0.001），KP Ⅲ级患者中 71%为Ⅳ级视图，64%为Ⅲ级视图。
KP 分级与 HFM 中的气道严重程度相关。与之前的假设不同，患者似乎不会“长大”而摆脱 CL 分级，这表明 KP Ⅲ级患者在青少年时期仍有发生气道不足的风险增加。鉴于气道阻塞相关的潜在显著发病率，正确识别和准备困难气道是治疗 HFM 患者的重要组成部分。
临床问题/证据水平：风险，III 级。
