Handler S D
Birth Defects Orig Artic Ser. 1985;21(2):15-31.
Particular attention to airway problems must be paid to any child with a craniofacial anomaly. Knowledge of the potential for upper airway obstruction in children with craniofacial anomalies, early recognition of the signs of obstruction, and prompt treatment are extremely important aspects of the treatment plan for each patient. An infant with choanal atresia or a nasal glioma will need definitive repair of his specific deformity to ensure the airway prior to consideration of any other problem. Similarly, the child with severe mandibular hypoplasia may require an early tongue-lip adhesion or tracheotomy to relieve airway distress until mandibular growth or surgical advancement enlarges the natural airway. Adenotonsillar hypertrophy may present earlier and with more severe sleep apnea in a child with an already compromised pharyngeal lumen. Early tonsillectomy and/or adenoidectomy must be considered in these patients even if this may possibly lead to velopharyngeal incompetence. Sleep apnea may also occur as a complication of the creation of a pharyngeal flap. If operative intervention for the craniofacial anomaly is contemplated, the potential for airway problems increases. The anesthetic induction and intubation are extremely difficult in the child with mandibular hypoplasia. The anesthetist and otolaryngologist must have a full range of techniques available to them to accomplish this task. If intermaxillary fixation is required postoperatively, or if the endotracheal tube is in the operative field, consideration should be given to a short-term tracheotomy to protect the airway during and after the operation. Close cooperation among the members of the craniofacial team is mandatory to prevent and/or treat any upper airway obstruction that may occur in the child with a craniofacial anomaly. Anticipation of possible airway compromise, early recognition of any existing obstruction, and prompt management of the problem are imperative to the successful diagnosis and treatment of craniofacial anomalies.
对于任何患有颅面畸形的儿童，都必须特别关注气道问题。了解颅面畸形儿童发生上气道阻塞的可能性、早期识别阻塞迹象以及及时治疗是每位患者治疗计划中极其重要的方面。患有后鼻孔闭锁或鼻胶质瘤的婴儿在考虑任何其他问题之前，需要对其特定畸形进行明确修复以确保气道通畅。同样，严重下颌发育不全的儿童可能需要早期进行舌唇粘连或气管切开术以缓解气道窘迫，直到下颌生长或手术推进扩大自然气道。腺样体扁桃体肥大在咽腔已经受损的儿童中可能出现得更早且伴有更严重的睡眠呼吸暂停。即使这可能会导致腭咽闭合不全，这些患者也必须考虑早期进行扁桃体切除术和/或腺样体切除术。睡眠呼吸暂停也可能作为咽瓣手术的并发症出现。如果考虑对颅面畸形进行手术干预，气道问题的可能性会增加。下颌发育不全的儿童进行麻醉诱导和插管极其困难。麻醉师和耳鼻喉科医生必须掌握一系列可用技术来完成这项任务。如果术后需要颌间固定，或者气管内导管在手术区域内，应考虑在手术期间和术后进行短期气管切开术以保护气道。颅面治疗团队成员之间密切合作对于预防和/或治疗颅面畸形儿童可能出现的任何上气道阻塞至关重要。预测可能的气道受损情况、早期识别任何现有的阻塞以及及时处理问题对于成功诊断和治疗颅面畸形至关重要。
