Pediatric anomalies: A/W management
Advanced, Clinical Subspecialties
The pediatric airway is different than the adult airway. There are typical characteristics of a pediatric airway that make airway management different than the adult. Some of these are a larger occiput causing increased neck flexion as compared to the adult, a more anterior larynx, a large tongue compared to the airway, and a “large and floppy” epiglottis (Mick). Some congenital pediatric anomalies give even more reasons for changing airway management and/or increase the probability of a difficult airway. Congenital anomalies range from large or misshapen heads (hydrocephalus or craniosynostosis), abnormal facies that might affect mask ventilation, poor neck mobility or unstable spines, decreased size in mouth opening or oral cavity space, increased tongue size, masses affecting various parts of the airway, and other abnormalities of the airway. Some children acquire pathologies that can require altered airway management, and these include infection (abscesses or swelling of airway structures), among others.
There are some specific syndromes that are often related to pediatric airway anomalies.
- Down syndrome can present with cervical spine instability and a large tongue.
- Mucopolysaccharidoses can present with cervical spine instability and a large tongue.
- Apert syndrome presents with craniosynostosis, midface hypoplasia, and often a high-arched palate (sometimes with a cleft).
- Crouzon syndrome presents with craniosynostosis and midface hypoplasia, and “cervical spine abnormalities occur in up to one-third of patients” (Hollier).
- Patients with both Treacher-Collins’ syndrome and Robin Sequence have small mandibles and reduced size of oral cavities.
- There are other syndromes in addition to those above associated with airway, facial, or other abnormalities.