Current airway management in craniofacial anomalies

Abstract

Airway obstruction requiring intervention occurs frequently among children with craniofacial anomalies. The presence of a craniofacial anomaly is a common reason for tracheotomy in the pediatric population. Because of the complications associated with tracheotomy, however, numerous other methods have been proposed to alleviate severe airway obstruction in this patient population. Nonsurgical management of airway obstruction remains the initial treatment option in children with craniofacial abnormalities; however, a significant number of patients fail to respond to this management strategy. Perhaps the most significant recent alternative airway management technique is the use of distraction osteogenesis to advance the mandible and maxilla. This technique has been used both to achieve early decannulation and to avoid a tracheotomy in infants and children with craniofacial anomalies. Multiple options exist for relieving upper airway obstruction in craniofacial patients, and the application of these treatment strategies is dependent on the patient's disease and the philosophy of the treating institution. Future research into the management of airway obstruction in children with craniofacial anomalies will need to focus on predicting which children will benefit from conservative management and which children will need distraction osteogenesis or a tracheotomy.