The Difficult Route to Glottis in Cleft Patients Simplified.

Abstract

Cleft lip with or without palate is one of the most common craniofacial anomalies worldwide. Airway problems in children with cleft lip and palate were well recognized since very early times. The aim of this technical note is to describe a unique method of performing direct laryngoscopy in children with cleft lip and palate by using a palatal obturator to cover the alveolar and palatal defect in these patients. The palatal obturator was fabricated using cold cure acrylic after making an impression of the defect using putty-type impression material. The use of the palatal obturator facilitated the placement of the laryngoscope's blade by providing adequate leverage to it during the process of direct laryngoscopy prior to intubating children with cleft lip and palate defect. A discontinuous alveolar arch and palatal defect contribute to lack of effective leverage of the laryngoscope blade while attempting visualization of the glottis. This difficulty can be overcome by use of an obturator to cover the alveolar and palatal defect in order to provide adequate leverage while using a laryngoscope for visualizing the glottis.