This Article Résumé de cet Article Full Text Full Text (PDF) Submit a scholarly reply Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Services Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Hee, H.-I. Articles by Chen, C. Search for Related Content PubMed PubMed Citation Articles by Hee, H.-I. Articles by Chen, C.

Airway management in a patient with a cleft palate after pharyngoplasty: a case report

[Une étude de cas d’assistance respiratoire dans un contexte de fissure palatine et de pharyngoplastie]

Hwan-Ing Hee, FRCA^*, Nesil Deger Conskunfirat, MD, Shu-Yam Wong, MD and Chit Chen, MD

^* From the Department of Paediatric Anaesthesia, KK Women’s and Children’s Hospital, Singapore;
and the Department of Anesthesiology, Chang Gung Memorial Hospital, Taoyuan, Taiwan.

Address correspondence to: Dr. Chit Chen, Department of Anesthesiology, 8 K, AN, Chang Gung Memorial Hospital, 5 Fu-Shin Street, Kweishan, Taoyuan 333, Taiwan, Republic of China. Phone: 886-3-3281200, ext. 8154; E-mail: cacpan{at}CGMH.org.tw

Purpose: To describe a practical method of aiding nasotracheal intubation in a cleft palate patient with previous pharyngoplasty using a suction catheter under tactile guidance. Problems of airway management in these patients are also discussed.

Clinical features: A 26-yr-old woman presented for elective Le Fort maxillary osteotomy. She had a history of cleft lip and palate and subsequent palatoplasty and pharyngeal flap. She had no symptoms of upper airway obstruction or obstructive sleep apnea. Preoperative examination revealed a hypernasal voice and patent nasal passages. Anesthesia was induced and the patient paralyzed. An attempt to pass a 6.5-mm cuffed endotracheal tube through the right nostril met with resistance. A suction catheter was introduced into the nostril, while a finger was positioned over the flap and the velopharyngeal port, until its tip rested against the flap, the catheter coiled and a small loop could be palpated past the patent velopharyngeal port. The catheter was then hooked into the oropharynx. The endotracheal tube was "railroaded" over it and advanced into the glottis. There was minimal bleeding and no desaturation during the procedure.

Conclusion: Preoperative determination of the type of pharyngoplasty is essential to understand the anatomy of the patent velopharyngeal port. A history of pharyngeal flap infection, hyponasal voice or upper airway obstruction suggests possible port stenosis. We describe a tactile guided technique that is useful and practical. Use of a flexible suction catheter of small external diameter minimizes the potential for trauma, bleeding and creation of false passages.