J Dent Anesth Pain Med.  2018 Oct;18(5):309-313. 10.17245/jdapm.2018.18.5.309.

Airway management in pediatric tongue flap division for oronasal fistula closure: A case report

• So E
• Yun HJ
• Karm MH
• Kim HJ
• Seo KS
• Ha H

• KMID: 2424373
• DOI: http://doi.org/10.17245/jdapm.2018.18.5.309

Abstract

Oronasal fistulae (ONF) could remain after surgery in some patients with cleft palate. ONF ultimately requires intraoral surgery, which may lead to perioperative airway obstruction. Tongue flap surgery is a technique used to repair ONF. During the second surgery for performing tongue flap division, the flap transplanted from the tongue dorsum to the palate of the patient acts as an obstacle to airway management, which poses a great challenge for anesthesiologists. In particular, anesthesiologists may face difficulty in airway evaluation and patient cooperation during general anesthesia for tongue flap division surgery in pediatric patients. The authors report a case of airway management using a flexible fiberoptic bronchoscope during general anesthesia for tongue flap division surgery in a 6-year-old child.

Keyword

Airway Management; Oronasal Fistula; Tongue Flap

MeSH Terms

Airway Management*
Airway Obstruction
Anesthesia, General
Bronchoscopes
Child
Cleft Palate
Fistula*
Humans
Palate
Patient Compliance
Tongue*

Figure

• 

  Fig. 1 As the palate portion of the tongue flap was close to the soft palate, intubation using a general laryngoscope was difficult.

• 

  Fig. 2 An anesthesiologist performed oral intubation using a flexible fiberoptic bronchoscope in a patient who underwent anesthesia induction with sevoflurane.

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  Fig. 3 Intubation was performed successfully to the right side of the patient's tongue flap.

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