P024: AIRWAY MANAGEMENT IN A 46-YEAR-OLD TREACHER-COLLINS PATIENT
Michael S Ibrahim, BScPhm, MSc, MD; University of Florida Health Jacksonville
Introduction/Background: Difficulty in managing the airway is one of the most important causes of major anesthesia-related morbidity and mortality (1). Treacher-Collins syndrome is a rare familial and congenital syndrome that occurs approximately 1 in 10,000 live births (1). It is a syndrome that consists of deformities of the eyes, ears, maxilla, and mandible and is often associated with cleft palate and lip (1). Patients with Treachers-Collins syndrome have a difficult airway because of a large tongue, anterior larynx, foreshortened maxilla and mandible, protruding incisors, and an obtuse angle of the jaw (1,2). These features make it difficult or impossible to align oral, pharyngeal, and laryngeal axes to directly visualize the glottis opening, especially utilizing direct laryngoscopy (4). These patients often require multiple plastic, ear, nose, and throat procedures under general anesthesia, and are known to be one of the most difficult airways encountered by an anesthesiologist (1,3).
We present a case of a 46-year-old male patient with a history of Treacher-Collins who presented to the operating room, having never undergone anesthesia in the past, for a bone adhering hearing aid placement. An awake fiberoptic intubation was successfully performed. We discuss our protocol for awake fiberoptic intubations and conduct a literature review of alternative methods to secure the airway in patients with a history of Treacher-Collins Syndrome.
Methods: A literature review was performed using the PubMed database, utilizing keywords such as Treacher-Collins, intubation, and adult. A thorough review of the results was conducted.
Results: After undergoing a thorough literature review, we describe one of the oldest Treacher-Collins patients reported to undergo general anesthesia. We also report multiple other methods that have been utilized to secure the airway in a Treacher-Collins patient: awake intubation, fiberoptic bronchoscopy, laryngeal mask airway, fiberoptic bronchoscopy through a laryngeal mask airway, a bullard laryngoscope, an Augustine stylet, retrograde intubation, tracheostomy and use of AirWay scope (4).
Discussion/Conclusion: Treacher-Collins syndrome is a congenital and familial syndrome that presents the anesthesiologist with one of the most difficult airways. (1,2,3,4). Given that airway management is one of the most important causes of major anesthesia-related morbidity and mortality, it is imperative that appropriate techniques are applied to secure the airway (1). Multiple methods to secure the airway in these patients are described in relatively younger patients, however we describe a successful intubation in a 46-year-old Treacher-Collins patient via utilization of our awake fiberoptic intubation protocol.
1. Kovac, A. Use of the Augustine Stylet Anticipating Difficult Tracheal Intubation in Treacher-Collins Syndrome. Journal of Clinical Anesthesiology. 1992 September/October; Vol 4. pp 409-412.
2. Knill, R. Difficult Laryngoscopy Made Easy with a BURP. Canadian Journal of Anesthesia. 1993. 40:3. pp 279-282.
3. Muraika, L et al. Fiberoptic Tracheal Intubation Through a Laryngeal Mask Airway in a Child with Treacher Collins Syndrome. Anesthesia and Analgesia. 2003; 97. pp 1298-1299
4. Iguchi, H et al. Orotracheal Intubation with an AirWay Scope in a Patient with Treacher Collins Syndrome. Journal of Anesthesia. 2008; 22. pp 186-188