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Airway Statuses and Nasopharyngeal Airway Use for Airway Obstruction in Syndromic Craniosynostosis

Kouga, Takeshi MD; Tanoue, Koji MD; Matsui, Kiyoshi MD

Journal of Craniofacial Surgery: May 2014 - Volume 25 - Issue 3 - p 762–765
doi: 10.1097/SCS.0000000000000763
Original Articles

Syndromic craniosynostosis is associated with a high rate of respiratory difficulty, due mainly to midfacial hypoplasia. Nasopharyngeal airway establishment has been reported as the first-line approach to airway obstruction and may obviate the need for a highly invasive tracheotomy. No previous studies have compared airway obstruction status in syndromic craniosynostosis between cases requiring and not requiring airway managements. We focus on nasopharyngeal airway use and airway status outcomes to assess respiratory difficulty in patients with syndromic craniosynostosis. A retrospective data analysis of 51 cases with syndromic craniosynostosis was carried out. We divided 30 of the 51 cases with lateral pharyngeal x-rays taken before operations affecting airway diameters into 2 groups, one with neither nasopharyngeal airway insertion nor tracheotomy and the other with one or both of these interventions, and the mean diameters for 8 indices related to the pharyngeal space were compared. Cases with respiratory difficulty due to nasopharyngeal stenosis and requiring airway managements comprised a significantly higher proportion of those with Pfeiffer syndrome than patients with Crouzon or Apert syndrome. Comparative examination of lateral x-ray cephalometry between cases with neither nasopharyngeal airway insertion nor tracheotomy and cases with one or both revealed oropharyngeal diameters tended to be smaller in those with interventions. Cases requiring nasopharyngeal airway insertion were able to continue nasopharyngeal airway use for more than 1 year and a considerable number avoided tracheotomy. It may be worth considering an oropharyngeal-bypass nasopharyngeal airway before performing a tracheotomy.

From the Department of General Medicine, Kanagawa Children’s Medical Center, Yokohama, Japan.

Received August 5, 2013.

Accepted for publication January 14, 2014.

Address correspondence and reprint requests to Takeshi Kouga, MD, Kanagawa Children’s Medical Center, 2-138-4 Mutukawa, Minami-ku, Yokohama-shi, Kanagawa, 232-8555, Japan; E-mail:

The authors report no conflicts of interest.

© 2014 by Mutaz B. Habal, MD.