AIRWAY MANAGEMENT FOR SYNGNATHIA

ABSTRACT

Syngnathia(maxillomandidular fusion) is a rare congenital anomaly involving soft tissue bony adhesions between the maxilla and mandible. Bony fusion, as in this case, is extremely rare and to the time, no specific anesthetic management has been reported. In our case, physical examinition of the 130-day infant patient(weight 5.5kg) with syngnathia revealed apparent left side fusion between maxilla and mandible. The opening between upper and lower gingiva was limited to 10mm on the right side. Left choanal atresia, microstomia, low set ears and blue sclera were also detected. When patient arrived at the OR.5l/min oxygen was administered using nasal prong with end-tidal CO2 monnitoring cannula though mough. Glycopyrrolate 0.1mg and ketamine 5mg were administered intravenously. A solution of 2% lidocaine 2ml and 0.1% phenylephrine 1ml was used to topicalize the right nostril. Subanesthetic doses(2~3mg) of ketamine were used to provide sedation while maintaining spontaneous ventilation. Warm, softed I.D. 3.5mm preformed nasotracheal tube was inserted via the rigrht nostril with a 3.2mm O.D. fiberoptic bronchoscope. After that vecuronium and dexamethasone were given intravenously. The Infant had been anesthetized uneventfully with isoflurane. Fiberoptic nasotracheal intubation under spontaneous ventilation using low doses of ketamine offers a safe and non-invasive technique compared with tracheostomy or blind nasotracheal intubtion. To increase safey, oxygen should be given via nasal or oral routes and adequate monitoring, especially capnography and pulse oxymeter, should be performed.