The role of upper airway endoscopy in craniofacial malformations

Published:September 18, 2021DOI:https://doi.org/10.1016/j.siny.2021.101293

      Abstract

      Objective

      To study the role of upper airway endoscopy (UAE) in craniofacial malformations in all different management approaches described in the literature.

      Methods

      A narrative review was performed, based on a search in pubmed.

      Results

      UAE use was reviewed over five domains: 1) Diagnosis of glossoptosis and endoscopic classification: drug-induced sleep endoscopy is recommended to graduate tongue base obstruction; there is still no consensus on the graduation system to be used. 2) Airway abnormalities: there is a high incidence of additional lesions in conjunction with glossoptosis. 3) Swallowing evaluation: a formal comparison with fluoroscopy (gold standard) has not yet been performed in this population. 4) Intubation: thin bronchoscopes allow intubation of small babies; moreover, intubation with rigid video-assisted laryngoscopes show a high success rate in this population. 5) Treatment outcome monitoring: there is no consensus on the ideal parameters to be checked.

      Conclusion

      Some approaches have already been well established in the management of patients with craniofacial malformations, e.g. the endocopic evaluation of glossoptosis and associated lesions and its role as an intubation assistance tool, while others need to be subject of further research, e.g. its role in swallowing investigation and as a postoperative success control predictor.

      Keywords

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      References

        • Sher A.E.
        Mechanisms of airway obstruction in Robin sequence: implications for treatment.
        Cleft Palate-Craniofacial J : official publication of the American Cleft Palate-Craniofacial Association. 1992; 29: 224-231
        • Sher A.E.
        • Shprintzen R.J.
        • Thorpy M.J.
        Endoscopic observations of obstructive sleep apnea in children with anomalous upper airways: predictive and therapeutic value.
        Int J Pediatr Otorhinolaryngol. 1986; 11: 135-146
        • Shprintzen R.J.
        • Singer L.
        Upper airway obstruction and the Robin sequence.
        Int Anesthesiol Clin. 1992; 30: 109-114
        • Argamaso R.V.
        Glossopexy for upper airway obstruction in Robin sequence. The Cleft palate-craniofacial journal.
        official publication of the American Cleft Palate-Craniofacial Association. 1992; 29: 232-238
        • Kochel J.
        • Meyer-Marcotty P.
        • Wirbelauer J.
        • et al.
        Treatment modalities of infants with upper airway obstruction--review of the literature and presentation of novel orthopedic appliances.
        Cleft Palate-Craniofacial J : official publication of the American Cleft Palate-Craniofacial Association. 2011; 48: 44-55
        • Marques I.L.
        • de Sousa T.V.
        • Carneiro A.F.
        • Barbieri M.A.
        • Bettiol H.
        • Gutierrez M.R.
        Clinical experience with infants with Robin sequence: a prospective study.
        Cleft Palate-Craniofacial J : official publication of the American Cleft Palate-Craniofacial Association. 2001; 38: 171-178
        • de Sousa T.V.
        • Marques I.L.
        • Carneiro A.F.
        • Bettiol H.
        • Freitas J.A.
        Nasopharyngoscopy in Robin sequence: clinical and predictive value. The Cleft palate-craniofacial journal.
        official publication of the American Cleft Palate-Craniofacial Association. 2003; 40: 618-623
        • Sorin A.
        • McCarthy J.G.
        • Bernstein J.M.
        Predicting decannulation outcomes after distraction osteogenesis for syndromic micrognathia.
        Laryngoscope. 2004; 114: 1815-1821
        • Bravo G.
        • Ysunza A.
        • Arrieta J.
        • Pamplona M.C.
        Videonasopharyngoscopy is useful for identifying children with Pierre Robin sequence and severe obstructive sleep apnea.
        Int J Pediatr Otorhinolaryngol. 2005; 69: 27-33
        • Yellon R.F.
        Epiglottic and base-of-tongue prolapse in children: grading and management.
        Laryngoscope. 2006; 116: 194-200
        • Berkowitz R.G.
        Neonatal upper airway assessment by awake flexible laryngoscopy.
        Ann Otol Rhinol Laryngol. 1998; 107: 75-80
        • Ungkanont K.
        • Friedman E.M.
        • Sulek M.
        A retrospective analysis of airway endoscopy in patients less than 1-month old.
        Laryngoscope. 1998; 108: 1724-1728
        • Lee J.J.
        • Ford M.D.
        • Tobey A.B.
        • Jabbour N.
        Diagnosing tongue base obstruction in pierre Robin sequence infants: sleep vs awake endoscopy.
        Cleft Palate-Craniofacial J : official publication of the American Cleft Palate-Craniofacial Association. 2018; 55: 692-696
        • Manica D.
        • Schweiger C.
        • Sekine L.
        • et al.
        Diagnostic accuracy of current glossoptosis classification systems: a nested cohort cross-sectional study.
        Laryngoscope. 2018; 128: 502-508
        • Mandell D.L.
        • Yellon R.F.
        • Bradley J.P.
        • Izadi K.
        • Gordon C.B.
        Mandibular distraction for micrognathia and severe upper airway obstruction.
        Arch Otolaryngol Head Neck Surg. 2004; 130: 344-348
        • Andrews B.T.
        • Fan K.L.
        • Roostaeian J.
        • Federico C.
        • Bradley J.P.
        Incidence of concomitant airway anomalies when using the university of California, Los Angeles, protocol for neonatal mandibular distraction.
        Plast Reconstr Surg. 2013; 131: 1116-1123
        • Cheng A.T.
        • Corke M.
        • Loughran-Fowlds A.
        • Birman C.
        • Hayward P.
        • Waters K.A.
        Distraction osteogenesis and glossopexy for Robin sequence with airway obstruction.
        ANZ J Surg. 2011; 81: 320-325
        • Morovic C.
        Manejo actual em síndrome de Pierre Robin.
        Rev Chil Pediatr. 2004; 75: 36-42
        • Knapp K.
        • Powitzky R.
        • Digoy P.
        Subglottic stenosis: another challenge for intubation and potential mechanism of airway obstruction in Pierre Robin Sequence.
        Int J Pediatr Otorhinolaryngol. 2011; 75: 1075-1077
        • Waters E.T.
        • Oberman J.P.
        • Biswas A.K.
        Pierre Robin sequence and double aortic arch: a case report.
        Int J Pediatr Otorhinolaryngol. 2005; 69: 105-110
        • Miller C.K.
        • Willging J.P.
        Fiberoptic endoscopic evaluation of swallowing in infants and children: protocol, safety, and clinical efficacy: 25 Years of experience.
        Ann Otol Rhinol Laryngol. 2020; 129: 469-481
        • da Silva A.P.
        • Lubianca Neto J.F.
        • Santoro P.P.
        Comparison between videofluoroscopy and endoscopic evaluation of swallowing for the diagnosis of dysphagia in children. Otolaryngology--head and neck surgery.
        official journal of American Academy of Otolaryngology-Head and Neck Surgery. 2010; 143: 204-209
        • Armstrong E.S.
        • Reynolds J.
        • Carroll S.
        • Sturdivant C.
        • Suterwala M.S.
        Comparing videofluoroscopy and endoscopy to assess swallowing in bottle-fed young infants in the neonatal intensive care unit.
        J Perinatol : official journal of the California Perinatal Association. 2019; 39: 1249-1256
        • Marques I.L.
        • Prado-Oliveira R.
        • Leiriao V.H.
        • Jorge J.C.
        • de Souza L.
        Clinical and fiberoptic endoscopic evaluation of swallowing in Robin sequence treated with nasopharyngeal intubation: the importance of feeding facilitating techniques.
        Cleft Palate-Craniofacial J : official publication of the American Cleft Palate-Craniofacial Association. 2010; 47: 523-529
        • Pinheiro Neto C.D.
        • Alonso N.
        • Sennes L.U.
        • Goldenberg D.C.
        • Santoro Pde P.
        Polysomnography evaluation and swallowing endoscopy of patients with Pierre Robin sequence.
        Brazilian journal of otorhinolaryngology. 2009; 75: 852-856
        • Manica D.
        • Schweiger C.
        • Sekine L.
        • et al.
        Severity of clinical manifestations and laryngeal exposure difficulty predicted by glossoptosis endoscopic grades in Robin sequence patients.
        Int J Pediatr Otorhinolaryngol. 2016; 90: 270-275
        • Okawa M.
        • Kinouchi K.
        • Kitamura S.
        • Taniguchi A.
        • Sasaoka N.
        • Fukumitsu K.
        [Anesthetic management of an infant with Freeman-Sheldon syndrome].
        Masui The Japanese journal of anesthesiology. 2002; 51: 659-662
        • Lee W.C.
        • Kim K.J.
        • Min K.T.
        • Koo B.N.
        • Park W.K.
        • Lew D.H.
        Nasotracheal intubation in an infant with Pierre Robin syndrome using two fibreoptic bronchoscopes of different diameter.
        Paediatr Anaesth. 2004; 14: 366-367
        • Kleeman P.P.
        • Jantzen J.P.
        • Bonfils P.
        The ultra-thin bronchoscope in management of the difficult paediatric airway.
        Canadian journal of anaesthesia = Journal canadien d'anesthesie. 1987; 34: 606-608
        • Peterson J.D.
        • Puricelli M.D.
        • Alkhateeb A.
        • et al.
        Rigid video laryngoscopy for intubation in severe pierre Robin sequence: a retrospective review.
        Laryngoscope. 2020;
        • Marston A.P.
        • Lander T.A.
        • Tibesar R.J.
        • Sidman J.D.
        Airway management for intubation in newborns with Pierre Robin sequence.
        Laryngoscope. 2012; 122: 1401-1404
        • Olson T.P.
        • McMurray J.S.
        • Mount D.L.
        Endoscopic changes in the upper airway after mandibular distraction osteogenesis.
        J Craniofac Surg. 2011; 22: 105-109
        • Izadi K.
        • Yellon R.
        • Mandell D.L.
        • et al.
        Correction of upper airway obstruction in the newborn with internal mandibular distraction osteogenesis.
        J Craniofac Surg. 2003; 14: 493-499
        • da Costa A.L.
        • Manica D.
        • Schweiger C.
        • et al.
        The effect of mandibular distraction osteogenesis on airway obstruction and polysomnographic parameters in children with Robin sequence.
        Journal of cranio-maxillo-facial surgery : official publication of the European Association for Cranio-Maxillo-Facial Surgery. 2018; 46: 1343-1347
        • Siegel N.
        • Lopez J.
        • Shi A.C.
        • et al.
        Laryngoscopy grade improvement and difficult airway resolution in infants with Robin sequence undergoing mandibular distraction osteogenesis: a multi-institutional study.
        Cleft Palate-Craniofacial J : official publication of the American Cleft Palate-Craniofacial Association. 2020; (1055665620964052)
        • Tan T.Y.
        • Kilpatrick N.
        • Farlie P.G.
        Developmental and genetic perspectives on Pierre Robin sequence.
        Am J Med Genet Part C, Seminars in medical genetics. 2013; 163C: 295-305