Summary
The incidence of unanticipated difficult or failed airway in otherwise healthy children is rare, and routine airway management in pediatric patients is easy in experienced hands. However, difficulties with airway management in healthy children are not infrequent in nonpediatric anesthetists and are a main reason for pediatric anesthesia-related morbidity and mortality. Clear concepts and strategies are, therefore, required to maintain oxygenation and ventilation in children. Several complicated algorithms for the management of the unanticipated difficult adult and pediatric airway have been proposed, but a simple structured algorithm for the pediatric patient with unanticipated difficult airway is missing. This paper proposes a simple step-wise algorithm for the unexpected difficult pediatric airway based on an adult Difficult Airway Society (DAS) protocol, discusses the role of recently introduced airway devices, and suggests a content of a pediatric airway trolley. It is intended as an easy to memorize and a practical guide for the anesthetist only occasionally involved in pediatric anesthesia care as well as a call to stimulate discussion about the management of the unanticipated difficult pediatric airway.

https://onlinelibrary.wiley.com/doi/pdf/10.1111/j.1460-9592.2010.03284.x

Proposal for the management of the unexpected difficult pediatric airway.

What Method for Management of Unilateral Mandibular Angle Fractures Has the Lowest Rate of Postoperative Complications? A Systematic Review and Meta-Analysis

This chapter reviews the developmental anatomy and physiology of the pediatric upper airway as it relates to the practice of pediatric anesthesia. Differences between the pediatric and adult airways are important determinants of anesthetic techniques. Knowledge of normal developmental anatomy and physiologic function is required to understand and manage both the normal and the pathologic airways of infants and children. Techniques of mask ventilation, oral and nasal airway placement, use of supraglottic devices, and tracheal intubation are reviewed for normal and anatomically abnormal pediatric patients.

The Pediatric Airway

Three-dimensional versus standard miniplate fixation in the management of mandibular angle fractures: a systematic review and meta-analysis

Kinder mit Hinweisen auf bzw. mit Vorliegen eines schwierigen Atemwegs mussen in Zentren anasthesiert werden, die uber eine entsprechende personelle Expertise und apparative Infrastruktur verfugen. Besteht kein Anhalt fur einen schwierigen Atemweg, lassen sich Kinder grundsatzlich mit der richtigen Technik mittels einer passenden Gesichtsmaske beatmen und direkt-laryngoskopisch intubieren. Sollten dennoch Atemwegsprobleme auftreten, so kommt es aufgrund der verminderten Sauerstoffreserven und des erhohten Sauerstoffverbrauchs beim Kind sehr schnell zur Hypoxamie und in deren Folge zu einer lebensbedrohlichen Myokarddepression mit Bradykardie. Nebst einer Pravention solcher Situationen ist beim Auftreten von Schwierigkeiten bei der Maskenbeatmung ein rasches und strukturiertes Handeln erforderlich. Dazu gehoren die Optimierung der Lagerung und der Gesichtsmaskenbeatmung, die Behandlung einer funktionellen Atemwegsobstruktion, der Ausschluss pharyngealer bzw. laryngealer Fremdkorper mittels direkter Laryngoskopie und Intubation und - falls letzteres nicht moglich - das Beatmen uber eine Larynxmaske. Invasive Oxygenierungstechniken werden nach Durchfuhrung der oben geschilderten Masnahmen bei Kindern mit anamnestisch und in der Voruntersuchung unauffalligem Atemweg nicht benotigt. Bei unerwartet schwieriger direkt-laryngoskopischer Intubation haben die Oxygenierung und die Limitierung der Intubationsversuche sowie die Erwagung alternativer Intubationstechniken die hochste Prioritat. Nebst Optimierung der Einsehbarkeit des Larynx mittels auseren Drucks auf den Larynx (ggf. BURP) soll in einem ersten Schritt ein alternatives direkt- oder auch indirekt-laryngoskopisches Verfahren zur Anwendung kommen. In einem zweiten Schritt soll die Trachea fiberoptisch durch die LMA intubiert werden. Eine chirurgische Konio- oder Tracheotomie wird beim Kind ohne bekannte Atemwegsprobleme nicht notig sein.

Handlungsempfehlung zur Prävention und Behandlung des unerwartet schwierigen Atemwegs in der Kinderanästhesie

and 14% for the non–strut plate group (3 patients), with no significant differences in rates of infection (3 [4%] vs 2[9%]),dehiscence(4[6%]vs2[9%]),malunion(1[1%] vs2[9%]),nonunion(3[4%]vs0),hardwarefailure(1[1%] vs1[5%]),malocclusion(2[3%]vs2[9%]),andinjuryto the inferior alveolar nerve (1 [1%] vs 1 [5%]). The most common postoperative complaints were pain (13 [19%] vs 6 [27%]), followed by numbness (5 [7%] vs 2 [9%]), trismus (4 [6%] vs 3 [14%]), edema (3 [4%] vs 3 [14%]), andbitedeformity(2[3%]vs2[9%]),withamean(range) follow-uptimeof54.7(2-355)daysforthestrutplategroup vs 46.8 (8-308) days for the non–strut plate group. Conclusions and Relevance:The 3-dimensional curved strutplateisaneffectivetreatmentmodalityforanglefractures, with comparable infection rates, low incidence of alveolar nerve injury, and trends for decreased length of operation, complications, and infections compared with other techniques.

https://jamanetwork.com/journals/jamaotolaryngology/articlepdf/1699775/ooa130037_592_597.pdf

Repairing Angle of the Mandible Fractures With a Strut Plate

The airway exchange catheter can be used both to ventilate the lungs and to act as a guide for reintubation in patients of all ages who have a tenuous airway. We report the case of a 2-year-old boy with an anatomically challenging airway in whom both an airway exchange catheter and a rigid bronchoscope were used to visualize and maintain a secure airway. We also review the literature as it pertains to the management of the difficult pediatric airway.

https://journals.sagepub.com/doi/pdf/10.1177/014556130908800608

Management of the difficult pediatric airway: efficacy of airway exchange catheters with rigid bronchoscopy.

We describe a case of primary malignant paraganglioma of the thyroid gland that was found in a 55-year-old woman who had undergone surgery for bilateral carotid body tumors. The paraganglioma was treated with a total thyroidectomy followed by radiation therapy, and the patient was disease-free after more than 2 years of follow-up. Malignant paragangliomas of the thyroid gland are extremely rare. The diagnosis of malignancy is based on histopathologic findings, tumor behavior, and metastasis. These tumors can be misdiagnosed as other types of thyroid malignancies, thus resulting in less than optimal treatment. A genetic etiology was suspected in our patient.

Malignant paraganglioma of the thyroid gland with synchronous bilateral carotid body tumors.

Robotic Surgery in Otolaryngology
In the last decade, robotic surgery has become more common in just about every surgical subspecialty including otolaryngology/head and neck surgery. By collaborating with colleagues from other disciplines, our field has advanced into the forefront of technology and medical science. The application of the robot as simply another surgical instrument has now evolved into a thriving field of its own.

/pdf/robotic-surgery-in-otolaryngology-1k62s5weas.pdf

Robotic Surgery in Otolaryngology

Primary intraosseous carcinoma of the head and neck is rare, and lesions isolated to the anterior maxilla are obviously even more rare. The diagnosis of intraosseous carcinoma can be difficult, and it must be based on strict criteria. We report the case of a 40-year-old man who was referred for definitive treatment of a cancerous lesion of the anterior maxilla. The patient's mass had initially been thought to be a benign odontogenic cyst. The patient was treated with surgery and prosthetic rehabilitation. We describe the clinical presentation, pertinent workup including imaging, and the treatment of this case, and we review the literature.

https://journals.sagepub.com/doi/pdf/10.1177/014556131109000517

Primary intraosseous carcinoma of the anterior maxilla: an unusual case and review of the literature.

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