Conference abstract

Airway management in children with noma sequelae undergoing maxillo-facial reconstructive surgery

Pan African Medical Journal - Conference Proceedings. 2018:9(5).08 Dec 2018.
doi: 10.11604/pamj-cp.2018.9.5.731

Contact the corresponding author
Keywords: NOMA, difficult airway, maxilla-facial surgery, reconstructive surgery
Poster

Airway management in children with noma sequelae undergoing maxillo-facial reconstructive surgery

Wesley Rajaleelan1,&, Marloes Otterman2

1Southern New Hampshire Radiology Consultants (SNHRC), Vellore, South India, 2University Medical Centre Utrecht, The Netherlands

&Corresponding author
Wesley Rajaleelan, outhern New Hampshire Radiology Consultants (SNHRC), Vellore, South India

Abstract

Introduction: NOMA (cancrum oris) is an exclusive disease of childhood characterized by ulcerative necrosis of the maxillo-facial structures, affecting up to 140,000 children annually. It is fatal in 80 - 90% of cases in the acute setting. Survivors are left with disfiguring maxillo-facial deformations that make airway manipulation for reconstructive surgery very challenging. Here, we describe a case series of anaesthetic airway management for children with sequelae of NOMA in Sub-saharan Africa.

Methods: over two interventions of Mdicins Sans Frontires-OCA mission at the NOMA hospital for children, Sokoto, Nigeria. 16 patients with chronic sequelae of NOMA, underwent maxillo-facial reconstructive surgery. Each patient posed significant airway challenges due to anatomic malformations, trismus and restricted neck movements. Lack of preoperative imaging and limited resources added to the challenge. We were able to surmount these with the use of a three tier hierarchial plan; plan A (intended airway management strategy), plan B (secondary management strategy) and plan C (surgical access to the trachea).

Results: preoperative work up included measuring thyromental, sternomental and inter-incisor distances, neck movements and mouth opening. Of the 16 patients in this series, 14 were intubated using plan A, two required deployment of plan B and none required plan C. We predominantly used fibre-optic and nasal intubation for these patients.

Conclusion: maxillo-facial reconstructive surgery for NOMA poses a huge challenge to the anesthesiologists, especially in children. Adequate planning, screening and assessment of the airway with primary, secondary and back up plans are crucial for successful NOMA intervention. With this strategy in place cannot intubate, cannot ventilate situations can be handled during an emergency. Psychological and nutritional rehabilitation is essential prior to surgery.