Cleft Lip Palate,Cystic Hygroma:Special Anesthetic Problems

4th Pediatric Infectious Diseases Conference

ISSN 0973 - 0958

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Dr Sunita Goel
Lecturer in Anaesthesiology
BJ Wadia Childrens hospital

Cleft lip and Palate :

Cleft lip and palate are present in various combinations in as many as 1/1000 live born infants. Infants with these lesions may be both anemic and malnourished because of feeding difficulties and may have had repeated respiratory infections.

Associated conditions:

Congenital Heart Disease
Pierre Robin Syndrome
Treacher Collins syndrome
Subglottic stenosis

Surgical procedures:

Cleft lip repair: performed at 10-12 weeks of age
Cleft palate repair: Nowadays from 9 months onwards
Palatoplasty and pharyngoplasty: Palatoplasty performed from 9 months onwards Pharyngoplasty is performed from 5 to 6 year onwards

Special anesthetic problems:

Airway problems, including difficulty in intubation
Blood loss
Problems related with associated conditions
Pharyngoplasty is performed to decrease the velopharyngeal incompetence and improve speech. This procedure increases resistance to ventilation.
Post-operative airway obstruction may occur in the PICU.
Chronic airway obstruction may persist after the operation and lead to pulmonary hypertension and/ or obstructive sleep apnea.

Cystic Hygroma:

Cystic hygroma is in fact a cystic lymphangioma which usually occurs in the neck and less commonly in the axilla. Intraoral extension of this benign tumor may cause airway obstruction. 3% of cervical tumors extend in to the mediastinum.

Special anesthetic problems:

Existing airway obstruction.
Difficulty with intubation due to distortion of the airway.
Complete removal of the tumor may involve extensive dissection and be accompanied by major blood loss.

Next : Anaesthesia in Burns and Neurology

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