BACKGROUND
Children born with hemifacial microsomia (HFM) can suffer from airway compromise. There is a paucity of data correlating degree of HFM severity with airway difficulty. This study aims to determine the relationship between degree of micrognathia and airway insufficiency in the HFM population.
METHODS
Patient demographics, airway function, Kaban-Pruzansky (KP) grade, and Cormack Lehane (CL) grade were collected and compared with appropriate statistics for HFM patients treated between 2000 and 2022.
RESULTS
Seventy patients underwent 365 operations with KP grading as follows: 34% I, 23% IIA, 11% IIB, and 33% grade III. Goldenhar syndrome was present in 40% of patients and 16% had bilateral disease. KP grade (p<0.001) predicted mean number of airway-affecting procedures undergone and difficult airway status (p<0.001), with 75% of difficult airways in KP III patients. There was no association of airway compromise with Goldenhar syndrome, laterality, or age (p>0.05). Most CL grades were I (61%) or IIA (13%), with fewer IIB, III, and IV (4-7%). KP grade predicted CL grade (p<0.001), with 71% of grade IV views and 64% of grade III views seen in KP III patients.
CONCLUSIONS
Kaban-Pruzansky grade correlated with airway severity in HFM. Patients do not appear to outgrow their CL grade, as previously hypothesized, suggesting that KP III patients remain at increased risk for airway insufficiency into the teen years. Given the potential significant morbidity associated with airway compromise, proper identification and preparation for challenging airway is a critical part of caring for patients with HFM.