Severe micrognathia: indications for EXIT-to-Airway.
The ex utero intrapartum treatment (EXIT) procedure has become an important management option in cases of fetal airway obstruction. Select cases of severe micrognathia may be candidates for EXIT-to-Airway due to high-risk of airway obstruction at birth. Here we present three successful EXIT-to-Airway procedures for the management of congenital micrognathia in its most severe manifestations. CASE 1: A 23-year-old G3P1011 with a pregnancy complicated by severe micorgnathia, jaw index <5th percentile, as well as polyhydramnios. At 36 weeks EXIT-to-Airway was performed utilizing a bronchoscopically positioned laryngeal mask airway (LMA) during 23 min of uteroplacental support followed by tracheostomy. CASE 2: A 26-year-old G4P0120 with a pregnancy complicated by severe micrognathia, jaw index <5th percentile, and an obstructed oropharynx associated with polyhydramnios. At 37 weeks EXIT-to-Airway was performed with placement of tracheostomy. CASE 3: A 36-year-old G6P3023 with fetal magnetic resonance imaging (MRI) revealing esophageal atresia, polyhydramnios, and severe micrognathia with a jaw index <5th percentile. At 35 weeks the patient underwent EXIT-to-Airway with formal tracheostomy during 35 min of uteroplacental bypass. In the most severe cases of fetal micrognathia, EXIT-to-Airway provides time to evaluate and secure the fetal airway prior to delivery. We propose indications for EXIT-to-Airway in micrognathia to include a jaw index <5%, with indirect evidence of aerodigestive tract obstruction such as polyhydramnios, glossoptosis or an absent stomach bubble.
Fetal Care Center of Cincinnati, Divisions of Pediatric General, Thoracic, and Fetal Surgery, Otolaryngology, Genetics, and Maternal Fetal Medicine, Cincinnati Children's Hospital, University Hospital, Good Samaritan Hospital, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA.
Lee M
LM
Morris
Foong-Yen
FY
Lim
Ravindhra G
RG
Elluru
Robert J
RJ
Hopkin
Ronald K
RK
Jaekle
William J
WJ
Polzin
Timothy M
TM
Crombleholme
D000328:Adult; D000402:Airway Obstruction / Q000209:etiology / Q000401:mortality / Q000601:surgery*; D004933:Esophageal Atresia / Q000150:complications; D005260:Female; D005315:Fetal Diseases / Q000601:surgery*; D006801:Humans; D008334:Mandible / Q000002:abnormalities / Q000000981:diagnostic imaging; D008844:Micrognathism / Q000150:complications / Q000601:surgery*; D011247:Pregnancy; D011296:Prenatal Diagnosis; D014139:Tracheostomy / Q000379:methods*; D016896:Treatment Outcome; D016216:Ultrasonography, Prenatal; D055815:Young Adult