title: Can we predict a difficult intubation in cleft lip/palate patients?
abstract: OBJECTIVE
  To find predictors of a difficult intubation in infants with an isolated or a syndromic cleft lip/palate.
  
  
  METHODS
  Retrospective review: single-blind trial.
  
  
  METHODS
  Tertiary care centre.
  
  
  METHODS
  A total of 145 infants born with cleft lip/palate were enrolled. Three clinical and seven lip/palate anatomic parameters were evaluated. The grade of intubation was determined by the anesthesiologist at the time of the labioplasty/staphylorrhaphy surgery at 3 and 10 months, respectively.
  
  
  METHODS
  Intubation grade.
  
  
  RESULTS
  The relative risk of a difficult intubation in the cleft lip, cleft palate without the Pierre Robin sequence, cleft lip-palate, and cleft palate with Pierre Robin sequence groups was 0, 2.7, 10, and 23%, respectively. The infants born with the Pierre Robin sequence had a statistically significant higher intubation grade. The degree of difficulty was increased in cases with early airway and feeding problems (p < .0001). Within the group of cleft palate patients without any lip malformation, a wider cleft was associated with a higher intubation grade with statistical significance (p  =  .0323).
  
  
  CONCLUSIONS
  Infants born with Pierre Robin sequence have a statistically significantly higher risk of difficult intubation. Within this group, of all the studied factors, a clinical history of early airway and feeding problems was the best predictor of a difficult endotracheal intubation. In cleft palate patients without any cleft lip, larger width of the cleft is also a significant predictor.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Laval University, Quebec, QC.
authors.forename: Isabelle
authors.initials: I
authors.lastname: Arteau-Gauthier
authors.forename: Jacques E
authors.initials: JE
authors.lastname: Leclerc
authors.forename: Audrey
authors.initials: A
authors.lastname: Godbout
mesh_terms: D002971:Cleft Lip / Q000150:complications* / Q000601:surgery; D002972:Cleft Palate / Q000150:complications* / Q000601:surgery; D000075202:Contraindications; D006785:Hospitals, University; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007442:Intubation, Intratracheal; D007828:Laryngoscopy; D007902:Length of Stay; D010855:Pierre Robin Syndrome / Q000150:complications*; D012189:Retrospective Studies; D012306:Risk