Predictors of difficult laryngoscopy in children presenting for cleft lip and palate surgery

Background : Endotracheal intubation is required to maintain a patent and clear airway as well as ensure good surgical access during cleft lip and palate repair in children. This study is aimed at identifying factors that would predict the risk of difficult intubation in patients presenting for cleft lip and palate surgery in order to focus on preventive measures and save lives. Patients and Methods : Data on anaesthetic techniques and ease of intubation was prospectively documented in 88 consecutive patients scheduled for elective cleft lip (61.4%) or palate repair (38.6%) over a period of 24 months. Three variables: age, type of cleft and laryngoscopic assessment using Cormack and Lehane grading were analyzed using univariate analysis in order to determine risk factors for difficult laryngoscopy. Result : There were 88 paediatric patients aged two months to 12 years comprising 51 boys and 37 girls. Tracheal intubation was easy in 73 (83%) patients and difficult in 15 (17%) patients. Of the 15 patients with difficult laryngoscopy, 13 (86.7%) were children aged less than 24 months, 8 (53.3%) presented with complete cleft palate and difficulty occurred across all the four grades of laryngoscopic view. Age and Cormack and Lehane laryngoscopic view grading were found to be significantly associated with difficult laryngoscopy (p Conclusion : Difficult laryngoscopy is common in children less than two years old presenting for cleft lip and palate surgery. Cleft surgery in this age group should be performed in hospitals where facilities for adequate monitoring and anaesthetic care are available.