Proper size of endotracheal tube for cleft lip and palate patients and intubation outcomes Shahin AbdollahiFakhim, Dariush SheikhZadeh, Nikzad Shahidi, GholamReza Nojavan, Gholamreza Bayazian *, Hamideh Aleshi Pediatrics Otolaryngology Department, Pediatrics Hospital, Tabriz University of Medical Sciences, Tabriz, Iran 1. Introduction Cleft lips and palates are among the most common birth deformities. Cleft lip occurs in 1 in 1000 live births in the United States, whereas cleft palate deformity occurs in 1 in 2000 live births [1]. Cleft lip deformities occur with the highest incidence among Native Americans (3.6 in 1000 births), Asians (2.1 in 1000), and whites (1 in 1000), with the lowest incidence in blacks (0.41 in 1000) [2]. By contrast, the incidence of cleft palate does not differ among ethnic groups reported as 0.5 in 1000 live births. This anomaly can be isolated or associated with other craniofacial syndromes. Over 150 syndromes are described in association with cleft lip/palate but fortunately they are rare [3]. One of the more common condition is Pierre Robin sequence of microgenathia, glossoptosis and cleft palate [4]. Other syndromes such as velocardiofacial, Treacher Collins and Klippel Feil are frequently reported in association with cleft lip and palate. The cleft lip and palate children are born with subsequent deficiencies. They make the situation worse with drinking and eating disabilities, breathing problems, improper dental develop- ment, facial beauty problems, psychological problems and oral and listening deficiencies, which eventually cause death if not treated. Therefore, patients seem more contend to have surgery as soon as possible. Cleft lip and palate is challenging procedure both for the surgeon and the anesthesiologist [5]. Anesthesia in cleft lip/palate surgery is complicated with difficult intubation reported from 4.7 to 8.4% of the patients [6–8]. Xue et al. reported the 16.46% incidence of difficult laryngoscopy when the cleft lip/palate is bilateral [8]. Inherent anatomical features of pediatric airways, cleft alveolus, protruding premaxilla, high vaulted arch and associated congenital syndromes such as Pierre Robin, Treacher Collins, Klipple Feil make the airway management more difficult in these children [9]. International Journal of Pediatric Otorhinolaryngology 77 (2013) 776–778 ARTICLE INFO Article history: Received 19 December 2012 Received in revised form 5 February 2013 Accepted 11 February 2013 Available online 11 March 2013 Keywords: Intubation Tracheal tube Cleft lip and palate Subglottic stenosis ABSTRACT Objectives: The aim of the current study was to identify the proper size of endotracheal tube for intubation of cleft lip and palate patients and intubation outcomes in these patients. Patients and methods: In this analytic cross-sectional study, 60 nonsyndromic cleft lip and palate patients were selected who had surgery between April 2010 and April 2012 at Pediatrics Hospital, Tabriz University of Medical Sciences, Iran. Demographic findings, previous admissions, and surgical history were registered. The proper tube size was measured by normal children formulas. Then tube size was confirmed by patients’ minimum resistance to intubation, proper ventilation reported by anesthesiolo- gist, and appropriate air leakage at an airway pressure of 15–20 cm H 2 O. If intubation was unsuccessful then smaller size of endotracheal tube would be tried. Frequency of intubation trials and the biggest endotracheal tube size were recorded. Results: Their average age, weight and height were 21.39 Æ 4.95 months, 9.97 Æ 1.18 kg and 74.30 Æ 26.61 cm, respectively. The average tracheal tube size and frequency of intubation trials were 4.34 Æ 0.78 and 1.63 Æ 0.80, respectively. Seven cases required an endotracheal tube size smaller than the recommended size for that age including one case in unilateral cleft palate, three cases in unilateral cleft lip, one case in unilateral cleft lip and palate, and two cases in bilateral cleft lip and palate. Conclusions: Findings proved that considering subglottic stenosis incidence in these children, it is reasonable to determine the tube size for nonsyndromic cleft lip and palate patients by applying the currently available standards for normal children. ß 2013 Elsevier Ireland Ltd. All rights reserved. * Corresponding author at: ENT ward, Imam Reza Hospital, Tabriz, Iran. Tel.: +98 9126953782; fax: +98 4113352076. E-mail addresses: gr_bayazian@yahoo.com, bayaziang@tbzmed.ac.ir (G. Bayazian). Contents lists available at SciVerse ScienceDirect International Journal of Pediatric Otorhinolaryngology journal homepage: www.elsevier.com/locate/ijporl 0165-5876/$ – see front matter ß 2013 Elsevier Ireland Ltd. All rights reserved. http://dx.doi.org/10.1016/j.ijporl.2013.02.009