As you evaluate a neonate with congenital facial abnormalities and prepare the
airway management plan, you remember that it can be more difficult to obtain
emergent surgical airway access in neonates when compared to adults. All of the
following contribute to this difficulty EXCEPT:
a) The hyoid bone can be more easily palpated than the thyroid cartilage, which
can confuse the practitioner when identifying landmarks for surgical
cricothyrotomy
b) In neonates, the isthmus of the thyroid gland often obstructs access to the
trachea and must be surgically divided for tracheostomy
c) The neonatal larynx is softer, making it more difficult to establish landmarks
for the neck dissection
d) The neonatal larynx is displaced cephalad, and is more protected by the
mandible, making it more difficult to identify landmarks
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Answer
Answer b. The thyroid gland does not usually need to be divided for neonatal
tracheostomy. Challenges associated with this procedure include difficulty in
identifying landmarks and difficulty with accessing the structures. The thyroid
cartilage and tracheal rings are softer and less distinct when compared to the
surrounding soft tissues (1). Additionally, the neonate / infant’s neck is shorter,
with cephalad displacement of the thyroid cartilage (2). This results in the
mandible further impeding surgical access, and making it technically challenging
to perform surgical airways in neonates and small infants.
Notes
- This question originally printed in the Pediatric Anesthesiology Review Topics kindle book series, and appears courtesy of Naerthwyn Press, LLC.
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