TYK405
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
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.