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Table of Contents
Year : 2020  |  Volume : 4  |  Issue : 3  |  Page : 145-146

Adult anesthesia mask for inhalational induction in a child with large Tessier facial cleft-7

Department of Anaesthesiology AIIMS, Patna, Bihar, India

Date of Submission16-Mar-2020
Date of Decision02-Apr-2020
Date of Acceptance12-Apr-2020
Date of Web Publication18-Jul-2020

Correspondence Address:
Dr. Rajnish Kumar
Department of Anaesthesiology, Fifth Floor, OT Complex, AIIMS, Patna, Bihar
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/BJOA.BJOA_23_20

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How to cite this article:
Kumar R, Kumar A, Kumar R. Adult anesthesia mask for inhalational induction in a child with large Tessier facial cleft-7. Bali J Anaesthesiol 2020;4:145-6

How to cite this URL:
Kumar R, Kumar A, Kumar R. Adult anesthesia mask for inhalational induction in a child with large Tessier facial cleft-7. Bali J Anaesthesiol [serial online] 2020 [cited 2021 Jan 22];4:145-6. Available from: https://www.bjoaonline.com/text.asp?2020/4/3/145/290087


Transverse facial clefts (Tessier-7) are rare congenital anomalies, which consists of macrostomia, lateral facial muscular diastasis, and bony abnormalities of the maxilla and zygoma. We present the anesthetic management of a 1-year–6 months old, 8 kg, male admitted for correction of a large bilateral facial cleft. On preoperative assessment, the child had an adequate mouth opening with a high arched palate, a bifid uvula, retracted lower jaw, and large bilateral lateral facial clefts [Figure 1].
Figure 1: Large facial cleft

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Due to the large facial cleft, mask ventilation was a concern. In our operating room, we had different types of anatomical masks. We noted that the silicone transparent anatomical face mask adult size 4 had the width approximately similar to the facial cleft of the child. After the administration of intravenous midazolam and fentanyl, inhalational induction of anesthesia with 100% oxygen and incremental concentration of sevoflurane was started using this adult mask size 4.

We used the three-hand technique for ventilation. We noted that by ensuring a good tight seal around the chin [Figure 2], the leak during mask ventilation was kept minimal. After adequate depth was ensured, the Cormack–Lehane grade-1 view was obtained on direct laryngoscopy. Atracurium 0.5 mg/kg was given for adequate muscle relaxation, and tracheal intubation was performed successfully with a 4 mm ID uncuffed endotracheal tube. After the surgery, we extubated the child, and the rest of the hospital stay was uneventful.
Figure 2: Adult face mask over child face

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Difficult airway management is always challenging for anesthesiologists. The cause of a difficult airway is various. In our case, due to large facial cleft, the pediatric mask could not make a proper seal. Preoxygenation and mask ventilation in an anticipated difficult airway are vital. The simple innovation of using an adult mask size for a pediatric patient worked very well in the case of this wide facial cleft.

Some reports showed that the use of an adult mask for preoxygenation in an infant for various surgeries.[1],[2],[3],[4] Veerabathula et al.[5] innovated using simple dental impression material molded to match the facial contour. They covered the facial defect, and with its aid, they were able to ventilate using an appropriately sized pediatric face mask in a child with a bilateral Tessier 3 anomaly.

Adult face masks should, however, be used with caution in a child. Proper placement should ensure that there is no pressure on the eyeballs. To conclude, we wish to state that for Tessier type facial anomalies, the use of an adult size face mask in children can help address many questions regarding mask ventilation and preoxygenation.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

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Conflicts of interest

There are no conflicts of interest.

  References Top

Carenzi B, Corso RM, Stellino V, Carlino GD, Tonini C, Rossini L, et al. Airway management in an infant with congenital centrofacialdysgenesia. Br J Anaesth 2002;88:726-8.  Back to cited text no. 1
Ramachandran R, Rewari V, Kumar A. Difficult airway management in an infant with bilateral tessier number 4 cleft. Acta Anaesthesiol Belg 2014;65:77-80.  Back to cited text no. 2
Kumar K, Ninan S, Saravanan P, Prakash KS, Jeslin L. Airway management in an infant with tessier N. 4 anomaly. J Anaesthesiol Clin Pharmacol 2011;27:239-40.0  Back to cited text no. 3
[PUBMED]  [Full text]  
Krishna HM, Kundu R. Adult face mask for inhalational induction in a child with maxillofacial injury. Anesth Essays Res 2012;6:215-7.  Back to cited text no. 4
  [Full text]  
Veerabathula P, Patil M, Upputuri O, Durga P. Simple solution for difficult face mask ventilation in children with orofacial clefts. Paediatr Anaesth 2014;24:1106-8.  Back to cited text no. 5


  [Figure 1], [Figure 2]


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