Pediatric Airway Management

What damage can a young child with developing brain cause with poor oxygenation at night? After years of poor oxygenation to brain, an older person may develop Dementia & Alzhemiers.

Can a child have impaired airway? YES 1) Large tonsils 2) Large tongue 3) Small arches 4) Retrognathic mandible (class II) 5) Long soft palate (MP=4) 6) large palatal & mandibular tori 7) Nasal obstruction 8) Limited opening

Signs Impaired airway: 1) Gasping for air 2) sound air turbulence 3) Snoring 4) Brain shocks awake to make you breath 5) Panic attacks at night

Walls of air pipe:

1. Upper wall = Palatial extension
2. Side wall = Med Pterygoid-Tonsils-Fat
3. Lower wall = Size Tongue vs size arch

Pedo Airway concerns:

        Large tongue Small arch Mandibular Tori Palatal depth

         Palatal tori Posterior Crossbites Restricted arches Enlarge tonsils

Fat deposits Small trachea Large Medial Pterygoid

Premolar extraction is concern for reducing airway: 1. Small air pipe 2. Large tongue small arch 3. Take out teeth shrinks arch 4. Class II skeletal pushes tongue into airway 5. Grind/Clench increases size muscle -Medial Pterygoid

Refer for airway management: 1) ENT if tonsils too big 2) OFP if Medial Pterygoid or Masseters enlarged 3) Ortho & Oral Surgery if arch is too small for large tongue 4) Special ENT if tongue is oversized and arch right size (TORS)

Why refer child to Orofacial Pain Specialist ? 1) Tension headaches 2) Locked jaw 3) Destructive grind 4) Snoring-gasping-breath holding 5) Severe wear primary & permanent 1st molar

Is there an urgency for referring a child or teen with locked jaw? YES, to have any chance to recapture disc !

The chewing system orthopedic program needs to be urgently referred by pedodontist or general dentist in a child or teen with restricted opening.