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Case Series | Anaesthesiology | Volume 15 Issue 8, August 2026 | Pages: 1507 - 1512 | India
Association of Cleft Anatomy with Difficult Laryngoscopy in Children (9 Months-3 Years) Undergoing Cleft Surgery: A Case Series
Abstract: Background: Airway management in children with cleft lip and palate remains a significant anesthetic challenge because craniofacial deformities may result in difficult laryngoscopy and tracheal intubation. Accurate preoperative prediction of airway difficulty is essential for safe anesthetic planning. This case series was conducted to evaluate the association between cleft anatomy, particularly maximum cleft width, and difficult laryngoscopy in children undergoing primary cleft surgery. Methods: An observational case series was conducted on seven children aged 9 months to 3 years undergoing primary cleft lip and/or palate repair. Cleft deformities were classified as unilateral cleft lip and palate, bilateral cleft lip and palate, or isolated cleft palate. Maximum cleft width was measured at the hard-soft palate junction using standardized intraoral landmarks. Airway assessment included mask ventilation, Cormack-Lehane (CL) grade, number of intubation attempts, requirement for external airway maneuvers, and peri-intubation desaturation. Difficult laryngoscopy was defined as Cormack-Lehane Grade III or IV. Results: Among the seven patients, 42.9% had bilateral cleft lip and palate, 28.6% had unilateral cleft lip and palate, and 28.6% had isolated cleft palate. The mean maximum cleft width was 11.14 ± 2.56 mm. Difficult laryngoscopy was observed in 4 (57.1%) children, all of whom had wider clefts with a mean cleft width of 12.75 ± 2.27 mm, compared with 9.00 ± 0.87 mm in children without difficult laryngoscopy. Bilateral cleft lip and palate was consistently associated with Cormack-Lehane Grade III or IV and increased intubation attempts. Grade III laryngoscopy was the most frequent finding (57.1%), while Grade IV was observed in 28.6% of cases. Conclusion: Greater cleft width and bilateral cleft anatomy were associated with increased difficulty during direct laryngoscopy. Preoperative measurement of maximum cleft width may serve as a simple and useful predictor of difficult airway, allowing better preparation, appropriate airway planning, and improved perioperative safety in children undergoing cleft surgery.
Keywords: Cleft lip and palate, Difficult laryngoscopy, Pediatric airway, Cormack-Lehane grade, Cleft width
How to Cite?: Dr. Sai Vijayashree C, Dr. Gurulingappa Patil, "Association of Cleft Anatomy with Difficult Laryngoscopy in Children (9 Months-3 Years) Undergoing Cleft Surgery: A Case Series", Volume 15 Issue 8, August 2026, International Journal of Science and Research (IJSR), Pages: 1507-1512, https://www.ijsr.net/getabstract.php?paperid=SR26815140317, DOI: https://dx.doi.org/10.21275/SR26815140317