Oral and Maxillofacial Surgery

Anatomical Differences in Children

• Proportionally larger head: Flexes neck when supine
• Larger tongue: Relative to oral cavity size
• Higher larynx: C3-C4 vs C6 in adults
• Smaller airways: Proportionally narrower at all levels
• Cricothyroid membrane: Very small in children <10-12 years
• Narrowest point: Cricoid ring (vs vocal cords in adults)

Emergency Airway Access

Cricothyroidotomy

• Adult procedure: Standard emergency surgical airway
• Pediatric limitation: Small cricothyroid membrane <10-12 years
• Anatomy: Distance between thyroid and cricoid cartilages
• Risk: High complication rate in young children

Tracheostomy in Pediatrics

• Preferred method: For children <10-12 years
• Advantages:
  • Larger surgical target
  • More familiar anatomy
  • Lower complication risk
  • Better long-term management
• Technique: Surgical exposure below cricoid cartilage
• Location: Between 2nd-4th tracheal rings

Age-Specific Recommendations

• <2 years: Tracheostomy only
• 2-8 years: Tracheostomy strongly preferred
• 8-12 years: Tracheostomy preferred, cricothyroidotomy possible
• >12 years: Either procedure acceptable, cricothyroidotomy faster

Pediatric Airway Equipment

• Bag-mask ventilation: Most important skill
• Laryngeal mask airway: Good bridge device
• Endotracheal tubes: Uncuffed <8 years traditionally
• Emergency kit: Age-appropriate sizes readily available