Airway Management in Neonatal Lingual Thyroglossal Duct Cyst

OBJECTIVE: 1) Recognize the neonatal presentation of lingual thyroglossal duct cyst (LTGDC). 2) Understand techniques for perioperative airway management in neonatal LTGDCs, particularly during anesthesia induction. METHOD: Retrospective chart review was performed of patients presenting between 1999 and 2009 to a tertiary care, pediatric academic hospital and diagnosed with neonatal LTGDC. Diagnostic interventions, anesthetic and surgical techniques, outcomes and complications were reviewed. RESULTS: Five patients were diagnosed with neonatal LTGDC during the study period. Onset of symptoms began during the neonatal period and the mean age at diagnosis was 2 months (range: 1-3 months). Most common complaints included labored breathing (80%), feeding intolerance (60%), noisy breathing (40%), and cyanosis (60%). Diagnostic modalities included flexible fiberoptic laryngoscopy (60%), imaging (60%), and intra-operative (20%). Perioperative airway management of these patients evolved over this period to culminate in our currently recommended protocol. Inhalational induction was performed with the patient sitting upright and the bed turned toward the surgeon with all airway equipment prepared. When an appropriate plane of anesthesia was achieved, the patient was laid supine, direct laryngoscopy performed and the patient intubated with a small endotracheal tube placed over a rigid telescope. A bronchoscope and flexible intubation equipment were readily available. Surgical excision was then performed with endoscopic methods using electrocautery. Complications included a delayed diagnosis (40%), and additional surgical procedures (20%). CONCLUSION: LTGDCs are a rare and potentially lethal etiology of neonatal supraglottic airway obstruction. An inhalational anesthetic technique with rigid intubation provides a safe and efficient method of perioperative airway management.