Dyspnea and dysphagia from upper airway obstruction after occipitocervical fusion in the pediatric age group

Meng Huang, David D. Gonda, Valentina Briceño, Sandi K. Lam, Thomas G. Luerssen, Andrew Jea*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

14 Scopus citations

Abstract

Upper airway obstruction resulting from overflexion of the craniocervical junction after occipitocervical fusion is a rare but potentially life-threatening complication and is associated with morbidity. The authors retrospectively reviewed the medical records and diagnostic images of 2 pediatric patients who underwent occipitocervical fusion by the Neuro-Spine Program at Texas Children's Hospital and experienced dyspnea and/or dysphagia from new upper airway obstruction in the postoperative period. Patient demographics, operative data, and preoperative and postoperative occiput-C2 angles were recorded. A review of the literature for similar complications after occipitocervical fusion was performed. A total of 13 cases of prolonged upper airway obstruction after occipitocervical fusion were analyzed. Most of these cases involved adults with rheumatoid arthritis. To the best of the authors' knowledge, there have been no previous reports of prolonged upper airway obstruction in children after an occipitocervical fusion. Fixation of the neck in increased flexion (-18° to -5°) was a common finding among these adult and pediatric cases. The authors' cases involved children with micrognathia and comparatively large tongues, which may predispose the oropharynx to obstruction with even the slightest amount of increased flexion. Close attention to a satisfactory fixation angle (occiput-C2 angle) is necessary to avoid airway obstruction after an occipitocervical fusion. Children with micrognathia are particularly sensitive to changes in flexion at the craniocervical junction after occipitocervical fixation.

Original languageEnglish (US)
Pages (from-to)1-6
Number of pages6
JournalNeurosurgical focus
Volume38
Issue number4
DOIs
StatePublished - 2015
Externally publishedYes

Keywords

  • Dysphagia
  • Dyspnea
  • Occipitocervical fusion
  • Pediatric spine
  • Respiratory failure
  • Spinal instrumentation

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

Fingerprint Dive into the research topics of 'Dyspnea and dysphagia from upper airway obstruction after occipitocervical fusion in the pediatric age group'. Together they form a unique fingerprint.

Cite this