Creating an Interactive Algorithm for Improved Management of Difficult Airways in Micrognathic and Retrognathic Infants

Newborns with conditions such as Pierre Robin sequence, Treacher Collins syndrome, and Goldenhar syndrome are born with underdeveloped mandibles, a condition known as “micrognathia”. Micrognathic and retrognathic (posterior positioned jaw) patients face challenges and risk of injury when anesthesia is required, due to a hypoplastic mandible, posterior displacement of the tongue, and other facial anomalies that ultimately cause airway obstruction and difficult intubation. Currently, a “Difficult Airway Algorithm” is used to guide physicians to make the best choices during adult intubation, depending on the particular challenges and dynamics of the case. However, there are no widely available or accepted difficult airway algorithms for micrognathic infants. Furthermore, simulation models exist for practicing intubation on newborns, but only one model is available with micrognathia and is not readily available at many medical teaching facilities. Lack of training resources and contact with patients with this condition prevent physicians from acquiring the experience necessary to adequately care for these infants. An interactive web application was created to provide an accessible way to increase exposure to the anatomy of micrognathic newborns and the recommended techniques for intubation. A unique interactive algorithm within the application was developed specifically for the treatment and airway management of children with micrognathia. Interactivity allows the user to explore different paths within the algorithm and learn additional information through text, illustration, and animation. Additionally, a separate section of the application allows for exploration and deconstruction of a 3D model of a micrognathic patient, allowing for reinforcement of anatomical and spatial concepts. Together the unique interactive flowchart, the 3D anatomy viewer, and an additional background information section with supplemental text and illustrations, provide a useful overview for users that anticipate the need to manage a micrognathic airway. This project will contribute to the safety of these children inside and outside the operating room by increasing clinician’s exposure to the different options available during intubation. The workflow and foundation of this project has the potential to be expanded and applied to a variety of medical scenarios