A novel intubation technique in bilateral cleft palate pediatric patients: hard gum shield-aided intubation

Paediatr Anaesth. 2013 Apr;23(4):349-54. doi: 10.1111/pan.12080. Epub 2012 Nov 28.


Background: Cleft palate anesthesia is challenging due to difficult airway. Left paraglossal intubation moves resting point of laryngoscope laterally but associated with narrower laryngoscopic view and possible trauma, and we invented the use of hard gum shield as a bridge over defective palate to facilitate intubation with possible wider window and defective tissue protection.

Methods: Eighty bilateral cleft palate children, ASA physical status I-II aged 9 months to 6 years scheduled for plastic surgery had general anesthesia, were involved in prospective, controlled, randomized study, and were randomly divided by closed envelope method into two groups: group I (40 patients): intubated by hard gum shield-aided intubation and group II (40 patients): intubated by left paraglossal intubation. Both techniques compared as regards (i) intubation time; (ii) Cormack and Lehane score; (iii) need for external laryngeal manipulation; (iv) easiness of intubation: easy, modest, or difficult intubation; and (v) complications: desaturation and failed intubation.

Results: Intubation time was shorter in group I (28.47 ± 3.78 vs. 37.63 ± 6.64 s, P = 0.001). Cormack and Lehane score was better in group I (P = 0.003). Need for external laryngeal manipulation was less in group I (P = 0.015). Easiness of intubation was better in group I (P = 0.022). No difference was found in complications between groups.

Conclusion: Hard gum shield-aided intubation facilitated intubation more than left paraglossal in bilateral cleft palate children with shorter intubation time, better glottic view, easier intubation, less need for laryngeal manipulation than left paraglossal intubation with no difference in complications.

Publication types

  • Comparative Study
  • Randomized Controlled Trial

MeSH terms

  • Airway Management
  • Capnography
  • Carbon Dioxide / blood
  • Child
  • Child, Preschool
  • Cleft Palate / surgery*
  • Female
  • Gingiva*
  • Humans
  • Infant
  • Intubation, Intratracheal / instrumentation*
  • Intubation, Intratracheal / methods*
  • Male
  • Monitoring, Intraoperative
  • Prospective Studies
  • Sample Size


  • Carbon Dioxide