Abstract: PURPOSE: To investigate prospectively the morbidity of difficult airway and management in children with hemifacial microsomia. Methods: One hundred and seventy-two patients with hemifacial microsomia scheduled for distraction osteogenesis operation were evaluated for airway condition before induction of anesthesia, the difficult airway grade was determined by evaluating the degree of mouth opening, thyromental distance, the inability to slide the lower jaw in front of the upper jaw, neck activity, Mallampati classification, and Cormack classification. Rapid induction, slow induction with sedation or ketamine-based anesthesia was performed according to the assessment of patients with difficult airways. Results: The morbidity of difficult airway was 31.4% in 172 hemifacial microsomia patients. The ratio of limited mouth opening was 12.2%, and short thyromental distance was 17.4%. The inability to slide the lower jaw was behind the upper jaw in 8.7% of the patients, decreased neck mobility was accounted for 2.3%, 19.8% of the patients had Mallampati classification of Ⅲ or Ⅳ,and the ratio of Cormack grade Ⅲ or Ⅳ patients was 12.2%. All patients were intubated successfully during induction of anesthesia. Conclusions: Managing the airway of children with hemifacial microsomia can potentially be difficult. The need for perioperative careful evaluation is emphasized.

Key words: Hemifacial microsomia, Difficult airway, Endotracheal intubation