Here is a tragic story that took place yesterday (and strikes at my own heart, because I have the same rare deformity that the unfortunate patient had):
A 10-year-old Texas boy with the rare genetic craniofacial anomaly syndrome Treacher Collins syndrome, whose airway was compromised by a small jaw and tiny throat, died shortly after being administered anesthesia for a routine dental procedure, when he stopped breathing due to airway collapse while unconscious. Normally, the jaw holds the tongue forward out of the airway when at rest, but in children with TCS and other craniofacial disorders, the small, underdeveloped jaw lies too far back from normal position, so the tongue blocks the narrowed airway. In children with TCS, they often need a tracheostomy soon after birth (and often throughout life in conjunction with the reconstructive surgeries).
Treacher Collins Syndrome Ups Risk of Dental Complications
The follow-up story says that the death was preventable, and gives some coverage of the celebration of the boy's life at a local funeral home:
Medical Professionals Say Child's Death at Dentist Was Preventable
This story illustrates the need for the dental profession (and anesthesiology in general) to be aware of children (and adults too) with craniofacial disfigurements that affect the internal structure of the upper airway. This can happen at any age.
Do dental schools not devote any significant teaching time to dental and anesthetic complications of people with narrowed airways? Medical schools surely do (I have been worked on by anesthesiologists at teaching hospitals, who use me for training fellow anesthesiologists), and I have seen a whole textbook devoted to anesthetic management of the difficult airway.
The above story NEARLY happened to me when I was 3, at a local private pediatric dentist's office in Fort Wayne, IN
. I was put to sleep (most likely with nitrous oxide) for a dental procedure. During that procedure, I quit breathing (respiratory arrest) due to my own compromised airway when I was unconscious (my tiny jaw and tongue too large for my mouth and throat due to my TCS). The dentist had to call in EMS and fire personnel from a local station. They had to resuscitate me. My mom did not find out until afterwards (she was in the waiting room, away from the operatory itself). Mom tells me that the dentist was so shaken that he himself appeared that he almost needed the resuscitation himself!
From that time on (since I was age 3), all of my childhood dentistry was taken care of at Riley Hospital for Children in Indianapolis, a tertiary-level children's hospital with a craniofacial clinic and the dental clinic staffed with people knowledgeable in difficult airways and equipped with emergency equipment.
Anesthesia has always been a challenge for me due to my compromised airway. Whenever I have surgery (since I was young), I have had awake fiberoptic intubation performed. I also have severe obstructive sleep apnea and use CPAP. I also had a tracheostomy from birth for several years, and several more tracheostomies in conjunction with my jaw surgeries over the years.
I will praise thee; for I am fearfully and wonderfully made... (Psalm 139:14)