Page 28 - Plasticos-Vol-3

Upper airway
obstruction
Almost one quarter of the patients experience
upper airway obstruction, ranging from mild
degree to severe, life-threatening condition
of oxygen depletion. The main cause of this
condition is that the lower jaw is very small
while the attaching tongue grows normally in
size and becomes relatively large compared
to the smaller-than-normal oral cavity. The
seemingly oversized tongue has no space to
lie but to shift backward and block the airway
behind it.
Depending on the severity of the breathing
difficulties, possible treatments are infant
positioning (prone or semi-prone), oxygenation
equipment, breathing devices with positive
inhaling force, artificial airways, tracheostomy
(a tube being surgically inserted into the
windpipe to bypass the blocked airway), and
mandibular distraction osteogenesis (to push
the jaw together with the tongue forward).
Cleft palate
Cleft palate is found in almost 25 percent of
patients with TCS. Most of these patients also
have abnormal fluid retention in their middle
ear due to Eustachian tube dysfunction. If
left untreated, this might lead to infection
and worsening of hearing levels. However,
the suitable timing for cleft palate repair for
TCS patients is likely to be delayed until the
effective airway can be ensured.
Congenital heart disease
Found in about 10 percent of the patients and
must be detected and treated before any other
surgery to avoid severe cardiac complications.
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Treatment specific to
this syndrome
Treatment before teenage years
After emergency conditions are taken care
of and the patients are in optimal condition,
treatment of the soft-tissue anomalies on the
face, such as clefts at the corner of the mouth
or abnormal skin tags on the cheek and ear,
will be considered.
The child should be checked regularly to make
sure that organs on the face function normally.
This includes hearing, speech, breathing and
oral health. The child’s ability to make speech
sounds might be impaired. If there are concerns
about the child’s speech, they will see a speech
and language pathologist for the assessment
and treatment.
Psychological and social problems associated
with facial deformity can significantly affect
quality of life in people with TCS. Parents
should have adequate knowledge about
appropriate child care from before school age.
It might be helpful to reach out to mental
health professionals and support groups of
other families living with the same condition.
Management of teasing and maintaining the
child’s self-esteem are of utmost importance.