Anesthesia Considerations 

Treacher Collins Syndrome

 

 

Background 

 

• TCS is an autosomal dominant disorder of bilateral facial development

• Abnormalities can result in airway narrowing & respiratory compromise.  Affected patients may require prone positioning or surgery to maintain a patent airway.  

• Features: ​

  • Malar hypoplasia & a cleft in the zygoma 

  • Eyes have an antimongloid slant with colobomas (eyelid notch) along the lateral 1/3 of the lower lid

  • Lashes are absent from the medial 2/3 of the lower eyelid

  • Face has a convex profile with a retrusive chin & jaw.  Associated with an overbite 

  • External ear abnormalities are common 

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Considerations 

 

• Pediatric patient considerations 

• Potentially very difficult airway​

  • Airway is difficult due to high arched palate & mandibular hypoplasia 

  • Airway becomes more difficult as patient gets older

  • Airway plan essential with multiple adjuncts, have ENT/surgical option on stand-by, plan on spontaneously breathing sleep technique (titrated TIVA vs IH) 

  • LMA & video laryngoscope use have been successfully described in these patients 

• OSA considerations. OSA is a common comorbidity 

• Association with congenital heart disease (uncommon) 

• Deafness common 

 

 

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