Diagnosis, Classification, and Management of Pediatric Tracheobronchomalacia

Choi, Sukgi S.; Lawlor, Claire M.; Rahbar, Reza; Jennings, Russell W.

doi:10.1001/jamaoto.2018.3276

Cited by 50 publications

(52 citation statements)

References 54 publications

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“…Airway assessment was completed with computed tomography to visualize the anatomic relationships of the great vessels and other mediastinal structures to the trachea and main bronchi 6 and dynamic three-phase bronchoscopy (rigid and flexible) to detect and classify regions and severity of tracheobronchial compression and malacia. 7 Surgical repair utilized mildly hypothermic cardiopulmonary bypass with cardioplegic arrest and included closure of the ventricular septal defect and subtotal closure of the patent foramen ovale. The central pulmonary arteries were plicated or partially resected or completely replaced with an interposed Gore-Tex tube graft (WL Gore, Flagstaff, AZ) bringing them anterior to the aorta (ie, LeCompte maneuver).…”

Section: Methodsmentioning

confidence: 99%

Early Infant Symptomatic Patients With Tetralogy of Fallot With Absent Pulmonary Valve: Pulmonary Artery Management and Airway Stabilization

Chow

Hoganson

Kaza

et al. 2020

The Annals of Thoracic Surgery

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Section: Methodsmentioning

confidence: 99%

Early Infant Symptomatic Patients With Tetralogy of Fallot With Absent Pulmonary Valve: Pulmonary Artery Management and Airway Stabilization

Chow

Hoganson

Kaza

et al. 2020

The Annals of Thoracic Surgery

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“…The airway collapse may be attributable to the dynamic posterior intrusion and/or combined with a region of fixed anterior collapse. If the entire cartilage ring configures in an upside-down U shape or even bow shape, the posterior membrane is broader and more dynamic and intrudes into the airway lumen during expiration and periods of increased intra-thoracic pressure (Figure 1) (14). Also, intrinsic weakness of cartilages can have a profound effect on airway compliance; in the worst cases resulting in severe airway collapse at rest or with minimal exhalation effort.…”

Section: Anatomymentioning

confidence: 99%

“…The right mainstem is divided into the proximal and distal right mainstem (R1, R2), and the left mainstem is divided into the proximal, middle, and distal left mainstem (L1, L2, L3). For each of these regions, we determine the percentage of airway narrowing and contribution of anterior collapse and/or posterior intrusion (13,14) (Figure 2) as well as note any other airway distortion (such as lateral intrusion) or other airway lesions such as masses, cobblestoning, fistulas, etc.…”

Section: Diagnosis and Evaluationmentioning

confidence: 99%

“…In recent years, dynamic airway evaluation and angiography using a contrast-enhanced multidetector computed tomography (MDCT) with two-dimensional (2D) and three-dimensional (3D) reconstructions have become an important modality to aid in the evaluation of thoracic anomalies in pediatric patients (13,14) (Figure 3). The dynamic airway evaluation can be performed in two phases of end-inhalation and end-exhalation (paired end-inspiratory and end-expiratory).…”

Section: Diagnosis and Evaluationmentioning

confidence: 99%

“…Primary or congenital TM/TBM can be found alone or in conjunction with other genetic and congenital disorders (5,8,9). Given the common origin of the trachea and esophagus during embryologic development, TM/TBM is a common respiratory problem in children who have esophageal atresia with or without tracheal-esophageal fistula (EA/TEF) (10)(11)(12)(13)(14). TM/TBM may also be associated with other airway and lung pathologies, such as laryngomalacia, laryngeal clefts, bronchopulmonary dysplasia, or cystic fibrosis (7,15,16).…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Tracheomalacia and Tracheobronchomalacia in Pediatrics: An Overview of Evaluation, Medical Management, and Surgical Treatment

Kamran

Jennings

2019

Front. Pediatr.

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Diagnosis and Management of Pediatric Dysphagia

Lawlor

Choi

2020

JAMA Otolaryngol Head Neck Surg

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ppropriate nutritional intake is essential for the rapid growth and development that occurs during infancy and childhood. 1 Feeding and swallowing dysfunction are diagnosed with increasing frequency, especially in children with a history of prematurity, neuromuscular disorders, cardiopulmonary disorders, anatomic anomalies of the upper aerodigestive tract, and gastrointestinal tract disorders. [2][3][4] Early diagnosis and intervention by a multidisciplinary team are essential to the management of swallowing disorders in children. 5 Physiologic Characteristics of SwallowingThe normal swallow is classically divided into 4 phases: the preparatory phase, the oral phase, the pharyngeal phase, and the esophageal phase. The preparatory phase is when food is taken into the oral cavity, moistened with saliva, chewed, and prepared into a bolus using the oral tongue and hard palate. This phase develops at approximately age 6 months. Before age 6 months, the preparatory phase consists of sucking from a nipple. The oral phase is the propulsion of the food bolus into the oropharynx by the oral tongue and the triggering of the swallow reflex. The soft palate elevates to prevent food from regurgitating into the nasopharynx. The pharyngeal phase is the passage of the food bolus through the oropharynx and hypopharynx toward the esophagus via coordinated muscle contraction. The velum approximates the pharyngeal musculature, the larynx elevates and the vocal folds adduct, and the tongue and pharyngeal muscles propel the bolus into the pharynx. 2,5,6 Respiration ceases during the pharyngeal phase; in fact, while eating, the respiratory rate becomes faster and more irregular than during tidal breathing. 7,8 The esophageal phase consists of cricopharyngeus relaxation, allowing the food bolus to enter the esophagus, and coordinated smooth muscle peristalsis passes the bolus into the stomach. 2,9 Development of the suck and swallow begins in utero as early as gestational week 10 or 11. Gestational age 34 to 38 weeks is typically when most children develop efficiency and tolerance of oral feeding. 5,10,11 In infants, all 4 phases are under involuntary reflex control. In children and adults, the preparatory and oral phases are under voluntary control, and the pharyngeal and esophageal phases remain involuntary. 2 A physiologic swallow is the result of the complex integration of more than 30 nerves and muscles and must progress with the child as their anatomy matures. 2 Dysphagia is defined as difficulty swallowing and must be distinguished from behavioral feeding disorders, such as oral aversion. 1 Dysphagia can be further categorized depending on the disordered phase of swallowing. Oral dysphagia can present as absent oral reflexes, immature or absent suck, uncoordinated biting/chewing, and poor handling of the food bolus. Pharyngeal dysphagia can present as laryngeal penetration, when the food bolus enters the laryngeal vestibule; aspiration, when the food enters the airway below the vocal folds; choking, when food obstructs the airway...

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Diagnosis, Classification, and Management of Pediatric Tracheobronchomalacia

Cited by 50 publications

References 54 publications

Early Infant Symptomatic Patients With Tetralogy of Fallot With Absent Pulmonary Valve: Pulmonary Artery Management and Airway Stabilization

Early Infant Symptomatic Patients With Tetralogy of Fallot With Absent Pulmonary Valve: Pulmonary Artery Management and Airway Stabilization

Tracheomalacia and Tracheobronchomalacia in Pediatrics: An Overview of Evaluation, Medical Management, and Surgical Treatment

Diagnosis and Management of Pediatric Dysphagia

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