Pediatric airway surgery

Abstract

The pediatric airway-general implicationsThe pediatric airway has several distinct features compared to the adult airway. First, dimensions are much smaller. This is particularly important with regards to the subglottis. The inner-diameter of the subglottis of a newborn usually measures between 3 and 4 mm (1). A pathological process in this area, leading to a circular lumen reduction of only one millimeter, can result in a life-threatening near-occlusion.A second feature of the pediatric airway is that the cartilaginous parts are still malleable and cannot provide the same stability as an adult airway skeleton. This can become a problem after airway reconstructions and usually results in the need of prolonged postoperative stentings to support a laryngotracheal repair. The lack of stability of the trachea in a newborn (compared to an adult) also makes it more prone to develop tracheomalacia. Vessel malformations (vascular rings) can apply pressure to the airway, causing dynamic collapse and making surgical correction often inevitable (2).On the other hand, the flexibility of the pediatric trachea facilitates long-segmental resections. In children, up to 50 percent of the airway length can be resected without extensive tension on the anastomosis (3).With regards to the functional aspects of the pediatric larynx, the anatomical relationship between the glottis and the hyoid is also a unique feature. The thyrohyoid membrane is shorter than in adults and the thyroid notch usually projects behind the hyoid. This high location of the larynx raises the tip of the epiglottis behind the uvula, thus, permitting simultaneous breathing and swallowing (4). Consequently, swallowing problems are rare in children and the pediatric larynx can handle even profound changes in its configuration. In fact, extensive laryngotracheal resections and reconstructions are possible without risking severe postoperative swallowing problems. Diseases of the pediatric airway Laryngotracheal stenosisAirway injury secondary to traumatic intubation remains the most common cause of laryngotracheal stenosis, accounting for about 90% of all pediatric acquired airway stenosis (5). The majority of intubation-related injuries are due to the comorbidities. This comprehensive review should give an overview on most common airway problems in neonates and children as well as available surgical techniques.

Predictors for failure of supraglottic superimposed high‐frequency jet ventilation during endoscopic upper airway surgery in pediatric patients

“…Severe comorbidities in pediatric patients with severe stenosis including syndromic abnormalities, severe cardiovascular abnormalities, and neurological impairment have been previously described 3 . This correlation may contribute to a higher failing rate in patients with higher grade stenosis,however, comorbidities were found not to be related to SSHFJV failure in our series.…”

Treatment of tracheal stenosis with extracorporeal membrane oxygenation support in infants and newborns

“…Tracheal stenosis in children is a rare life‐threatening condition and poses a challenge for the healthcare team. Patients usually have a troubled medical history, such as pregnancy problems, childbirth complications, prematurity, and anatomical anomalies 1,2 . Moreover, the pediatric population has peculiarities such as smaller airway size, increased oxygenation needs, and greater malleability of the cartilaginous wall of the trachea.…”

“…Moreover, the pediatric population has peculiarities such as smaller airway size, increased oxygenation needs, and greater malleability of the cartilaginous wall of the trachea. The latter could lead to a more critical anastomosis, leading to post‐manipulation airway edema, and compromised airflow 1,2 …”

Preclinical assessment of resorbable silk splints for the treatment of pediatric tracheomalacia

“…Established surgical procedures for severe tracheomalacia include aortopexy, resection, and stenting . Aortopexy relieves vascular compression on the trachea and has a high success rate and low morbidity . However, the procedure has limited utility where long or multiple segments of the trachea are affected, or where the source of compression is not a nearby vessel .…”

“…1 Aortopexy relieves vascular compression on the trachea and has a high success rate and low morbidity. 6 However, the procedure has limited utility where long or multiple segments of the trachea are affected, or where the source of compression is not a nearby vessel. 5 Resection of the affected airway segment followed by anastomosis is another option to relieve symptoms of severe tracheomalacia.…”