The management of tracheobronchial obstruction in children

Tracheobronchial obstruction is very uncommon in children and small infants. Stenosis and malacia, either congenital or acquired, are probably the most frequent diagnosis in this setting. Clinical symptoms are common to both airway anomalies and bronchoscopy plays a crucial role in the diagnostic wo...

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Bibliographic Details
Published inMinerva pediatrica Vol. 61; no. 1; p. 39
Main Authors Antón-Pacheco, J L, García-Hernández, G, Villafruela, M A
Format Journal Article
LanguageEnglish
Published Italy 01.02.2009
Subjects
Algorithms
Bronchial Diseases - chemically induced
Bronchial Diseases - etiology
Bronchial Diseases - therapy
Child
Child, Preschool
Constriction, Pathologic
Female
Humans
Infant
Infant, Newborn
Male
Tracheal Stenosis - diagnosis
Tracheal Stenosis - etiology
Tracheal Stenosis - therapy
Tracheobronchomalacia - complications
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Summary:Tracheobronchial obstruction is very uncommon in children and small infants. Stenosis and malacia, either congenital or acquired, are probably the most frequent diagnosis in this setting. Clinical symptoms are common to both airway anomalies and bronchoscopy plays a crucial role in the diagnostic work-up. Management is complex and surgeons involved in it should be familiar with multiple surgical and endoscopical techniques. Symptomatic short tracheal stenosis are best treated by means of resection and reconstruction, although endoscopic dilation or laser resection can be tried first in selected cases. In long tracheal stenosis, slide tracheoplasty is the surgical procedure of choice. Tracheobronchial malacia is usually self-limiting by the age of 3 years and most cases show mild symptoms that can be treated conservatively. In a small group of patients airway compromise is severe enough to require surgical or endoscopical treatment. Aortopexy or tracheostomy are the classic treatments for congenital tracheomalacia, but increasing experience with endoscopic airway stent placement in children is making this technique more attractive and popular. Acquired tracheomalacia is usually caused by a long-standing tracheostomy and if decannulation is impaired surgical treatment is mandatory.
ISSN:0026-4946