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Pathologies of the larynx and trachea in childhood.

Sittel C - GMS Curr Top Otorhinolaryngol Head Neck Surg (2014)

Bottom Line: Endoscopic treatment is possible in selected patients, but open reconstruction is superior in more severe cases.Tracheostomy is not a safe airway in early infancy, it's indication should be strict.Infectious diseases can be managed conservatively by a pediatrician in the majority of cases.

View Article: PubMed Central - HTML - PubMed

Affiliation: Klinikum Stuttgart, Klinik für Hals-, Nasen-, Ohrenkrankheiten, Plastische Operationen, Stuttgart, Germany.

ABSTRACT
Pathologies in the larynx and trachea in the pediatric age can be characterized in 4 main groups: airway stenosis, acute infections, benign neoplasia and foreign body aspiration. In this review main diagnostic strategies and therapeutic options are presented. Laryngomalazia is the most frequent condition of supraglottic stenosis. The term supraglottoplasty summarizes all different techniques used for it's repair using an endoscopic approach. Glottic stenosis is rare in children. Usually a compromise between voice preservation and airway restoration has to be sought. Type of reconstruction and timing are varying considerably in individual cases, endoscopic approaches should be preferred. Subglottic stenosis remains the largest group in paediatric airway pathology, with cicatrial stenosis being predominant. Today, cricotracheal resection is the most successful treatment option, followed by the classical laryngotracheal reconstruction with autologous cartilage. In early infancy subglottic stenosis is particularly demanding. Endoscopic treatment is possible in selected patients, but open reconstruction is superior in more severe cases. Tracheostomy is not a safe airway in early infancy, it's indication should be strict. Foreign body aspiration needs to be managed according to a clear algorhythm. Recurrent respiratory papillomatosis should be treated with emphasis on function preservation. The role of adjuvant medication remains unclear. Infectious diseases can be managed conservatively by a pediatrician in the majority of cases.

No MeSH data available.


Related in: MedlinePlus

Characteristics of the foreign bodies retrieved at “Klinikum Stuttgart” between 2006–2012
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Figure 21: Characteristics of the foreign bodies retrieved at “Klinikum Stuttgart” between 2006–2012

Mentions: The majority of foreign bodies in the tracheobronchial system is characterized and correctly diagnosed by the triad of sudden coughing or choking, auscultatory wheezing and unilaterally attenuated breath sounds [16]. Thus, collecting a good history from the parents is of particular importance. However, the history is not typical in all cases [26] or the aspiration may have been unobserved. Therefore, in up to 15% of the cases [38] it leads to persistent foreign bodies, which are then correctly diagnosed by bronchopulmonary complications after several days. In addition to auscultation, the chest X-ray is part of the low-threshold primary diagnosis. Most foreign bodies, however, are food related and are not radio-opaque. Of the 106 retrieved foreign bodies in our clinic in the period from 2006 to 2012, only 22 were of a material that was primarily radiologically detectable. Nuts, seeds and carrot pieces in this series were most frequently aspirated (Figure 21 (Fig. 21)). The indications for tracheobronchoscopy should therefore not be too tight. Thorough diagnosis and adequate clinician experience kept the rate of endoscopic interventions without foreign body detection within tolerable limits. Hence in the series mentioned, we detected 106 foreign bodies whereas in only 43 cases we could not prove one.


Pathologies of the larynx and trachea in childhood.

Sittel C - GMS Curr Top Otorhinolaryngol Head Neck Surg (2014)

Characteristics of the foreign bodies retrieved at “Klinikum Stuttgart” between 2006–2012
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4273170&req=5

Figure 21: Characteristics of the foreign bodies retrieved at “Klinikum Stuttgart” between 2006–2012
Mentions: The majority of foreign bodies in the tracheobronchial system is characterized and correctly diagnosed by the triad of sudden coughing or choking, auscultatory wheezing and unilaterally attenuated breath sounds [16]. Thus, collecting a good history from the parents is of particular importance. However, the history is not typical in all cases [26] or the aspiration may have been unobserved. Therefore, in up to 15% of the cases [38] it leads to persistent foreign bodies, which are then correctly diagnosed by bronchopulmonary complications after several days. In addition to auscultation, the chest X-ray is part of the low-threshold primary diagnosis. Most foreign bodies, however, are food related and are not radio-opaque. Of the 106 retrieved foreign bodies in our clinic in the period from 2006 to 2012, only 22 were of a material that was primarily radiologically detectable. Nuts, seeds and carrot pieces in this series were most frequently aspirated (Figure 21 (Fig. 21)). The indications for tracheobronchoscopy should therefore not be too tight. Thorough diagnosis and adequate clinician experience kept the rate of endoscopic interventions without foreign body detection within tolerable limits. Hence in the series mentioned, we detected 106 foreign bodies whereas in only 43 cases we could not prove one.

Bottom Line: Endoscopic treatment is possible in selected patients, but open reconstruction is superior in more severe cases.Tracheostomy is not a safe airway in early infancy, it's indication should be strict.Infectious diseases can be managed conservatively by a pediatrician in the majority of cases.

View Article: PubMed Central - HTML - PubMed

Affiliation: Klinikum Stuttgart, Klinik für Hals-, Nasen-, Ohrenkrankheiten, Plastische Operationen, Stuttgart, Germany.

ABSTRACT
Pathologies in the larynx and trachea in the pediatric age can be characterized in 4 main groups: airway stenosis, acute infections, benign neoplasia and foreign body aspiration. In this review main diagnostic strategies and therapeutic options are presented. Laryngomalazia is the most frequent condition of supraglottic stenosis. The term supraglottoplasty summarizes all different techniques used for it's repair using an endoscopic approach. Glottic stenosis is rare in children. Usually a compromise between voice preservation and airway restoration has to be sought. Type of reconstruction and timing are varying considerably in individual cases, endoscopic approaches should be preferred. Subglottic stenosis remains the largest group in paediatric airway pathology, with cicatrial stenosis being predominant. Today, cricotracheal resection is the most successful treatment option, followed by the classical laryngotracheal reconstruction with autologous cartilage. In early infancy subglottic stenosis is particularly demanding. Endoscopic treatment is possible in selected patients, but open reconstruction is superior in more severe cases. Tracheostomy is not a safe airway in early infancy, it's indication should be strict. Foreign body aspiration needs to be managed according to a clear algorhythm. Recurrent respiratory papillomatosis should be treated with emphasis on function preservation. The role of adjuvant medication remains unclear. Infectious diseases can be managed conservatively by a pediatrician in the majority of cases.

No MeSH data available.


Related in: MedlinePlus