Chapter 202 : Evaluation & Management of the Pediatric Airway Flashcards
noisy breathing from vibration of tissues above the level of the larynx
Stertor
structures which cause stertor
“NNOSH”
Nose
Nasopharynx
Oropharynx
Hypopharynx
Supraglottis
hallmark of any laryngeal obstruction and can be described as a high pitched, musical, or harsh sound often mistaken for “wheezing.”
stridor
LEVEL OF OBSTRUCTION of inspiratory stridor
glottis
LEVEL OF OBSTRUCTION of biphasic stridor
at or below the level of the glottis, in the subglottis and upper trachea
LEVEL OF OBSTRUCTION of expiratory stridor
lesions in the distal trachea or mainstem bronchi
most common cause of stridor
laryngomalacia
profile of infants with laryngomalacia
term males with a normal birth weight
population at higher risk for laryngomalacia
Premature Hispanic infants and black infants of all gestational ages
type of noisy breathing in laryngomalacia
intermittent inspiratory stridor within the first 2 weeks of life, which resolves slowly over several months high-pitched, but compared with the stridor of vocal cord paralysis, it is rela- tively low in pitch and does not have a musical quality.
what happens to the stridor of MILD laryngomalacia when the patient cries?
often improves with crying, as tone in the pharynx is increased
what happens to the stridor of MOD TO SEVERE laryngomalacia when the patient cries?
stridor typically will worsen with crying because of the increased airflow through the severely collapsed larynx
median time to spontaneous resolution
7-9 months ***majority will have no stridor by 18 months)
neurologic disorder that may be associated with laryngomalacia
cerebral palsy
cause of inspiratory stridor of LM (4 key points)
collapse of the supraglottic larynx, which creates a narrow airway and turbulent airflow related to neuromuscular hypotonia
What is the laryngeal adductor reflex (LAR)?
vagal nerve-mediated reflex activated by sensory stimulation of the mechanoreceptors and chemoreceptors of the superior laryngeal nerve located in the region of the aryepiglottic fold
endoscopic finding often associated with LM
omega- shaped epiglottis (NOTE: can also be found in otherwise normal infants with no airway obstruction)
high prevalance of this laryngeal co-morbidity in LM
gastroesophageal reflux disease (GERD)
FEES finding in severe LM
laryn- geal penetration in 88% of infants and aspiration beyond the vocal folds in 72% of infants.
anatomic abnormalities that lead to supraglottic obstruction in laryngomalacia
(1) anterior prolapse of the mucosa overlying the arytenoid cartilages (57%) (2) short aryepiglottic folds that tether the epiglottis posteriorly (15%) (3) posterior collapse of the epiglottis (12%), (4) or some combination of these findings (15%)
current standard treatment for LM
supraglottoplasty (aryepiglottoplasty)
condition presenting with inspiratory or biphasic stridor with a high-pitched musical quality
Vocal fold paralysis (VFP)
causes of VFP in a newborn
1) birth trauma or forceps delivery 2) thoracic diseases or procedures 3) central or peripheral 4) neurologic diseases 5) idiopathic causes.
Iatrogenic left VFP is a known complication of this particular thoracic surgery. Associated sign?
patent ductus arteriosus ligation or repair of an interrupted aortic arch, which may be associated with difficulty weaning the infant off ventilator support
Which recurrent laryngeal nerve is susceptible to injury and where?
The left recurrent laryngeal nerve is susceptible to injury at the point that it passes around the ductus arteriosus, unless a right aortic arch is present.
Stertere is the Latin translation of:
Stertor
True/False: Stertor can be heard below the supraglottic
FALSE
Biphasic stridor is at the level of the:
Glottis, sublottic
Expiratory stridor is at the level of the:
Distal trachea
Inspiratory stridor is at the level of the:
Glottis
Dynamic flexible laryngoscopy is best done in an ____ patient
Awake
Most common cause of infantile stridor:
Laryngomalacia
True/False: most cases of stridor secondary to laryngomalacia will self-resolve by 18 months
TRUE
Classic description of laryngomalacia on endoscopy:
Omega-shaped
Stridor associated with vocal fold paralysis in neonates
High-pitched, inspiratory/biphasic
Laryngomalacia and vocal fold paralysis is best diagnosed by:
Fiberoptic flexible laryngoscopy
Disorder presenting with high-pitched episodic stridor
Paradoxic vocal fold motion
Chromosome anomaly associated with laryngeal webs
Chromosome 22q11.2
Subglottic stenosis defintion in newborns
Cricoid diameter < 3.5 mm
Most commonly used classification system for Laryngeal-Laryngotracheoesophageal clefts
Benjamin-Inglis
