Chapter 48 - chronic pediatric airway diseases Flashcards
2 most common causes of stridor in infant
laryngomalacia
unilateral VC paralysis (usually iatrogenic)
By what age do kids outgrow laryngomalacia?
18-24 mo
Most common tumor of infancy. And where are most found?
infantile hemangioma, H/N
Which types of HPV must be targeted by vaccines to decrease risk of RRP?
6, 11
When is stridor worse with laryngomalacia
feeding, supine, or agitated
Percentage of laryngomalacia pts that experience significant UA obstruction. What does this result in?
10%
feeding diff/FTT, pectus excavitum, apneic episodes, cyanosis, hypoxia
These pts warrant consideration for surgery
Relationship between GERD and laryngomalacia
GERD may contribute to airway edema and further compromise the airway
Acid suppression can improve mild cases of laryngomalacia
Size of term infant subglottic lumen
4.5-5.5mm
What does a 4.0 ETT mean?
inner diameter 4mm
Formula to choose ETT size…and which age group does this work in
inner diameter = 4 + age/4
More accurate for older children
Causes of congenital subglottic stenosis
elliptical cricoid congenital narrowing (Downs, trapped 1st tracheal ring)
Causes of acquired subglottic stenosis
ETT (duration, size) neck trauma laryngeal procedures caustic ingestion radiotherapy tracheal infection
Grading system for SGS
Myer-Cotton I- 0-50% obstruction II- 51-70% III- 71-99% IV- no detectable lumen
Ways to treat SGS
scar lysis with balloon dilation
augmentation (cartilage graft to make airway bigger)
resection (remove affected segment, reanastamose)
If mature, thick lesion, more superior to inferior dimension, may need more than balloon
Embryology of laryngeal cleft
TE septum forms caudal to cranial, cleft forms if incomplete development/fusion
Classification system of laryngeal cleft
Benjamin-Inglis
1- isolated to supraglottic interarytenoid region, above or at VC
2- extends to upper cricoid, not through lower cricoid
3- through inferior border cricoid, possibly into cervical trachea
4- into thoracic trachea, possibly to carina
Symptoms of laryngeal cleft based on grade
I-II: hoarse, stridor, chronic cough, lingering URI, recurrent pneumonia
III-IV: respiratory distress, aspiration, presents at birth
Most frequent operation leading to VC paralysis
PDA ligation –> left TVC paralysis
Others: TEF repair, esophageal atresia repair, also birth trauma, Chiari (b/l), neoplasm of CNS/neck/mediastinum
Name 4 syndromes associated with laryngeal cleft
Opitz-Frias
Pallister Hall
VACTERL
CHARGE
Opitz-Frias syndrome
craniofacial (cleft), GU abnl, midline airway abnl
Pallister-Hall syndrome
Congenital hypothalamic hamartoblastoma, hypopituitarism, polydactyly, imperforate anus, cardiac abnl, renal malformations
VACTERL
Vertebral, Anal atresia, Cardiac, TEF, Ear, Renal, Limb
Presentation and workup and prognosis of unilateral VC paralysis
stridor, weak cry, feeding difficult, possible asp.
Imaging course of RLN from SB to mediastinum
Barium swallow if feeding diff
70% resolve spontaneously within 6 mo age unless iatrogenic (35% recover by 16mo)
Treatment for severe sx of unilat VC paralysis
VC medialization to improvve speech/swallow
narrows airway at glottis though
