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Endoscopically placed nitinol stents for pediatric tracheal obstruction
Mukesh Prasad1, John P Bent, Robert F Ward
1Department of Otorhinolaryngology, Cornell University Medical Center, NYPH-WMCCU, 520 East 70th Street Starr Building, Suite 541, NY 10021, New York, USA. mukeshprasad@post.harvard.edu
International Journal of Pediatric Otorhinolaryngology
|October 24, 2002
Summary
Nitinol stents provide a temporary solution for pediatric tracheal obstruction, enabling successful decannulation in two children awaiting tracheal resection. This approach improves quality of life by removing the need for tracheotomy tubes.
Area of Science:
- Pediatric pulmonology
- Interventional pulmonology
- Biomaterials in medicine
Background:
- Tracheal obstruction in children often necessitates tracheotomy, impacting quality of life.
- Acquired tracheal stenosis and tracheomalacia present complex challenges for pediatric airway management.
- Tracheal resection is often delayed in pediatric patients due to the need for growth, necessitating temporizing solutions.
Observation:
- A case series involving two pediatric patients (ages 5 and 15) with severe tracheal obstruction and tracheotomy dependence.
- Both patients had complex airway issues including tracheomalacia and stenosis, unresponsive to previous surgical interventions.
- Endoscopic placement of nitinol stents was performed under fluoroscopic guidance to address extensive tracheal disease.
Findings:
- Successful decannulation was achieved in both patients immediately following nitinol stent placement.
- One patient required stent adjustment due to initial sizing issues, and another experienced distal migration necessitating replacement.
- Both patients remained decannulated at long-term follow-up (25 and 26 months), awaiting definitive tracheal resection.
Implications:
- Nitinol stents offer a safe and effective temporizing measure for pediatric tracheal obstruction, facilitating decannulation.
- This intervention significantly improves the quality of life for children by eliminating tracheotomy dependence.
- The findings provide valuable insights into stent selection and placement for pediatric interventional pulmonology, guiding future practice.