Tracheobronchial anomalies in syndromic craniosynostosis with 3-dimensional CT image and bronchoscopy

Patients with syndromic craniosynostosis have many problems involving the upper airway, laryngotracheal airway, and tracheobronchial tree. Evaluation of tracheobronchial disorders in syndromic craniosynostosis is very important for accurately diagnosing these problems. We have used three-dimensional computed tomography (CT) imaging of the tracheobronchial tree (three-dimensional tracheal CT imaging) since a multidetector CT was installed in our hospital in 2004. In this study, we assessed the configuration of the tracheobronchial system using three-dimensional tracheal CT imaging and bronchoscopy.During the period from 2004 to 2009, 48 patients with syndromic craniosynostosis underwent surgery at our hospital. Of those, 16 patients required tracheostomy. These syndromic craniosynostosis cases were examined with three-dimensional tracheal CT imaging and bronchoscopy. All CT scans were performed on a multidetector CT (120 kV, 22-120 mA, 0.5 s/slice, 1-mm slice; Aquilion; Toshiba Co, Tokyo, Japan) without respiratory suppression.All 16 study patients presented with severe stenosis of the upper airway on bronchoscopic examination. Seven were confirmed to have abnormalities by both bronchoscopy and three-dimensional tracheal CT imaging. Four were confirmed to have abnormalities on either bronchoscopy or three-dimensional tracheal CT imaging, whereas 5 patients were apparently free of abnormalities as determined by both modalities.In conclusion, it was possible to accurately assess the configuration of the tracheobronchial system using both three-dimensional tracheal CT imaging and bronchoscopy. Our results suggest these examinations to be very useful for assessing the optimal timing of decannulation and respiratory function prognosis.