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Developmental changes of upper airway dimensions in children
Romain Luscan1,2, Nicolas Leboulanger1,2,3, Pierre Fayoux4
1Pediatric Otorhinolaryngology Department, APHP, Hôpital Universitaire Necker-Enfants-Malades, Paris, France.
Insights
Pediatric airway dimensions were mapped using CT scans, revealing three distinct growth phases from birth to adolescence. Age is the most significant factor influencing airway size, crucial for clinical decisions.
Area of Science:
- Pediatric radiology
- Anatomy
- Growth and development
Background:
- Accurate pediatric airway dimensions are vital for clinical practice.
- Current data on pediatric airway size is limited and imprecise.
- Informed airway management decisions rely on precise anatomical data.
Purpose of the Study:
- To determine the anatomical development and size of airway structures from birth to adolescence.
- To analyze airway development using high-resolution computed tomography (HRCT) scans.
- To correlate airway measurements with biometric data such as age and weight.
Main Methods:
- Retrospective analysis of HRCT scans of the respiratory tract in children aged 1 day to 14 years.
- Inclusion of 192 scans from a tertiary pediatric center.
- Performance of 23 airway measurements (larynx, trachea, mainstem bronchi) stratified by age groups, with correlation analysis against age and weight.
Main Results:
- Significant correlations were found between all airway measurements and both age and weight.
- Airway growth follows a cubic polynomial pattern with three distinct phases: rapid early growth, slow mid-growth, and adolescent acceleration.
- Age was the most relevant biometric parameter for 21 of the 23 airway measurements.
Conclusions:
- A comprehensive anatomical database of pediatric airway dimensions, especially the cricoid, has been established.
- Laryngeal, tracheal, and bronchial parameters exhibit three distinct growth phases correlated with age.
- This data enhances understanding of pediatric airway anatomy and supports clinical decision-making.
Background:
Knowledge about airway dimensions during child growth is of paramount importance for pediatric clinical practice. Decisions about airway management in children are based on relatively limited, imprecise, or incomplete data about airway size.
Aims:
The aim of this work was to determine the anatomical development and size of airway structures from birth to adolescence using high-resolution computed tomography scans and to study the correlation between airway measurements and biometric data.
Methods:
We conducted a retrospective study of all high-resolution computed tomography scans including the respiratory tract, performed in our tertiary pediatric center (for reasons unrelated to airway symptoms) between June 1, 2016, and October 15, 2017, on children aged from 1 day to 14 years old. On each scan, 23 measurements of the larynx, trachea, and mainstem bronchi were performed. Patients were stratified into 16 groups according to their age. We calculated median value for each measurement in each group. Statistical models were calculated to explore correlation between measurements and age or weight.
Results:
A total of 192 scans were included (127 boys/65 girls). The mean age was 7 years. The correlations between airway measurements and age or weight were always significant. The relationship between measurements and age was found to be suitably represented by a cubic polynomial equation suggesting that the airway has a rapid growth phase in the first 3 years, followed by a slow growth phase and a second rapid growth phase during adolescence. The most relevant biometric parameter was age concerning 21 of the measurements.
Conclusion:
This comprehensive anatomical database of upper airway dimensions provides important data in the field of pediatric airway anatomy, particularly relating to the cricoid. We demonstrated that laryngeal, tracheal, and bronchial parameters correlate better to age and have three different growth phases.
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