Related Experiment Videos
[Surgical treatment of tracheal obstruction in children]
1Assaf Harofeh Medical Center, Zrifin.
Insights
Surgical interventions safely and effectively treat tracheobronchial obstruction in infants and children. Procedures like anterior cricoid splitting and tracheal resection offer viable solutions for various airway issues.
Area of Science:
- Pediatric Surgery
- Thoracic Surgery
- Otolaryngology
Context:
- Tracheobronchial obstruction presents a significant challenge in pediatric care.
- Congenital and acquired conditions necessitate surgical intervention for airway patency.
Purpose:
- To report surgical outcomes for 47 infants and children with tracheobronchial obstruction.
- To evaluate the safety and efficacy of various surgical techniques for airway reconstruction.
Summary:
- The study details surgical management for diverse conditions including subglottic stenosis, tracheomalacia, and tracheal stenosis.
- Procedures employed ranged from anterior cricoid splitting and aortopexy to tracheal resection and cartilage grafting.
- No operative mortality was observed, with two unrelated deaths, highlighting the safety of surgical approaches.
Impact:
- Surgical management is a safe and effective strategy for relieving tracheobronchial obstruction in pediatric patients.
- This study provides valuable data on the success rates of different surgical interventions for complex airway problems.
Abstract:
47 infants and children with tracheobronchial obstruction requiring surgical treatment are reported. 10 had subglottic stenosis; 17 severe tracheomalacia; 19 intraluminal tracheal stenosis (in 2 of whom it was congenital); 12 granulation tissue or webs; 4 both tracheal stenosis and tracheal fistula; and 1 had a tear of the right main bronchus. The anterior cricoid splitting procedure for the management of severe acquired subglottic stenosis was performed in 10, in 2 of whom it failed and tracheostomy was required. Aortopexy was performed in 14 cases and pulmonary arteriopexy in 1. A rib cartilage graft and a prosthetic splint fabricated from Marlex mesh were applied in 2 cases after failed aortopexy. The 19 patients with tracheal stenosis were treated as follows: tracheal splitting with autologous free tibial periosteal graft was used in 2 infants; transbronchoscopic resection was successful in 12 children; wedge resection of the tracheal fistula and anterior anastomosis was done in 4; segmental tracheal resection with end-to-end anastomosis in 1; and suture of a bronchial tear was performed in 1. There was no operative mortality; 2 patients died; but the deaths were not directly related to surgery. In our experience, the surgical approach is both safe and expedient in relieving tracheal obstruction in most infants and children.