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Magnetic resonance imaging determination of tracheal orientation in normal children. Practical implications
J M Reed1, D M O'Connor, C M Myer
1Children's Hospital Medical Center, Department of Pediatric Otolaryngology and Maxillofacial Surgery, Cincinnati, Ohio, USA.
Insights
This study provides normative anatomical data for the pediatric airway using MRI. The pediatric trachea has an anterior angulation, suggesting current tracheotomy tube designs may require modification.
Area of Science:
- Pediatric anatomy
- Medical imaging
- Upper airway research
Background:
- Establishing normative anatomical data for the pediatric upper airway is crucial for clinical practice.
- Previous studies have not fully characterized the three-dimensional anatomy and angulation of the pediatric trachea.
Observation:
- Magnetic resonance imaging (MRI) was used to study the trachea and surrounding structures in 100 children.
- Measurements included hyoid bone to sternal notch distance, skin to tracheal wall distance, and tracheal diameter.
- Tracheal angulation was measured relative to the vertical plane, revealing a significant anterior curve.
Findings:
- The pediatric trachea is not a linear structure, exhibiting an average anterior angulation of 9.9 degrees.
- The point of inflection varied with age, located below the sternal notch in younger children and above it in older children.
- Normative data for distances and diameters were established, with no significant gender differences.
Implications:
- The identified anterior angulation of the pediatric trachea suggests that current tracheotomy tube designs may not be optimal.
- Rigid tracheotomy tubes may lead to complications such as suprastomal collapse or innominate artery erosion.
- These findings necessitate a re-evaluation of pediatric airway management devices and surgical techniques.
Objective:
To determine normative anatomical data on the pediatric upper airway.
Design:
Anatomical study of the trachea and surrounding structures in vivo using magnetic resonance imaging. Three-dimensional positions of the hyoid bone, sternum, skin, and trachea were determined. Tracheal angulation was measured from the vertical plane.
Subjects:
One hundred children (53 males and 47 females) undergoing magnetic resonance imaging of the brain or chest.
Intervention:
None.
Results:
Ages ranged from 2 days to 20.4 years, with a median of 6.05 years. Gender differences were not significant. The mean distance from the hyoid bone to the sternal notch was 63.0 mm (SD, 22.04 mm). The skin to anterior tracheal wall distance averaged 9.34 mm (SD, 3.29 mm), and tracheal diameter averaged 8.48 mm (SD, 2.88 mm). The trachea was not found to be a linear structure. An anterior angulation change of 9.9 degrees (SD, 7.89 degrees) was detected. The point of inflection was found to lie below the sternal notch in children younger than 2 years and above the notch in older children.
Conclusions:
Normal anatomical data of the pediatric airway have been acquired using magnetic resonance imaging. Because the trachea exhibits a previously unknown anterior angulation, current design of tracheotomy tubes may not be ideal. Rigid tracheotomy tubes that do not conform to the anatomical structure of the trachea may be responsible for suprastomal collapse or innominate artery erosion.