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Clinical experience in airway endoscopy in children: an emphasis on the comparison between flexible and rigid
1Department of Otolaryngology-Head and Neck Surgery, National Taiwan University Hospital, Taipei, R.O.C.
Insights
Pediatric airway endoscopy effectively diagnoses and treats congenital and acquired lesions. Flexible endoscopy is preferred for routine diagnosis, while rigid endoscopy aids complex cases and interventions.
Area of Science:
- Pediatric Otolaryngology
- Pediatric Pulmonology
- Pediatric Endoscopy
Background:
- Pediatric airway lesions present complex diagnostic and management challenges.
- Early diagnosis and intervention are crucial for reducing morbidity and preventing adverse outcomes in infants and children.
- Endoscopic procedures provide direct access for diagnosing and treating airway abnormalities.
Purpose of the Study:
- To evaluate the utility and outcomes of flexible and rigid endoscopic procedures in pediatric airway management.
- To identify common pediatric airway lesions and indications for endoscopic intervention.
- To assess the safety and complication rates associated with pediatric airway endoscopy.
Main Methods:
- A retrospective review of 509 endoscopic procedures (292 flexible, 217 rigid) performed on 296 pediatric patients between April 1994 and May 1997.
- Flexible endoscopy was the primary tool for routine diagnosis, examining the entire upper airway to the tracheobronchial tree.
- Rigid endoscopy was utilized when flexible endoscopy was insufficient or surgical manipulation was required.
Main Results:
- Common indications included stridor, respiratory distress, feeding difficulties, hoarseness, and suspected foreign bodies.
- The most frequent diagnoses were laryngomalacia, subglottic stenosis, tracheobronchomalacia, and airway foreign bodies.
- Approximately 20% of patients had multiple concurrent airway lesions. No major complications occurred with flexible endoscopy, while two major complications arose from rigid endoscopy.
Conclusions:
- Flexible endoscopy is a safe and effective primary diagnostic tool for pediatric airway lesions.
- Rigid endoscopy is valuable for specific indications and interventions, though associated with a higher risk of major complications.
- Comprehensive endoscopic evaluation is essential for managing complex pediatric airway conditions, often involving multiple synchronous lesions.
Abstract:
Congenital and acquired lesions of the pediatric airway frequently pose perplexing problems in children, infants and newborns. Prompt investigation into the etiology and early intervention are essential to decrease the morbidity and to prevent some tragic events. Endoscopy grants access to the lesion sites for either diagnostic or therapeutic purposes. From April 1994 to May 1997, totally 509 endoscopic procedures, including 292 flexible and 217 rigid endoscopic procedures were performed in 296 pediatric patients at National Taiwan University Hospital. For routine diagnostic procedures, the flexible fiberscope is the instrument of choice which should include a detailed examination of entire upper airway, as farther to tracheobronchi as possible. When flexible endoscopy fails to demonstrate the exact airway lesion or certain surgical manipulation is demanded, rigid endoscopy is favored. The indications for endoscopy were: stridor, respiratory distress, follow-up endoscopy or tracheostoma evaluation, feeding difficulty, hoarseness or weak voice, and suspicious airway foreign body. Common airway problems in serial orders were: laryngomalacia, subglottic stenosis, tracheo/bronchomalacia and airway foreign body. Nearly 20% of patients in this series had multiple synchronous airway lesions. There was no major complication in our 292 flexible endoscopic procedures. Two major complications attributed to endoscopic manipulations occurred in 217 rigid endoscopic procedures.