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La-Anyane OM, Whitney NB, Harmon KA, Karas AF, Jeffe JS, Tragos C. Tracheostomy, the Not So Definitive Airway?: Tracheostomy Morbidity in Pediatric Craniofacial Patients. J Craniofac Surg 2023; 34:2413-2416. [PMID: 37639682 DOI: 10.1097/scs.0000000000009627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 06/03/2023] [Indexed: 08/31/2023] Open
Abstract
BACKGROUND Tracheostomy is the definitive treatment for airway management in severe cases of craniofacial-associated upper airway obstruction, like the Pierre-Robin sequence, but is associated with significant morbidity. The purpose of this study was to examine tracheostomy-associated morbidities and mortalities in craniofacial patients to identify opportunities to improve clinical care and patient prognosis. METHODS The study was a retrospective review of pediatric craniofacial patients who were tracheostomized between 2016 and 2022. Data regarding their demographics, craniofacial diagnoses, endoscopic airway anomalies, intubation grade of view classification, tracheostomy-related complications, and causes of mortality were analyzed. RESULTS Sixteen of the 17 tracheostomized pediatric patients had the Pierre-Robin sequence, with 5 of those patients having an additional syndromic craniofacial diagnosis. Additional airway anomalies were found in 82.4% of the patients. The mean length of hospital stay after tracheostomy was 4.08 months. Infection was the most common complication, observed in 94.1% of patients, followed by stomal granulation in 76.5% of patients. Two mortalities were observed: one following the compassionate removal of ventilator support and the other following the accidental dislodgment of the tracheostomy tube. CONCLUSIONS Tracheostomy-related complications were observed in all craniofacial patients in this group. Compared with the general pediatric population, tracheostomized craniofacial patients may endure longer hospital stays and greater stomal granulation rates. Mandibular distraction osteogenesis may allow for tracheostomy avoidance in these patients, and future research should focus on comparing the long-term complication rates and outcomes between tracheostomy mandibular distraction osteogenesis in this challenging patient population.
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Affiliation(s)
- Okensama M La-Anyane
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Rush University Medical Center, Chicago, IL
| | - Natalia B Whitney
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Rush University Medical Center, Chicago, IL
| | - Kelly A Harmon
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Rush University Medical Center, Chicago, IL
| | - Anatoli F Karas
- Department of Otorhinolaryngology, Rush University Medical Center, Chicago, IL
| | - Jill S Jeffe
- Department of Otorhinolaryngology, Rush University Medical Center, Chicago, IL
- Department of Otolaryngology, University of Utah, Primary Children's Hospital, Salt Lake City, UT
| | - Christina Tragos
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Rush University Medical Center, Chicago, IL
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Kiener A, Anderson A, Thomas A. Congenital Bronchial Stenosis Presenting as Neonatal Respiratory Distress: A Case Report. J Emerg Med 2019; 58:e83-e86. [PMID: 31744704 DOI: 10.1016/j.jemermed.2019.10.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2019] [Revised: 09/21/2019] [Accepted: 10/13/2019] [Indexed: 11/19/2022]
Abstract
BACKGROUND Neonatal respiratory distress has a broad differential that includes cardiac, pulmonary, anatomic, and infectious etiologies. Congenital stenotic lesions of the trachea and bronchus are rare and can occur anywhere along the tracheobronchial tree. Patients with tracheobronchial stenosis typically present in the neonatal period with respiratory distress. CASE REPORT We present a case of a 10-day-old term female who presented to the emergency department (ED) with tachypnea and increased work of breathing. She was found to have congenital bronchial stenosis of her right mainstem bronchus. She was stabilized in the ED and remained in the neonatal intensive care unit until successful slide tracheoplasty was performed. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Congenital bronchial stenosis is a rare etiology of respiratory distress in a neonate. Anatomic lower airway abnormalities are an important cause of neonatal tachypnea and must remain on the differential. In addition to respiratory stabilization with noninvasive or invasive support, evaluation should be directed at determining the location and anatomic characteristics of the area of stenosis.
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Affiliation(s)
- Alexander Kiener
- Department of Pediatrics, University of Washington School of Medicine, Seattle Children's Hospital, Seattle, Washington
| | - Andrea Anderson
- Division of Emergency Medicine, Department of Pediatrics, University of Washington School of Medicine, Seattle Children's Hospital, Seattle, Washington
| | - Anita Thomas
- Division of Emergency Medicine, Department of Pediatrics, University of Washington School of Medicine, Seattle Children's Hospital, Seattle, Washington
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Fiberoptic Bronchoscopic Balloon Dilatation of Bronchial Stenosis in Children. J Bronchology Interv Pulmonol 2019; 26:260-264. [PMID: 30829897 DOI: 10.1097/lbr.0000000000000581] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Bronchial stenosis and treatment with balloon dilatation are rarely experienced in children. The aim of this study was to investigate the results of fiberoptic bronchoscopic balloon dilatation (BBD) in children. METHODS Between January 2016 and March 2018, 7 children diagnosed as having bronchial stenosis and who underwent BBD as the first treatment option were enrolled in the study. RESULTS A total of 10 BBDs were performed in 7 patients with a median age of 10 months. Underlying causes were as follows: prolonged intubation and prematurity in 4 patients, extubation failure in 2 patients, and recurrent pneumonia and malignancy in 1 patient. The only complication was laceration, seen in 2 patients. The patients were symptom free for 11 months. CONCLUSION BBD is safe, effective, and might be the first-line treatment option for children with bronchial stenosis.
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Yokoi A. Congenital tracheal stenosis: what should we look at for successful tracheoplasty? Transl Pediatr 2018; 7:229-232. [PMID: 30159250 PMCID: PMC6087833 DOI: 10.21037/tp.2018.07.01] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
- Akiko Yokoi
- Department of Pediatric Surgery, Kobe Children's Hospital, Kobe, Japan
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Barnard BW, Du Plessis AM, Goussard P, Pitcher RD. Infantile intrathoracic large airway obstruction in a setting with a high prevalence of tuberculosis/HIV. Paediatr Int Child Health 2018; 38:106-112. [PMID: 29355460 DOI: 10.1080/20469047.2017.1422883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Background There has been no detailed analysis of the cause of intrathoracic large airway obstruction in infants in a resource-limited environment with a high prevalence of pulmonary tuberculosis (PTB) and human immunodeficiency virus (HIV). Aim To define the aetiology and severity of intrathoracic large airway obstruction in infants in a tertiary South African hospital with a high prevalence of PTB and HIV. Methods A retrospective study of infants was conducted with computerised tomography (CT) evidence of intrathoracic large airway obstruction from 1 January 2011 to 31 May 2014. CT scans were evaluated for the cause, site and severity of airway narrowing, with severity stratified as 'mild' (<50%), 'moderate' (51-75%) or 'severe' (>75%). Results Forty-four patients (28 males, 64%; median age 145 days, range 5-331), and 79 sites of attenuation were included. Vascular (22/44, 50%) and nodal (18/44, 41%) compressions accounted for over 90% of cases. Thirty-five patients (79.5%) had at least one site of moderate/severe attenuation, and 26 (59%) had multiple such sites. Adenopathy was the commonest cause of moderate/severe compression (18/35, 51%). All cases of nodal compression were of tuberculous origin. HIV-serology was recorded in 32 patients (73%), one of whom, with vascular compression, was HIV-infected. Half of the patients (11/22, 50%) with vascular compression had congenital abnormalities, most commonly cardiac anomalies (7/22, 32%). There were no synchronous vascular and nodal compressions. Conclusion Infantile intrathoracic large airway obstruction where there is a high prevalence of PTB and HIV is characterised by its extrinsic aetiology, severity and multicentricity, with more than half of all moderate/severe obstructions being caused by tuberculous adenopathy.
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Affiliation(s)
- Benjamin Wybrand Barnard
- a Division of Radiodiagnosis, Department of Medical Imaging and Clinical Oncology, Faculty of Medicine and Health Sciences , Stellenbosch University , Cape Town , South Africa
| | - Anne-Marie Du Plessis
- a Division of Radiodiagnosis, Department of Medical Imaging and Clinical Oncology, Faculty of Medicine and Health Sciences , Stellenbosch University , Cape Town , South Africa
| | - Pierre Goussard
- b Division of Pulmonology, Department of Paediatrics, Faculty of Medicine and Health Sciences , Stellenbosch University , Cape Town , South Africa
| | - Richard Denys Pitcher
- a Division of Radiodiagnosis, Department of Medical Imaging and Clinical Oncology, Faculty of Medicine and Health Sciences , Stellenbosch University , Cape Town , South Africa
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Schweiger T, Hoetzenecker K, Prosch H, Hackl M, Oszvath B, Lang G, Klepetko W. Progressive Stenosis of Both Main Bronchi Associated With Recurrent Infections of a Carinal Pouch. Ann Thorac Surg 2017; 105:e1-e3. [PMID: 29233352 DOI: 10.1016/j.athoracsur.2017.07.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2017] [Revised: 07/08/2017] [Accepted: 07/14/2017] [Indexed: 11/18/2022]
Abstract
A 55-year-old woman was referred to our department with a bilateral stenosis of both main bronchi starting at the level of the carina and a blind-ended pouch originating from the carina. Differential diagnosis of diffuse narrowing of the intrathoracic central airways was excluded during the diagnostic workup. Recurrent infection of the blind-ended pouch remained a possible explanation of this unusual type of stenosis. Carinal resection and reconstruction by end-to-end anastomosis of the trachea to the right main bronchus and reimplantation of the left main bronchus to the intermediate bronchus with intraoperative extracorporeal membrane oxygen support resulted in an excellent long-term outcome.
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Affiliation(s)
- Thomas Schweiger
- Division of Thoracic Surgery, Medical University of Vienna, Vienna, Austria
| | | | - Helmut Prosch
- Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Martin Hackl
- Department of Pneumonology, Landeskrankenhaus Natters, Natters, Austria
| | - Berta Oszvath
- Division of Thoracic Surgery, Medical University of Vienna, Vienna, Austria
| | - György Lang
- Division of Thoracic Surgery, Medical University of Vienna, Vienna, Austria
| | - Walter Klepetko
- Division of Thoracic Surgery, Medical University of Vienna, Vienna, Austria.
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Traibi A, Seguin-Givelet A, Grigoroiu M, Brian E, Gossot D. Congenital bronchial atresia in adults: thoracoscopic resection. J Vis Surg 2017; 3:174. [PMID: 29302450 DOI: 10.21037/jovs.2017.10.15] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2017] [Accepted: 10/17/2017] [Indexed: 11/06/2022]
Abstract
Congenital bronchial atresia (CBA) is a rare congenital malformation consisting in an interruption of a lobar or-more frequently-of a segmental bronchus. It leads to mucus impaction and hyperinflation of the obstructed lung segment. It causes infectious complications and, in the long term, destruction of the adjacent lung parenchyma. Thus, a surgical resection is usually indicated, even in asymptomatic patients.
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Affiliation(s)
- Akram Traibi
- Thoracic Department, Curie-Montsouris Thorax Institute, Institut Mutualiste Montsouris, Paris, France
| | - Agathe Seguin-Givelet
- Thoracic Department, Curie-Montsouris Thorax Institute, Institut Mutualiste Montsouris, Paris, France.,Paris 13 University, Sorbonne Paris Cité, Faculty of Medicine SMBH, Bobigny, France
| | - Madalina Grigoroiu
- Thoracic Department, Curie-Montsouris Thorax Institute, Institut Mutualiste Montsouris, Paris, France
| | - Emmanuel Brian
- Thoracic Department, Curie-Montsouris Thorax Institute, Institut Mutualiste Montsouris, Paris, France
| | - Dominique Gossot
- Thoracic Department, Curie-Montsouris Thorax Institute, Institut Mutualiste Montsouris, Paris, France
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Guo HC, Ren CW, Dai J, Lai YQ. Surgical Treatment of Double Outlet Right Ventricle with Absent Pulmonary Valve and Bronchiarctia. Chin Med J (Engl) 2017; 130:881-882. [PMID: 28345557 PMCID: PMC5381327 DOI: 10.4103/0366-6999.202740] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Affiliation(s)
- Hong-Chang Guo
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China
| | - Chang-Wei Ren
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China
| | - Jiang Dai
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China
| | - Yong-Qiang Lai
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China
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9
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Schweiger C, Cohen AP, Rutter MJ. Tracheal and bronchial stenoses and other obstructive conditions. J Thorac Dis 2016; 8:3369-3378. [PMID: 28066618 DOI: 10.21037/jtd.2016.11.74] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Although tracheal stenosis and bronchial stenosis are relatively rare in the pediatric population, they are both associated with significant morbidity and mortality. While most cases of congenital tracheal stenosis in children present as complete tracheal rings (CTRs), other congenital tracheal obstructions are also encountered in clinical practice. In addition, acquired obstructive tracheal conditions stemming from endotracheal trauma or previous surgical interventions may occur. Many affected children also have associated cardiovascular malformations, further complicating their management. Optimal management of children with tracheal or bronchial stenoses requires comprehensive diagnostic evaluation and optimization prior to surgery. Slide tracheoplasty has been the operative intervention of choice in the treatment of the majority of these children.
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Affiliation(s)
- Claudia Schweiger
- Division of Pediatric Otolaryngology-Head and Neck Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Aliza P Cohen
- Division of Pediatric Otolaryngology-Head and Neck Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Michael J Rutter
- Division of Pediatric Otolaryngology-Head and Neck Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA; ; Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, OH, USA
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10
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Sauvat F, Michel JL, Harper L, Mirabile L, Hoi RW, Ramful D, Bey K, Schlossmacher P, Couloignier V, Revillon Y. Successful management of congenital bronchial stenosis using an expandable stent. J Pediatr Surg 2012; 47:e1-4. [PMID: 22244429 DOI: 10.1016/j.jpedsurg.2011.09.066] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2011] [Revised: 08/05/2011] [Accepted: 09/25/2011] [Indexed: 10/14/2022]
Abstract
Congenital bronchial stenosis is a very rare cause of neonatal dyspnea. Surgical management remains challenging in small children. We report successful implantation of a bronchial stent in a 3-month-old female infant presenting with congenital right bronchial stenosis and 18 months of follow-up. Use of stents in children remains controversial because of the problem of size mismatch as the child grows. Nevertheless, expandable stent implantation could be an interesting alternative to complex surgery for localized bronchial stenosis in neonates.
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Affiliation(s)
- Frederique Sauvat
- Department of Pediatric Surgery, CHR Felix Guyon, 97405 St Denis, Reunion Island.
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Zribi H, Brian E, Lenoir S, Validire P, Gossot D. [Congenital bronchial atresia in adults]. Rev Mal Respir 2011; 28:672-6. [PMID: 21645840 DOI: 10.1016/j.rmr.2010.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2010] [Accepted: 12/18/2010] [Indexed: 11/19/2022]
Abstract
Congenital bronchial atresia is a rare congenital obliteration of a segmental or lobar bronchus resulting in distension of the corresponding parenchyma. It is seldom diagnosed in the adult. It may lead to infectious complications and, in the long term, to damage to the adjacent lung parenchyma. A surgical resection is necessary and it can be achieved by thoracoscopy. We report a recent series of six patients.
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Affiliation(s)
- H Zribi
- Département Thoracique, Institut Mutualiste Montsouris, 42 Boulevard Jourdan, 75014 Paris, France
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12
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Chen IC, Wu JR, Lu CY, Tseng CM, Hsu JH, Dai ZK. Focal stenosis in right upper lobe bronchus in a recurrently wheezing child sequentially studied by multidetector-row spiral computed tomography and scintigraphy. Kaohsiung J Med Sci 2009; 25:680-4. [PMID: 19951855 DOI: 10.1016/s1607-551x(09)70575-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Lower respiratory tract infections associated with wheezing are not uncommon in infants and young children. Among the wheezing-associated disorders, allergic etiologies are more commonly encountered than anatomic anomalies. We present a 3-year-old girl with a sudden attack of asthmatic symptoms including dyspnea, cyanosis and diffuse wheezing Based on a history of choking, and atelectasis in the right upper lobe detected by chest films, flexible tracheobronchoscopy was arranged and incidentally detected a stenotic orifice in the right upper lobe bronchus. Multidetector-row spiral computed tomography and pulmonary scintigraphy subsequently also disclosed the focal stenosis. She suffered from recurrent wheezing, pneumonia and lung atelectasis during 1 year of follow-up. We emphasize the diagnosis, clinical course and management of focal stenosis in the right upper lobe bronchus.
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Affiliation(s)
- I-Chen Chen
- Division of Pediatric Cardiology and Pulmonology, Department of Pediatrics, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
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