Management of the Disrupted Airway in Children
Presented at the 2019 Society for Ear Nose and Throat Advancement in Children (SENTAC) Annual Meeting, San Diego, California, U.S.A., December 7–10, 2019.
This study was partially supported by the Ministry of Science and Technology (MOST) R.O.C., grants 106-2918-I-002 -020 and 108-2314-B-002-181-MY3; and by the National Taiwan University Hospital (NTUH), Taipei, Taiwan, grant 109-N03 (w-c.h.). m.j.r. is a consultant for Bryan Medical and Tracoe, a patent holder for a balloon dilator, and receives royalties from this product (Tracoe Aeris balloon dilator, Bryan Medical). The authors have no other funding, financial relationships, or conflicts of interest to disclose.
Abstract
Objective
Our objective was to gather data that would enable us to suggest more specific guidelines for the management of children with airway disruption.
Study Design
Retrospective case series with data from five tertiary medical centers.
Methods
Children younger than 18 years of age with a disrupted airway were enrolled in this series. Data pertaining to age, sex, etiology and location of the disruption, type of injury, previous surgery, presence of air extravasation, management, and outcome were obtained and summarized.
Results
Twenty children with a mean age of 4.4 years (range 1 day–14.75 years) were included in the study. All were evaluated by flexible endoscopy and/or microlaryngoscopy in the operating room. Twelve (60%) children had tracheal involvement; seven had bronchial involvement; and one had involvement of the cricoid cartilage. Nine children had air extravasation, and all these children required surgical repair. Of the 11 who did not have air extravasation, only one underwent surgical repair. Complete healing of the disrupted airway was seen in all cases.
Conclusion
This series suggests that if there is no continuous air extravasation demonstrated on imaging studies or clinical examination, nonoperative management may allow for spontaneous healing without sequelae. However, surgical repair may be considered in those patients with continuous air extravasation unless a cuffed tube can be placed distal to the site of injury. For children in whom airway injury occurs in a previously operated area, the risk of extravasation is reduced. This risk is also diminished if positive pressure ventilation can be avoided or minimized.
Level of Evidence
4 Laryngoscope, 131:921–924, 2021
