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Journal of Oral Pathology & Medicine :... Nov 2022Vascular anomalies are rare lesions of diverse nature that may affect the head and neck region. Any mass in or around the upper airway has the potential to obstruct or... (Review)
Review
Vascular anomalies are rare lesions of diverse nature that may affect the head and neck region. Any mass in or around the upper airway has the potential to obstruct or compromise it. The absolute priority, before etiologic treatment, is the evaluation of the risk for the airway and its management. Prenatal diagnosis of an upper airway obstruction requires a planned delivery in a center having a specialized team experienced in managing a compromised feto-neonatal airway, and who could perform an ex-utero intrapartum treatment to secure the airway. Even after birth, the airway remains central in the patient's overall management. Signs and symptoms of airway compromise must be evaluated keeping in mind the specific requirements of infants and small children and being aware that rapid worsening may occur. The treatment is then tailored to the patient and his lesion with the goal of improving symptoms while avoiding treatment-related complications. Maintaining reasonable expectations by the patient and families are part of a successful management. Cure is achievable for small and localized lesions, but symptom relief and mitigation of functional, esthetic and psychological impairments is the goal for large and complex lesions. If a tracheotomy was required, decannulation is one of the primary management goals.
Topics: Child; Female; Humans; Infant; Infant, Newborn; Pregnancy; Airway Obstruction; Esthetics, Dental; Laryngostenosis; Prenatal Diagnosis; Tracheotomy; Vascular Malformations
PubMed: 35347777
DOI: 10.1111/jop.13297 -
Paediatric Anaesthesia Mar 2020Infants and children undergoing craniofacial surgery may present with a wide range of diseases and conditions posing an array of challenges to the anesthesiologist.... (Review)
Review
Infants and children undergoing craniofacial surgery may present with a wide range of diseases and conditions posing an array of challenges to the anesthesiologist. Optimal perioperative care requires an understanding of these diseases and their impact on airway and anesthetic management. For those children with anomalies affecting airway anatomy, soft tissues of the head and neck, or skeletal mobility, advanced airway management techniques (ie, modalities other than direct laryngoscopy) may be required to secure the airway. Additionally, some craniofacial surgical procedures have direct implications on airway management, such as with Le Fort III midface advancement involving halo distractor application, where the distractor device precludes facemask ventilation. For all of these patients, the anesthetic and airway management plans must be tailored to the surgery being performed, the patient's specific conditions, and take into consideration all phases of perioperative care. In this review, we present some of the more commonly encountered craniofacial abnormalities affecting airway management.
Topics: Airway Management; Airway Obstruction; Child; Child, Preschool; Craniofacial Abnormalities; Humans; Infant
PubMed: 31837242
DOI: 10.1111/pan.13790 -
Archivos de Bronconeumologia Aug 2014The most common causes of non-malignant central airway obstruction are post-intubation and post-tracheostomytracheal stenosis, followed by the presence of foreign... (Review)
Review
The most common causes of non-malignant central airway obstruction are post-intubation and post-tracheostomytracheal stenosis, followed by the presence of foreign bodies, benign endobronchial tumours and tracheobronchomalacia. Other causes, such as infectious processes or systemic diseases, are less frequent. Despite the existence of numerous classification systems, a consensus has not been reached on the use of any one of them in particular. A better understanding of the pathophysiology of this entity has allowed us to improve diagnosis and treatment. For the correct diagnosis of nonspecific clinical symptoms, pulmonary function tests, radiological studies and, more importantly, bronchoscopy must be performed. Treatment must be multidisciplinary and tailored to each patient, and will require surgery or endoscopic intervention using thermoablative and mechanical techniques.
Topics: Airway Obstruction; Bronchial Diseases; Bronchial Neoplasms; Bronchoscopy; Constriction, Pathologic; Foreign Bodies; Humans; Intubation, Intratracheal; Lung Transplantation; Postoperative Complications; Severity of Illness Index; Tomography, X-Ray Computed; Trachea; Tracheal Diseases; Tracheobronchomalacia; Tracheostomy
PubMed: 24703501
DOI: 10.1016/j.arbres.2013.12.012 -
Paediatric Respiratory Reviews Mar 2016Stridor is a variably pitched respiratory sound, caused by abnormal air passage during breathing and often is the most prominent sign of upper airway obstruction. It is... (Review)
Review
Stridor is a variably pitched respiratory sound, caused by abnormal air passage during breathing and often is the most prominent sign of upper airway obstruction. It is usually heard on inspiration (typically resulting from supraglottic or glottic obstruction) but also can occur on expiration (originating from obstruction at or below glottic level and/or severe upper airway obstruction). Stridor due to congenital anomalies may exist from birth or may develop within days, weeks or months. Various congenital and acquired disorders prevail in neonates, infants, children, and adolescents, and have to be distinguished. History, age of the child and physical examination together often allow a presumptive diagnosis. Further investigations may be necessary to establish a definite diagnosis, and flexible airway endoscopy is the diagnostic procedure of choice in most circumstances ("stridor is visible").
Topics: Airway Obstruction; Bronchoscopy; Humans; Respiratory Sounds
PubMed: 26707546
DOI: 10.1016/j.prrv.2015.10.003 -
Indian Journal of Pediatrics Aug 2015Children with upper airway obstruction are both unique and variable in their presentation and management, often posing a challenge to the pediatrician. Several... (Review)
Review
Children with upper airway obstruction are both unique and variable in their presentation and management, often posing a challenge to the pediatrician. Several anatomical and physiologic peculiarities make a child vulnerable to develop an obstruction of upper airways. The characteristic finding in upper airway obstruction is stridor-inspiratory, biphasic or expiratory. The etiologies vary widely throughout the age groups and according to the mode of presentation. The approach starts with suspicion, mandates careful clinical evaluation of the degree of obstruction and many a times emergency measures precede any investigation or even precise diagnosis. Maintaining an open and stable airway is of the utmost importance, often requiring a team approach of emergency physician, pediatrician, otorhinolaryngologist and pediatric pulmonologist. The commonest condition presenting with upper airway obstruction in pediatric population is viral croup. Croup is a clinical diagnosis in a febrile child, with barking cough and stridor preceded by upper respiratory infection. It is treated with systemic or inhaled steroids and nebulized epinephrine. Epiglottitis and bacterial tracheitis are acute bacterial infections of upper airways, presenting as true airway emergencies. Though the mainstay of therapy is IV antibiotics, the prime concern is maintenance of airway, which frequently requires endotracheal intubation. Rigid bronchoscopy is the procedure of choice for airway foreign bodies, a common cause of upper airway obstruction in children below 3 y of age. Airway malacias are the commonest cause of chronic stridor and are mostly managed conservatively.
Topics: Airway Obstruction; Bronchoscopy; Child; Child, Preschool; Humans
PubMed: 26104110
DOI: 10.1007/s12098-015-1811-6 -
JAMA Otolaryngology-- Head & Neck... May 2020
Topics: Airway Obstruction; Humans; Nose
PubMed: 32215617
DOI: 10.1001/jamaoto.2020.0165 -
South African Medical Journal =... Oct 2022Congenital high airway obstruction syndrome (CHAOS) is a rare condition that can be diagnosed antenatally by ultrasound. It is usually lethal without immediate...
Congenital high airway obstruction syndrome (CHAOS) is a rare condition that can be diagnosed antenatally by ultrasound. It is usually lethal without immediate intervention at delivery. A 24-year-old woman was diagnosed with fetal CHAOS at 27 weeks' gestation. The couple declined termination of pregnancy. A multidisciplinary team including obstetricians, geneticists, paediatric surgeons, neonatologists and anaesthetists was constituted to plan an ex utero intrapartum treatment (EXIT) procedure. After several simulations, a caesarean section was performed at 38 weeks' gestation under deep inhalational anaesthesia. The fetus was fully delivered with placenta remaining in utero to maintain perfusion. A surgical airway was established via tracheostomy in approximately 5 minutes. The operation was then completed with no maternal complications. The child remains well at 3 years of age. To our knowledge, this is the first EXIT procedure performed for CHAOS in the public sector. This procedure can be lifesaving and is possible with proper planning.
Topics: Child; Humans; Pregnancy; Female; Young Adult; Adult; Fetal Diseases; Cesarean Section; South Africa; Airway Obstruction; Tracheostomy
PubMed: 36472335
DOI: 10.7196/SAMJ.2022.v112i10.16471 -
Current Opinion in Pulmonary Medicine May 2016Patients with lung cancer often develop endobronchial disease, endobronchial tumor extension or airway compression. Various nonmalignant diseases can also lead to severe... (Review)
Review
PURPOSE OF REVIEW
Patients with lung cancer often develop endobronchial disease, endobronchial tumor extension or airway compression. Various nonmalignant diseases can also lead to severe central airway obstruction.Since the early 1980s, technical advances of interventional bronchoscopic techniques have improved symptom-free survival and quality of life for patients with lung cancer. Apart from other techniques, various airway stents have been developed. Although interventional procedures are not definitive therapies, they often relieve the strangling sensation produced by airway occlusion. There have been various new developments and the authors review the available current literature on endobronchial stents
RECENT FINDINGS
For patients with respiratory symptoms because of malignant airway obstruction, stent placement provides symptom palliation and improved quality of life.
SUMMARY
Various options for central airway obstruction are in development and will change our daily work. In particular, coated stents have a large potential in minimizing stent complications.
Topics: Airway Obstruction; Animals; Bronchoscopy; Humans; Lung Neoplasms; Palliative Care; Quality of Life; Stents
PubMed: 26907718
DOI: 10.1097/MCP.0000000000000266 -
Revue Des Maladies Respiratoires May 2022In the overwhelming majority of cases, Airway stents offer relief of malignant or benign central airway obstruction. In some non-tumoral situations, they can be... (Review)
Review
In the overwhelming majority of cases, Airway stents offer relief of malignant or benign central airway obstruction. In some non-tumoral situations, they can be curative, providing a bridge to local or systemic treatments in the context of malignant obstruction. The efficacy and tolerance of these medical devices have dramatically improved over the past three decades with the development of silicone airway stents and, more recently, of third-generation, covered, self-expandable metallic stents with an increasingly widened panel of shapes. We review herein the main categories of airway stents with their specific indications, pitfalls, and advantages, not only in neoplastic situations, but also in the treatment of benign stenoses of the respiratory tract. The recent advances and perspectives in the field are also taken into consideration, particularly the development of biodegradable, drug-eluting, and patient-specific customized AS.
Topics: Airway Obstruction; Bronchoscopy; Humans; Respiratory System; Silicones; Stents; Treatment Outcome
PubMed: 35305856
DOI: 10.1016/j.rmr.2022.02.059 -
Otolaryngologic Clinics of North America Feb 2018Infantile hemangiomas (IHs) of the airway are far less common than their cutaneous counterparts, and their symptoms mimic those of viral croup. As a result, by the time... (Review)
Review
Infantile hemangiomas (IHs) of the airway are far less common than their cutaneous counterparts, and their symptoms mimic those of viral croup. As a result, by the time these lesions are diagnosed, they are often advanced and causing airway compromise. Fortunately, the evolution of propranolol as an effective and safe pharmacotherapy has simplified management of IH and reduced the likelihood of complications previously seen with steroid therapy and surgery. Nevertheless, the otolaryngologist must be prepared with an alternate plan to manage lesions refractory to pharmacotherapy. This article reviews the clinical presentation and current management of IHs of the airway.
Topics: Airway Obstruction; Hemangioma; Humans; Infant; Laser Therapy; Propranolol; Respiratory Tract Neoplasms; Thoracic Surgical Procedures; Treatment Outcome
PubMed: 29217058
DOI: 10.1016/j.otc.2017.09.001