Cause Of Airway Obstruction Research Articles

Glandular hamartoma of the larynx: Report of a case

Glandular hamartoma is an extremely rare congenital malformation of the larynx. Presenting symptoms result from airways obstruction and may include slowly rising respiratory distress, stridor, changes in voice, eating and activity levels. Management consists in local mass excision with a good functional result and prognosis. Recurrences are usually associated with incomplete removal. We present a 3-month-old infant with a history of stridor and respiratory distress caused by a firm 0.4 cm wide and 1.4 cm long mass arising in the supraglottic region and detected with endoscopic approach. The lesion was excised endoscopically with an uneventful postoperative course and an excellent long-term prognosis. Histopathologically the lesion consisted of mature tissues with abnormal growth and disorganized architecture, chiefly composed of mature glandular structures, smooth muscular fibers, mature fat, surrounded by fibrous stroma and covered by typical squamous epithelium. The aim of our report is to underline how this condition must be considered by physicians, paediatricians and anaesthetists as an important cause of airway obstruction.

P035: Continuing Trends in Awake Tracheotomy Airway Intervention

P035: Continuing Trends in Awake Tracheotomy Airway Intervention

Pneumopathies récidivantes révélant une tumeur carcinoïde bronchique : à propos de deux observations

Carcinoid tumors are the most common endobronchial tumor in the pediatric population, and represent a rare cause of airway obstruction. The authors report two cases of boys aged 10 and 11 years old, who presented with a 12-month history of recurrent pneumonia. Bronchial endoscopy showed an endobronchial tumor. Chest CT-scan identified local extension and lung-associated lesions; octreoscan was performed to detect distant metastases. Histopathological study concluded in typical carcinoid tumor. The outcome after surgical conservative resection is uneventful with a follow-up of 7 and 26 months. Bronchial tumors must be considered in children with recurrent pneumonia or persistant respiratory symptoms, and require CT scan and bronchial endoscopy for their diagnosis.

Acquired paediatric subglottic cysts: A series from Manchester

Subglottic cysts (SGC) have long been regarded as a rare cause of airway obstruction but through increased awareness an increase in the number of cases of SGC has been reported. This paper describes the pathogenesis and management of SGC. Retrospective case series. Ethical approval not sought. Royal Manchester Children's Hospital. Two hundred and six new referrals for direct laryngotracheobronchoscopy (DLTB) were identified from records between September 2003 and September 2005. Age at birth, sex, length of intubation, presenting symptoms, age at presentation, DLTB findings, interventional procedures, and follow-up DLTBs. Fourteen out of 206 (6.8%) infants were diagnosed as with subglottic cysts. This represented the fourth most common cause of upper airway pathology. Thirteen out of 14 (93%) infants were preterm (26.8 weeks S.D. 25.3-28.3 weeks). All infants had been intubated ranging from 1 to 180 days (median 42 days). The onset of symptoms ranged from 1 to 13 months (median 4.25 months). Initially, 8/14 (57.2%) infants had SGC cysts marsupialised with microforceps. A further six cysts (50%) were decapped between 2 and 4 months and one between 6 and 12 months. The number of cases of SGC has been increasing over the last three decades and represents the fourth most common causes of airway obstruction in our series. There is a delay in onset of symptoms and high rate of recurrence in the first 4 months. It is therefore prudent to reschedule further endoscopic evaluation between 2 and 4 months and after 6 months should the clinical need arise.

Management Of Repeated Postextubation Laryngospasm: A Case Report

Laryngospasm is one of the common causes of airway obstruction in the postextubation period. Though definitive predisposing or causative factors can usually be identified, it is also known to occur without any apparent provocation.[1] Absence of a specific etiology makes treatment difficult in such cases. We describe our management of a patient who had repeated episodes of unanticipated postextubation laryngospasm. The various treatment options that can be used for this recurring condition are described.

Evaluation of the causes of Upper Airway Obstruction Leading to Tracheostomy in Shiraz

Introduction: To determine the causes of upper airway obstruction leading to tracheostomy; endoscopic evaluation was done in Khalili Hospital, Iran. Materials and Methods: During a 2 year period, 47 patients who underwent tracheostomy,were evaluated endoscopically to determine the causes of airway obstruction leading to tracheostomy. Results: forty-seven cases were included in the study including 40 males and 7 females with mean age of 31.9 years. The most common cause of obstruction was subglottic stenosis (40.5%) and laryngeal carcinoma (38.3%). The cause of subglottic stenosis in the majority of the patients was prolonged endotracheal intubations (95%). Other less common causes were direct laryngeal trauma (4.5%), vocal cord paralysis (2.1%), supraglottitis (2.1%), tracheal foreign bodies (2.1%), severe trismus (2.1%), and status asthmaticus (2.1%). Conclusions: Subglottic stenosis secondary to prolonged intubations is the major cause of upper airway obstruction leading to tracheostomy. Converting endotracheal intubations to tracheostomy in patients who need prolonged ventilator support may prevent subglottic stenosis and decrease the rate

Airway management after major trauma

The primary goal in the early management of the severely-injured patient is the provision of sufficient oxygen to the tissues to avoid organ failure and secondary central nervous system damage. The first priority is to establish and maintain a patent airway. With the addition of high-concentration oxygen and the presence of adequate tissue perfusion, this will enable sufficient spontaneous breathing or assisted ventilation to oxygenate the patient. The possibility of an unstable cervical injury exists in patients exposed to significant blunt trauma; during airway interventions, neck movement must be minimized to avoid secondary harm to the spinal cord. Depending on the series, 2–12% of major trauma victims have a cervical spine injury and 7–14% of these are unstable. Approximately 10% of comatose trauma patients have a cervical spine injury. Head injury with impaired consciousness and reduced pharyngeal tone is the commonest trauma-related cause of airway obstruction. The airway may also be soiled with blood or regurgitated matter. Blunt or penetrating injuries that obstruct the airway include maxillary, mandibular and laryngotracheal fractures, and large anterior neck haematomas. Significant partial and incipient airway obstruction are also potential causes of early death. Vigilant reassessment with immediate restoration and protection of airway patency is essential.

Stenting allows weaning and extubation in ventilator- or tracheostomy dependency secondary to benign airway disease

Central airway obstruction can cause severe respiratory insufficiency leading to mechanical ventilation (MV) or artificial airway (AA) dependency. Interventional bronchoscopic procedures have been reported to be of help in weaning patients with malignant airway stenoses from mechanical ventilation, whereas their use in benign disease is only anecdotal. The objectives of this study are to evaluate early, intermediate and long-term outcome of interventional bronchoscopy and stent placement in the treatment of MV/AA dependency due to benign airway obstruction. In a retrospective cohort analysis for the period 1999-2004, we evaluated 15 consecutive ICU patients with documented benign central airway obstruction, who were referred for bronchoscopic management of their condition after multiple failed attempts at weaning from MV or decannulation of the AA. Indications for bronchoscopic treatment were surgery refusal, medical or surgical inoperability, or absence of alternative treatment options. Malacia, post-intubation stenosis and goiter were the main causes of airway obstruction and MV/AA dependency. All patients were treated by means of rigid bronchoscopy, dilatation procedures and stent insertion. All but one patient (93.3%) were successfully and permanently extubated/decanulated immediately after the bronchoscopy. Minor complications occurred in 6 patients (40%) leading to a second intervention. All complications could be managed endoscopically and long-term follow up was uneventful. Interventional bronchoscopy with stent insertion can allow successful withdrawal from MV/AA and can offer longstanding airway patency in selected ventilator- or tracheostomy-dependant individuals with benign airway stenoses,when surgery in not feasable or contra-indicated.

Acute and chronic airway obstruction

Acute airway obstruction can occur in a child with a previously normal airway, or with the acute exacerbation of a chronic problem. The narrow diameter of the infant airway makes it particularly susceptible to obstruction. Early recognition of the airway at risk is vital as respiratory reserve is limited and deterioration can be very rapid. Assessment is largely clinical, based on history and examination. Listen for stridor, croupy cough, hoarse voice and wheeze. Look for signs of increased work of breathing and hypoxia or hypercarbia. Acute causes of airway obstruction are often infective, such as croup, epiglottitis, bacterial tracheitis and abcess. Other causes include laryngeal foreign body, trauma and thermal injury. In some cases nebulised epinephrine and steroids will improve symptoms and ‘buy time’ until experienced assistance arrives. Many causes of chronic airway obstruction are congenital, but subglottic trauma secondary to intubation can be a cause of stenosis. These infants may present as an emergency after an acute deterioration, but many require a general anaesthetic for planned investigation or airway surgery. Careful preoperative assessment is essential. It is easy to underestimate the degree of airway narrowing. Airway assessment in theatre requires examination during spontaneous respiration. Anaesthesia is usually maintained using inhalational agents with topical laryngeal anaesthesia. Commonly seen conditions include laryngomalacia, tracheomalacia, subglottic stenosis, laryngeal papillomas and cysts. Many are treated by resection or laser surgery, but tracheostomy may be needed to provide a safe airway.

Mucus in chronic airway diseases: sorting out the sticky details

Mucous hypersecretion is a major cause of airway obstruction in asthma, chronic obstructive pulmonary disease, and cystic fibrosis. EGFR ligands and IL-13 are known to stimulate mucous induction, but the detailed mechanisms of epithelial mucous regulation have not been well defined. In this issue of the JCI, Tyner et al. show, in a mouse model of chronic mucous hypersecretion, that ciliated epithelial cell apoptosis is inhibited by EGFR activation, allowing IL-13 to stimulate the differentiation of these cells into goblet cells, which secrete mucus. In defining this coordinated, 2-step process, we can consider the therapeutic effects of blocking mucous production. This begs the question, Is it possible to reduce airway obstruction in chronic lung disease by inhibiting EGFR activation and/or by inhibiting IL-13?

How competent are obstetric and gynaecology trainees in managing maternal cardiac arrests?

SummaryThe recent Confidential Enquiry (2000 – 2002) has emphasised ‘emergency drills for maternal resuscitation should be regularly practised in clinical areas in all maternity units’. It was therefore planned to assess the knowledge of airway management and ventilation among obstetrics and gynaecology trainees in the Yorkshire Deanery (Training Region). Questionnaires were given to trainees attending the Modular Training Programme and were collected on the same day. A total of 71 questionnaires were collected which represents 62% of the 113 trainees in Yorkshire region. Replies were received from 39 registrars, 27 Senior House Officers (SHO), four Senior SHOs (SSHO) and one clinical fellow. MRCOG Part 1 was passed by 52% and 36% of trainees had MRCOG Part 2. A total of 69% of trainees did not know that chin lift opens the airway in some 70 – 80% of patients; 50% of trainees were not aware why jaw thrust is preferred over chin lift; 76% of the trainees knew the most common cause of airway obstruction in a patient with an altered level of consciousness – the tongue falls back and obstructs the pharynx (‘swallowing the tongue’). Knowledge of the main cause of airway obstruction was good among obstetrics and gynaecology trainees, but their understanding of how to manage this was found to be relatively poor. Attendance at a local Basic Life Support course should be compulsory for obstetric and gynaecology trainees early in their career.

Postoperative management and complications at end-to-end anastomosis of the trachea

We report two cases of head and neck cancer invading the trachea. Tumor resection and end-toend anastomosis were performed at the same time. One case was a thyroid papillary carcinoma, and the other was metastasis of a paratracheal node that invaded the thyroid, trachea and esophagus. Both patients required long-term intubation because of obstruction of the airway due to laryngeal edema and a tracheostomy was necessary. We can infer from these cases that the causes of severe vocal edema were infection, history of radiotherapy and extensive resection. In addition, it is quite likely that one of the causes of airway obstruction was recurrent laryngeal nerve palsy. Long-term intubation may be considered a cause of laryngeal edema and recurrent nerve palsy. Because it is difficult to estimate the risk of vocal edema, and difficult to know how long intubation will be required, we have to carefully consider the complications related to such procedures.

An unusual cause of airway obstruction after guided insertion of the ProSeal LMA

An unusual cause of airway obstruction after guided insertion of the ProSeal LMA

Mandibular distraction osteogenesis for neonatal airway obstruction

Micrognathia as a cause for airway obstruction is a very difficult problem encountered in the neonate with craniofacial disorders. Recognition and treatment of obstruction is necessary to prevent significant morbidity. Mandibular distraction osteogenesis is an option in selected patients that prevents the need for tracheostomy.

Ectopic thyroid: A rare cause of tracheal obstruction

The endoluminal presence of thyroid tissue in the trachea is a rare cause of airway obstruction. Only 14 well documented cases of intratracheal ectopic thyroid tissue have been reported in English Literature since 1966. These lesions are mostly benign and nearly all patients present with symptoms of respiratory obstruction. We present a case of ectopic thyroid in cervical trachea presenting with symptoms of airway obstruction. Thorough clinical examination and investigations were carried out. A right hemithyroidectomy and excision of a part of the tracheal wall through a tracheotomy was performed for removal of the ectopic thyroid tissue from trachea. The clinicians & radiologists must be aware of this entity to avoid mistaking it for evidence of invasion by a malignant neoplas, and hence this report.

An unusual cause of airway obstruction

An unusual cause of airway obstruction

Pediatric laryngology committee: Controversies in the diagnosis and management of pediatric vocal cord paralysis

Pediatric vocal cord paralysis represents a relatively common cause of airway obstruction presenting to the pediatric otolaryngologist. Depending on whether the paralysis is unilateral or bilateral, the child may present with symptoms of stridor, vocal dysphonia or aphonia, and/or aspiration. A thorough search for a possible underlying disorder is critical. Exact timing of intervention and the method of intervention vary according to symptoms and remain controversial. This seminar will consist of talks from established pediatric otolaryngologists with a wide scope of experience with these disorders. Diagnostic evaluation including flexible fiberoptic evaluation of swallowing (FEES) as well as flexible digital stroboscopy will be discussed. Surgical treatment options including vocal fold injection, thyroplasty, laser cordotomy/arytenoidectomy, vocal fold pexy, posterior costal cartilage graft, and nerve reinervation procedures will be discussed as treatment options. Digital video will be used to demonstrate the various procedures. Timing of such interventions will be discussed as well as this remains a key controversy.

Defective endotracheal tube – cause of airway obstruction

Pediatric AnesthesiaVolume 13, Issue 8 p. 739-740 Defective endotracheal tube – cause of airway obstruction Anna Maria Onisei MD, Anna Maria Onisei MD Pediatric Anesthesia FellowSearch for more papers by this authorPersis Shroff MD, Persis Shroff MD Assistant ProfessorSearch for more papers by this authorTimothy W Martin MD, MBA, FAAP, Timothy W Martin MD, MBA, FAAP Associate Professor, Chief, Department of Pediatric Anesthesiology, University of Arkansas for Medical Sciences, Arkansas Children's Hospital Little Rock, AR, USA (Email: [email protected])Search for more papers by this author Anna Maria Onisei MD, Anna Maria Onisei MD Pediatric Anesthesia FellowSearch for more papers by this authorPersis Shroff MD, Persis Shroff MD Assistant ProfessorSearch for more papers by this authorTimothy W Martin MD, MBA, FAAP, Timothy W Martin MD, MBA, FAAP Associate Professor, Chief, Department of Pediatric Anesthesiology, University of Arkansas for Medical Sciences, Arkansas Children's Hospital Little Rock, AR, USA (Email: [email protected])Search for more papers by this author First published: 09 October 2003 https://doi.org/10.1046/j.1460-9592.2003.01105.xRead the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Volume13, Issue8October 2003Pages 739-740 RelatedInformation

Evaluation of upper airway lesions by virtual endoscopy

Objective: The utility of virtual endoscopy (VE) is compared to direct laryngoscopy and was also investigated with respect to accuracy of diagnosis and reproduction of images. Patients and methods: Twenty-one patients with various degrees of upper airway obstruction were examined by helical spiral CT axial images. The data was reconstructed using a VE software program. The cause of obstruction was identified and the results were compared to the direct endoscopic findings done by the otolaryngologists under G.A. Results: Virtual endoscopy evaluation of the upper airway was accurate in assessing stenosis width and length of fixed airway lesions. Correlation between direct laryngoscopy and VE was excellent with respect to the shape and contour of the stenotic segment. VE added little information in cases of laryngeal tumors and it could not illustrate any of the cases of impaired vocal fold mobility. Conclusion: Virtual endoscopy was excellent for the measurement and definition of the fixed airway lesions yet it was not as sensitive as actual endoscopy in detecting the cause of airway obstruction based on dynamic movement.

Retropharyngeal or cervicomediastinal haematomas following stellate ganglion block

Retropharyngeal or cervicomediastinal haematomas following stellate ganglion block