Obstruction of the larynx may cause death at any age. There are, however, a number of relatively unique obstructive entities that are found predominantly within the paediatric age group. Retrospective review of the autopsy files at the ACH was undertaken over a thirty year period (1962 -91) to characterise more clearly the range and clinicopathological presentations of these conditions, as well as the mechanisms by which laryngeal obstruction may be caused. Less than 1 % of fatal episodes involved laryngeal obstruction. The two most common causes of airway occlusion were acute epiglottitis (when cultured, most often due to Haemophilis influenzae infection), and foreign body inhalation. Children who had died unexpectedly from acute epiglottitis often had only a several hour history of a mild non-specific febrile illness reported. Foreign bodies impacted at the glottis included vegetables and a single case with a wood screw. Congenital malformations of the upper aerodigestive tract with mandibular hypoplasia, in the form of Pierre-Robin, Treacher-Collins and Goldenhar syndromes, occasionally resulted in acute respiratory obstruction and death from compression of the epiglottis by posterior displacement of the tongue. Similar backward displacement of the epiglottis occurred in an infant with a large lingual thyroglossal duct cyst. Congenital deformities of the epiglottis and laryngeal hypoplasia also predisposed to upper airway obstruction. A single case of an extensive cystic hygroma involving the epiglottis and aryepiglottic folds resulted in airway obstruction in a 7 month old infant, and a 1 year old child with treated neuroblastoma and Pseudomonas sp. septicaemia died from airway obstruction due to spontaneous interstitial haemorrhage around the laryngeal inlet. These cases demonstrate a wide range of disorders capable of causing sudden death in the paediatric age group due to obstruction of the larynx. In a number of these patients antemortem symptoms and signs were either absent, or were relatively minor and nonspecific, and so history was of no assistance in directing the autopsy examination. All levels of the upper airway should be carefully examined in cases of paediatric sudden death. Obstruction of the larynx may cause death at any age. There are, however, a number of relatively unique obstructive entities that are found predominantly within the paediatric age group. Retrospective review of the autopsy files at the ACH was undertaken over a thirty year period (1962 -91) to characterise more clearly the range and clinicopathological presentations of these conditions, as well as the mechanisms by which laryngeal obstruction may be caused. Less than 1 % of fatal episodes involved laryngeal obstruction. The two most common causes of airway occlusion were acute epiglottitis (when cultured, most often due to Haemophilis influenzae infection), and foreign body inhalation. Children who had died unexpectedly from acute epiglottitis often had only a several hour history of a mild non-specific febrile illness reported. Foreign bodies impacted at the glottis included vegetables and a single case with a wood screw. Congenital malformations of the upper aerodigestive tract with mandibular hypoplasia, in the form of Pierre-Robin, Treacher-Collins and Goldenhar syndromes, occasionally resulted in acute respiratory obstruction and death from compression of the epiglottis by posterior displacement of the tongue. Similar backward displacement of the epiglottis occurred in an infant with a large lingual thyroglossal duct cyst. Congenital deformities of the epiglottis and laryngeal hypoplasia also predisposed to upper airway obstruction. A single case of an extensive cystic hygroma involving the epiglottis and aryepiglottic folds resulted in airway obstruction in a 7 month old infant, and a 1 year old child with treated neuroblastoma and Pseudomonas sp. septicaemia died from airway obstruction due to spontaneous interstitial haemorrhage around the laryngeal inlet. These cases demonstrate a wide range of disorders capable of causing sudden death in the paediatric age group due to obstruction of the larynx. In a number of these patients antemortem symptoms and signs were either absent, or were relatively minor and nonspecific, and so history was of no assistance in directing the autopsy examination. All levels of the upper airway should be carefully examined in cases of paediatric sudden death.
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Mar 1, 2009
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