Michael J Rutter1, J Paul Willging, Robin T Cotton. 1. Division of Pediatric Otolaryngology/Head & Neck Surgery, Cincinnati Children's Hospital Medical Center, OH 45229-3039, USA. mike.rutter@cchmc.org
Abstract
BACKGROUND: Children with complete tracheal rings are often challenging to manage. Most children will present early with a severely compromised airway and will require tracheal reconstruction. OBJECTIVE: To show that a small number of minimally symptomatic patients with complete tracheal rings experience airway growth over time and do not require tracheoplasty. DESIGN: A retrospective medical chart review over a 10-year period. SETTING: A tertiary care pediatric hospital. PATIENTS: Children (N = 10) with a diagnosis of complete tracheal rings, confirmed on bronchoscopy, who were observed for a minimum of 1 year prior to determining the need for tracheoplasty. MAIN OUTCOME MEASURES: Patient symptoms, bronchoscopic findings, airway size, and the progression of these over time. Other congenital anomalies, the reason for initial diagnosis, and the need for tracheoplasty were documented. RESULTS: The 10 patients in our series fell into the following 3 categories: 5 patients were minimally symptomatic or asymptomatic, showed bronchoscopic evidence of progressive airway growth, and did not require tracheoplasty; 2 patients had worsening symptoms of exercise intolerance, showed minimal airway growth, and ultimately required tracheoplasty; and 3 patients are still being clinically observed and may eventually require tracheoplasty. Periods of observation have varied from 1 year to over 12 years. CONCLUSIONS: Not all patients with complete tracheal rings require tracheoplasty. Some have satisfactory airway growth and do not require airway reconstruction. A period of observation to monitor airway growth and clinical symptoms is safe and may spare some patients from undergoing unwarranted airway reconstruction.
BACKGROUND:Children with complete tracheal rings are often challenging to manage. Most children will present early with a severely compromised airway and will require tracheal reconstruction. OBJECTIVE: To show that a small number of minimally symptomatic patients with complete tracheal rings experience airway growth over time and do not require tracheoplasty. DESIGN: A retrospective medical chart review over a 10-year period. SETTING: A tertiary care pediatric hospital. PATIENTS: Children (N = 10) with a diagnosis of complete tracheal rings, confirmed on bronchoscopy, who were observed for a minimum of 1 year prior to determining the need for tracheoplasty. MAIN OUTCOME MEASURES: Patient symptoms, bronchoscopic findings, airway size, and the progression of these over time. Other congenital anomalies, the reason for initial diagnosis, and the need for tracheoplasty were documented. RESULTS: The 10 patients in our series fell into the following 3 categories: 5 patients were minimally symptomatic or asymptomatic, showed bronchoscopic evidence of progressive airway growth, and did not require tracheoplasty; 2 patients had worsening symptoms of exercise intolerance, showed minimal airway growth, and ultimately required tracheoplasty; and 3 patients are still being clinically observed and may eventually require tracheoplasty. Periods of observation have varied from 1 year to over 12 years. CONCLUSIONS: Not all patients with complete tracheal rings require tracheoplasty. Some have satisfactory airway growth and do not require airway reconstruction. A period of observation to monitor airway growth and clinical symptoms is safe and may spare some patients from undergoing unwarranted airway reconstruction.
Authors: P Herrera; C Caldarone; V Forte; P Campisi; H Holtby; P Chait; P Chiu; P Cox; S-J Yoo; D Manson; P C W Kim Journal: Pediatr Surg Int Date: 2007-08-22 Impact factor: 1.827
Authors: Shin-Shiou Lin; Bing-Hsiean Tzeng; Kuan-Rong Lee; Richard J H Smith; Kevin P Campbell; Chien-Chang Chen Journal: Proc Natl Acad Sci U S A Date: 2014-04-28 Impact factor: 11.205