Shigeru Ueno1, Akihiro Fujino2, Yasuhide Morikawa3, Tadashi Iwanaka4, Yoshiaki Kinoshita5, Michio Ozeki6, Shunsuke Nosaka7, Kentaro Matsuoka8, Noriaki Usui9. 1. Department of Pediatric Surgery, Tokai University School of Medicine, Shimokasuya 143, Isehara, Kanagawa, Japan. ps_uenos@is.icc.u-tokai.ac.jp. 2. Department of Pediatric Surgery, National Center for Child Health and Development, 2-10-1, Okura Setagaya-ku, Tokyo, Japan. 3. Department of Pediatric Surgery, International University of Health and Welfare, Iguchi 537-3, Nasushiobara, Tochigi, Japan. 4. Department of Pediatric Surgery, The University of Tokyo Faculty of Medicine, Hongo 7-3-1, Bunkyo-ku, Tokyo, Japan. 5. Department of Pediatric Surgery, Niigata University School of Medicine, 757 Ichibancho, Asahimachi-dori, Chuo Ward, Niigata, Japan. 6. Department of Pediatrics, Gifu University Hospital, 1-1, Yanagido, Gifu, Japan. 7. Department of Radiology, National Center for Child Health and Development, 2-10-1, Okura Setagaya-ku, Tokyo, Japan. 8. Department of Pathology, Dokkyo Medical University Koshigaya Hospital, 2-1-50, Minami-Koshigaya, Koshigaya, Saitama, Japan. 9. Department of Pediatric Surgery, Osaka Women's and Children's Hospital, 840, Murodocho, Izumi, Osaka, Japan.
Abstract
PURPOSE: Airway obstruction caused by lymphatic malformation (LM) in the head and neck may require a tracheostomy. We present the results of our analysis of a nationwide survey on the indications for tracheostomy in children with head and neck LM. METHODS: We analyzed data in relation to tracheostomy based on a questionnaire about 518 children with head and neck LM without mediastinal involvement. RESULTS: Tracheostomy was performed for 43 of the 518 children. Most (32/43) of these children were younger than 1 year of age and the tracheostomy was almost always performed for airway obstruction (40/43). The lesion was in contact with the airway in 32 (72%) of these children, but in only 58 (12%) of the 473 children who were managed without tracheostomy. When the maximum circumferential area of contact was compared, only 20 (27%) of 74 patients with maximum contact of less than a half-circle required tracheostomy, whereas 11 of 13 with maximum contact of more than a half-circle required tracheostomy (P = 0.0001). Six patients without airway contact required tracheostomy because of acute swelling caused by hemorrhage, infection, or both. CONCLUSIONS: Children with head and neck LM required tracheostomy to relieve airway obstruction. Tracheostomy should be considered if the lesion is in contact with the airway and surrounds more than a half-circle, and when it causes acute swelling.
PURPOSE:Airway obstruction caused by lymphatic malformation (LM) in the head and neck may require a tracheostomy. We present the results of our analysis of a nationwide survey on the indications for tracheostomy in children with head and neck LM. METHODS: We analyzed data in relation to tracheostomy based on a questionnaire about 518 children with head and neck LM without mediastinal involvement. RESULTS: Tracheostomy was performed for 43 of the 518 children. Most (32/43) of these children were younger than 1 year of age and the tracheostomy was almost always performed for airway obstruction (40/43). The lesion was in contact with the airway in 32 (72%) of these children, but in only 58 (12%) of the 473 children who were managed without tracheostomy. When the maximum circumferential area of contact was compared, only 20 (27%) of 74 patients with maximum contact of less than a half-circle required tracheostomy, whereas 11 of 13 with maximum contact of more than a half-circle required tracheostomy (P = 0.0001). Six patients without airway contact required tracheostomy because of acute swelling caused by hemorrhage, infection, or both. CONCLUSIONS:Children with head and neck LM required tracheostomy to relieve airway obstruction. Tracheostomy should be considered if the lesion is in contact with the airway and surrounds more than a half-circle, and when it causes acute swelling.
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