Flexible minibronchoscopy in children.

Flexible endoscopy is assuming a role of increasing importance in the evaluation and diagnosis of upper aerodigestive tract disorders. With improved fiberoptic capabilities and miniaturization, these techniques are gaining in applicability to the pediatric population. At Children's Hospital, Boston, a newly designed Machida 1.9-mm bronchoscope has been employed in the evaluation of the upper airway. The use of this small caliber instrument has been investigated in 1) evaluation of endotracheal or tracheotomy tube position, thus decreasing the need for repeated chest radiographs to confirm location; 2) bedside evaluation of possible tracheal disease (eg, mucous plug, granuloma, tracheitis) in the intensive care unit patient to determine treatment plans and/or need for further rigid bronchoscopy, and 3) evaluation of airway dynamics in the awake patient. Our experience with the flexible fiberoptic minibronchoscope is reviewed, with a discussion of indications for its use, as well as possible limitations. Case studies are presented to demonstrate the usefulness of the instrument.