Pathologies of the larynx and trachea in childhood

Abstract

Pathologies in the larynx and trachea in the pediatric age can be characterized in 4 main groups: airway stenosis, acute infections, benign neoplasia and foreign body aspiration. In this review main diagnostic strategies and therapeutic options are presented. Laryngomalazia is the most frequent condition of supraglottic stenosis. The term supraglottoplasty summarizes all different techniques used for it's repair using an endoscopic approach. Glottic stenosis is rare in children. Usually a compromise between voice preservation and airway restoration has to be sought. Type of reconstruction and timing are varying considerably in individual cases, endoscopic approaches should be preferred. Subglottic stenosis remains the largest group in paediatric airway pathology, with cicatrial stenosis being predominant. Today, cricotracheal resection is the most successful treatment option, followed by the classical laryngotracheal reconstruction with autologous cartilage. In early infancy subglottic stenosis is particularly demanding. Endoscopic treatment is possible in selected patients, but open reconstruction is superior in more severe cases. Tracheostomy is not a safe airway in early infancy, it's indication should be strict. Foreign body aspiration needs to be managed according to a clear algorhythm. Recurrent respiratory papillomatosis should be treated with emphasis on function preservation. The role of adjuvant medication remains unclear. Infectious diseases can be managed conservatively by a pediatrician in the majority of cases.

Keywords: cricotracheal resection; laryngotracheal reconstruction; pediatric airway stenosis; pediatric subglottic stenosis.

Table 1. Classification scheme for laryngomalacia according to Olney

Figure 1. Laryngeal inlet stenosis through shortening of aryepiglottic folds and mucosal hyperplasia of the arytenoids

Figure 2. Laser surgical transection of the membranous widened aryepiglottic folds. Exposure with a Benjamin/Lindholm laryngoscope.

Figure 3. Same situs as in Fig. 1 after laser surgical intervention

Figure 4. Interarytenoid fibrosis, exposure with a vocal fold spreader in microlaryngoscopy

Figure 5. Bilateral temporary laterofixation after laser surgical seperation of an interarytenoid fibrosis

Figure 6. Glottic web in a 4-year-old male

Figure 7. Lasersurgical seperation

Figure 8. Temporary placeholder in the Lichtenberger technique

Figure 9. Laryngotracheal reconstruction with autogenous thyroid cartilage

(Illustration: courtesy of Sonja Burger)

Figure 10. Subglottic stenosis grade III in a 4-months-old female

Figure 11. Postoperative endoscopy 10 weeks after LTR-S

Figure 12. Complex glottic and subglottic stenosis after multiple interventions

Figure 13. Postoperative result after laryngotrachesl anterior and posterior reconstruction

Figure 14. Anterior laryngotracheal reconstruction

(Illustration: courtesy of Sonja Burger)

Figure 15. Posterior laryngotracheal reconstruction with laryngofissure-spreader

(Illustration: courtesy of Sonja Burger)

Figure 16. CTR: resection boarders

(Illustration: courtesy of Sonja Burger)

Figure 17. CTR: after removal of the stenosis, before anastomosis

(Illustration: courtesy of Sonja Burger)

Figure 18. CTR: thyrotracheal anastomosis

(Illustration: courtesy of Sonja Burger)

Figure 19. Subglottic stenosis grade III in a 5-year-old girl

Figure 20. Control endoscopy 6 weeks after CTR

Figure 21. Characteristics of the foreign bodies retrieved at “Klinikum Stuttgart” between 2006–2012

Figure 22. Fluctuating papilloma of the right vocal cord with subtotal laying of the glottis