Neonatal Airway Abnormalities

Abstract

Neonatal airway abnormalities are commonly encountered by the neonatologist, general pediatrician, maternal fetal medicine specialist, and otolaryngologist. This review article discusses common and rare anomalies that may be encountered, along with discussion of embryology, workup, and treatment. This article aims to provide a broad overview of neonatal airway anomalies to arm those caring for these children with a broad differential diagnosis and basic knowledge of how to manage basic and complex presentations.

Keywords: airway obstruction; congenital neck mass; larynx; neonate; respiratory tract; surgery; trachea.

Figure 1

Laryngoscopy image showing significant laryngomalacia. Note the curled appearance of the airway with obstruction of the glottis. The image on right demonstrates the same patient immediately after supraglottoplasty.

Figure 2

Flexible endoscopy image showing a unilateral vocal cord paralysis. The right vocal fold is abducted while the left is fixed in place.

Figure 3

Severe subglottic stenosis.

Figure 4

(A) Laryngoscopy image demonstrating large subglottic hemangioma obstructing a significant portion of subglottic airway. (B) This image demonstrates a more proximal view of the same patient’s airway showing improved subglottic patency after endoscopic treatment. Note the concomitant hypopharyngeal hemangioma.

Figure 5

(A) Bronchoscopic images of an infant with severe tracheomalacia. (B) Bronchoscopic image of the distal trachea in an infant with severe TBM including a distal tracheoesopheal fistula.

Figure 6

(A) CT reconstruction images of a patient with Treacher Collins syndrome. (B) CT reconstruction image of a patient with Treacher Collins syndrome. Note the maxillary and mandibular hypoplasia and micrognathia. This patient had bilateral microtia.

Figure 7

Sleep endoscopy image demonstrating tongue-base obstruction. Note the tongue base in contact with the epiglottis, which is prolapsed over the airway.

Figure 8

Infant with massive cervical teratoma. Infant was delivered via EXIT procedure with immediate mass resection following intubation while on maternal circulation.

Figure 9

(A) CT image showing a narrow pyriform aperture (B) CT image showing central megaincisor.

Figure 10

Posterior nasal endoscopy in a patient with severe choanal stenosis. Note the narrow choanal opening, with the septum to the right in this image.