Slide cricotracheoplasty in an infant (original) (raw)
Related papers
Fetal cricotracheal manipulation: effects on airway healing, cricoid growth and lung development
Pediatric Surgery International, 2003
The last decade has seen significant advance in the surgical management of pediatric subglottic stenosis, which remains one of the most fascinating problems of the laryngotracheal complex (LTC). Refined techniques for operating on these fragile structures should reduce cricotracheal scarring to a minimum, thus avoiding a lot of severe postoperative complications in a tricky moment of laryngeal's growing up. Experimental works indicates that the LTC growth is variously affected by longitudinal anterior, posterior or lateral incisions and actually the indications for laringotracheoplasty or cricotracheal resection in children with subglottic stenosis are still unclear. Reports on fetal manipulation of cricotracheal tissues are lacking as well as early effects on airway healing, LTC growth and lung development. The aim of this study was to evaluate if the airway mucosal healing is regenerative and scarless after cricotracheal manipulation in fetuses of New Zealand White Rabbits (NZWRFs). The consequences of fetal incisions on the cricoid growth and lung development are also examined, in a group of 12 NZWRFs, manipulated at 25±1 days of gestational age. The does underwent halothane anesthesia and all received a bilateral longitudinal cricoidotracheotomy. Twenty sham-operated fetuses were submitted to a limited cervicotomy (control's group). At the time of retrieval (31±0.5 days), en bloc laryngotracheobronchial tree and lungs were collected and processed for histological and morphometric analysis. Parameters recorded included: 1)histological full-thicknes examinations focusing on inflammation, foreign body reaction, fibrosis, neochondrogenesis; 2)morphometric analysis, including the fetal Subglottic Diameter (FSD), the fetal Subglottic Area (FSA), the Radial Alveolar Count (rAC) and Computer Assisted Morphometric Colorimetry (CAmc); 3)analysis of lung hypoplasia (LH) by means of lung weight/body weight (LW/BW) ratio, protein and DNA indexes; 4)finally, different fractions of lung tissue phospholipids for lung maturity assessment were studied. Student's t test, when indicated, was performed for statistical analysis (p <0.05 = significant). There was no maternal mortality in this study. Ten fetuses were available for a final evaluation (16.6% mortality). In one case only, an incomplete closure of the fetal cricoidotomy was seen and could be probably due to a technical mistake. Mean fetal subglottic diameter and area were respectively 0.13±0.05 mm and 3.15±0.45 mm2 in both groups. As well as in fetal dermal repair, regeneration of the airway cartilage and mucosa were complete and scarless. LW/BW ratio, DNA content and analysis of different fractions of phospholipids were similar in experimental vs. the control group. These findings suggest that the healing processes were fibrosis-free and without evidence of scars. A complete closure of the incisions was achieved without stenosis of the fetal subglottic region. In addition, it seems that the fetal cricoidotracheotomy doesn't interfere with the laryngeal function which coordinate the amount of liquid leaving the lungs via the trachea. In addition, only a small leakage of amniotic fluid is shown and this could be responsible for normal and mature lungs. Keywords Fetal surgery AE Subglottic stenosis AE Airway healing AE Cricoid growth AE Lung development
Anesthesia & Analgesia, 2009
BACKGROUND: Sellick described cricoid pressure (CP) as pinching the esophagus between the cricoid ring and the cervical spine. A recent report noted that with the application of CP, the esophagus moved laterally more than 90% of the time, questioning the efficacy of this maneuver. We designed this study to accurately define the anatomy of the Sellick maneuver and to investigate its efficacy. METHODS: Twenty-four nonsedated adult volunteers underwent neck magnetic resonance imaging with and without CP. Measurements were made of the postcricoid hypopharynx, airway compression, and lateral displacement of the cricoid ring during the application of CP. The relevant anatomy was reviewed. RESULTS: The hypopharynx, not the esophagus, is what lies behind the cricoid ring and is compressed by CP. The distal hypopharynx, the portion of the alimentary canal at the cricoid level, was fixed with respect to the cricoid ring and not mobile. With CP, the mean anterioposterior diameter of the hypopharynx was reduced by 35% and the lumen likely obliterated, and this compression was maintained even when the cricoid ring was lateral to the vertebral body. CONCLUSIONS: The location and movement of the esophagus is irrelevant to the efficiency of the Sellick's maneuver (CP) in regard to prevention of gastric regurgitation into the pharynx. The hypopharynx and cricoid ring move together as an anatomic unit. This relationship is essential to the efficacy and reliability of Sellick's maneuver. The magnetic resonance images show that compression of the alimentary tract occurs with midline and lateral displacement of the cricoid cartilage relative to the underlying vertebral body.
The Cleft Palate-Craniofacial Journal, 2006
Objective A large excrescence was found bulging from the mucoperiosteum of the nasopharynx in a neonate displaying abnormal craniofacial features. The aim of this study was to determine the nature of this tissue mass. Design Histological examination of this mass of tissue and the surrounding nasopharyngeal mucosal tissue, as well as tissue located in the sella turcica of the sphenoid bone, were carried out. In addition, tissue in a canal connecting the large mass to the sella turcica was removed for analysis. Results Nervous elements and adenohypophyseal tissue were histologically identified in the large excrescence, but were separate from adenohypophyseal tissue of the pharyngeal hypophysis. Both structures were located in the mucoperiosteum of the nasopharynx. Conclusions The large tissue mass found in the nasopharynx is histologically identical to a sellar hypophyseal gland, but differed from the adjacent pharyngeal hypophysis in histological composition. The mass, although sella...
Condylar hypoplasia: Clinical case
2021
The formation of the face and the stomatognathic system is complex in nature and involves the development of multiple tissue processes that...
Hypoplasia of the lung in the newborn
The Indian Journal of Pediatrics, 1973
Hypoplasia of the lung denotes underdevelopment of the alveolar tissue with a normal bronchial, tree; it may be unilateral, lobar, segmental or rarely bilateral. The condition may be primary or secondary (Levine and Mascia 1966). Primary hypoplasia of the lung is a rare condition and is more often seen on the left side. It is associated with other defects such as cardiac and skeletal abnormalities, agenesis of kidneys and Potter's syndrome (Levine and Mascia 1966). Secondary hypoplasia of the lung is the term applied to subnormal lung volume which may result from any condition causing reduced capacity of the thoracic cage or reduced space for pulmonary growth in early foetal life. Thus it occurs in nearly all cases of congenital diaphragmatic hernia and hydrothorax, and in most of sketetal anomalies like achondroplasia, osteogenesis imperfecta, cardiomegaly, intrathoracic cysts, bronchial stenosis, compression bv an anomalous pulmonary artery and anencephaly. Polycystic kidneys may diminish the thoracic space but there is no correlation between the
Cricoid ring: Shape, size, and variability in infants and children
Saudi journal of anaesthesia
Knowledge regarding the shape, size, and variability of the cricoid ring is important to properly choose the correct endotracheal tube (ETT) in the pediatric patient. Studies have measured the size of the cricoid ring using methodologies such as moulages, magnetic resonance imaging, and video-bronchoscopy. In the present study, computed tomography (CT) -based images were used to determine the shape, size, and configuration of the cricoid ring in the pediatric population taking into considerations growth and development. This is a retrospective review using 130 CT images of children ranging in age from 1 month to 10 years undergoing radiological evaluation unrelated to airway symptomatology. The CT scans were obtained in spontaneously breathing patients during either natural sleep or procedural sedation. Anteroposterior (AP) and transverse (T) diameters were measured at the cricoid ring using these images. The cricoid ring is generally round in children older than 1 year with a T/AP ...
Cricopharyngeal incoordination in infancy
Pediatric Surgery International, 1988
Cricopharyngeal incoordination in newborns and infants is a polyetiological condition. From 1973 to 1986, 13 patients with defective swallowing mechanisms were seen at our hospital. The patients were divided into two groups. The first group, consisting of 8 patients with transient cricopharyngeal incoordination due to immaturity and birth trauma, did not require surgical intervention. The second group, composed of 5 patients with permanent incoordination, required surgical treatment. Cricopharyngeal achalasia and familial autonomic dysfunction (Riley-Day syndrome) were the most frequent causes in this group. We thought it wise to simplify feedings by using a gastrostomy, which we also used for retrograde dilatation. Permanent cricopharyngeal incoordination may be treated by dilatation or myotomy. Familial dysautonomia required additional surgical procedures, depending on the associated upper gastrointestinal disorder. Indications for myotomy of the cricopharyngeal muscle in infancy have not been clarified to date. Dilatation may improve the passage of food through the upper esophagus, but if this procedure fails, myotomy is indicated.
Partial cricotracheal resection in children weighing less than 10 kilograms
Otolaryngology - Head and Neck Surgery, 2010
To assess the long-term outcome, safety, and efficacy of partial cricotracheal resection (PCTR) for subglottic stenosis in a group of children and infants weighing less than 10 kg at the time of the surgery. STUDY DESIGN: Historical cohort study. SETTING: Academic tertiary medical center. SUBJECTS AND METHODS: Thirty-six children weighing less than 10 kg at the time of the surgery were compared to a group of 65 children who weighed more than 10 kg. The Kaplan Meier method and Cox regression were carried out to detect differences in decannulation time and rates and to examine the influence of various parameters (i.e., comorbidities, type of surgery, and complications requiring revision surgery) at the time of decannulation. Evaluation of the long-term outcome was based on questionnaires assessing breathing, voice, and swallowing. RESULTS: Decannulation rate was 92 percent (33/36) for the group of children weighing less than 10 kg. No significant differences were found between the two body weight groups with respect to the aforementioned covariates. The median follow-up period was nine years (range, 1-23 yrs). Questionnaire responses revealed completely normal breathing and swallowing in 72 percent and 90 percent of the children, respectively. Seventy-one percent of the patients considered their voice to be rough or weak. CONCLUSION: PCTR in infants and children weighing less than 10 kg is a safe and efficient technique with similar long-term results when compared to results seen in older and heavier children.