Pediatric Airway Anomalies

Feature Summary

Pediatric Airway Anomalies are challenging problems for patients, families and clinical team. In the past, most of these patients were sent to different hospitals with miserable outcomes because every single hospital is lack of experience in reconstructive surgery of the pediatric airway. For a long period, a dedicated team was established at our Institute. Taipei Veterans General Hospital Pediatric Tracheal Disorder Team includes different professionals, including pediatric surgeons, anaesthetists, intensive care specialists, neonatologists, pulmonologists, radiologists, and cardiovascular surgeons. The aim of this program was to provide these multidisciplinary patients, at any time, with intensive care, radiological investigations, diagnostic and intervention endoscopy, reconstructive surgery, ECMO or cardiopulmonary bypass.

 

Overview

Pediatric Airway Anomalies may be either disorders intrinsic to the trachea itself or may represent external forces compressing the airway. Although congenital tracheal malformations are by definition present at birth, at times they may not cause symptoms until far later in life. The primary presenting symptom is most commonly biphasic stridor, with a considerably prolonged expiratory phase. Nevertheless, other airway-related symptoms (eg, wheezing, cough, pneumonia, croup) may be present as well.  Many types of tracheal anomalies are listed and sorted by the anatomical classifications such as tracheal stenosis, tracheomalacia, vascular anomalies and tracheal cleft, etc.

 

Procedure

Many tests are available to assist in the workup of congenital tracheal malformations. The initial otolaryngologic evaluation should include a fiberoptic nasopharyngolaryngoscopy to rule out any supraglottic or glottic abnormalities. Radiographic imaging is helpful, with many available modalities to consider. CT scanning of the neck and chest provides additional data, while MRI together with magnetic resonance angiography (MRA) can provide detailed vascular information and may obviate the need for conventional contrast angiography. However, the criterion standard diagnostic modality is still direct laryngoscopy with rigid bronchoscopy and possible rigid esophagoscopy.

Intervention may be needed in children with life-threatening episodes of airway obstruction, recurrent infection, respiratory failure, or failure to thrive. Continuous positive airway pressure (noninvasive or invasive via tracheostomy) is the most widely used therapy. Surgical approaches such as tracheal reconstruction, placement of a tracheal stent, surgical suspension of the trachea (tracheopexy), tracheal plasty (segmental resection and anastomosis) have been conducted in our patients. Each patient is cared and managed by multidisciplinary team and the treatment will be tailored individually.

 

Notification

  • Re-stenosis of airway
  • ECMO related complications
  • Recurrence of TE fistula
  • General risk of anesthesia

 

Estimated Cost

The procedure cost is about 400,000 NTD. Prices are subject to change without prior notice, and need to pay in accordance with the actual medical expenses.