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Lower airway bronchoscopic interpretation
Published in Don Hayes, Kara D. Meister, Pediatric Bronchoscopy for Clinicians, 2023
Kimberley R. Kaspy, Sara M. Zak
The subglottis is the uppermost portion of the trachea, just below the vocal cords but above the thoracic inlet. In pediatric patients, the cricoid cartilage is the narrowest portion of the airway compared to the vocal cords of adults.The most common lesion seen in the subglottis is subglottic stenosis (SGS).9 This can be congenital or acquired. The most common cause of acquired subglottic stenosis in pediatric patients is trauma/injury due to prolonged intubation.8,10Subglottic stenosis is graded based on the degree of narrowing in the airway, called the Cotton-Myer grading system.11Grade 1 SGS is less than 50% narrowing of the subglottisGrade 2 SGS is 51%–70% narrowing of the subglottisGrade 3 SGS is 71%–99% narrowing of the subglottis (seen in Figure 5.3a)Grade 4 SGS results when there is no detectable opening into the distal trachea, which is depicted in Figure 5.3b
Otorhinolaryngology
Published in Stephan Strobel, Lewis Spitz, Stephen D. Marks, Great Ormond Street Handbook of Paediatrics, 2019
Chris Jephson, C. Martin Bailey
The narrowest portion of a child’s airway is the subglottis, where the airway immediately below the vocal cords is enclosed within the cricoid cartilage. Acquired SGS occurs following periods of intubation when the pressure of the endotracheal tubing in this area can lead to ischaemia, ulceration and infection, which can in turn lead to stenosis (Figs 19.32, 19.33). Congenital SGS is much less common and can occur in isolation or in conjunction with a syndrome.
Acute Infections of the Larynx
Published in John C Watkinson, Raymond W Clarke, Terry M Jones, Vinidh Paleri, Nicholas White, Tim Woolford, Head & Neck Surgery Plastic Surgery, 2018
Sanjai Sood, Karan Kapoor, Richard Oakley
Viral laryngotracheobronchitis (LTB) is the most common cause of stridor in children (also known as ‘croup’) and usually has a self-limiting course30 in the majority of cases. However, in children progression to an impending airway can be more rapid when compared with adults due to the relatively narrow airway.31 The symptoms of respiratory distress and biphasic stridor occur as a result of airway narrowing below the level of the glottis. It is not known why the subglottis is specifically affected in this condition.
The impact of early surgical treatment of tracheal stenosis on neurorehabilitation outcome in patients with severe acquired brain injury
Published in Brain Injury, 2023
R. Formisano, M. D’Ippolito, M. Giustini, C. Della Vedova, L. Laurenza, M. Matteis, C. Menna, E. A. Rendina
It is well known that TS management requires different surgical approaches, which are guided by the site, length and type of stenosis. It is associated with possible complications (34), but mainly with a high success probability, receiving a definitive solution to this severe and life-threatening complication. In particular, no-surgical procedures, incorrectly considered safer options for the treatment of subglottic stenosis following intubation (35), make often wilder, longer or unbearable the way to reach the conclusive recovery. On the other hand, an early surgical resection may have potential disadvantages as well, such as the interruption of the rehabilitation process. However, surgery was performed following the Enhanced Recovery After Surgery (ERAS) recommendations (28) minimally interfering with the rehabilitation process (a mean hospital stay of 7 days in the Thoracic Surgery Unit).
Life-threatening idiopathic subglottic stenosis misdiagnosed as asthma
Published in Acta Oto-Laryngologica Case Reports, 2022
Niloofar Sherazi Dreyer, Kristine Grubbe Gregersen, Kristian Hveysel Bork
Subglottic stenosis is the obstruction of the central airway in the region below the glottis and bounded inferiorly by second tracheal ring. Causes of subglottic stenosis can be congenital, acquired, or idiopathic. The most common causes are trauma following intubation (prolonged/repetitive intubation or excessive endotracheal tube cuff pressure) and tracheostomy. Acquired causes may be external and internal traumas. External are typically trauma to the neck/larynx and internal traumas can include (intubation or tracheotomy) as mentioned earlier. Other acquired causes include infections as bacterial tracheitis, tuberculosis, gastroesophageal reflux disorder (GERD), systemic diseases (amyloidosis, sarcoidosis, polyarteritis, granulomatosis with polypangiitis), radiation therapy, inhalational injury, tracheal malignancy, and foreign body aspiration [1].
Prognostic factors and importance of recognition of adult croup
Published in Acta Oto-Laryngologica, 2018
Tomoyasu Tachibana, Yorihisa Orita, Takuma Makino, Yasutoshi Komatsubara, Yuko Matsuyama, Yuto Naoi, Michihiro Nakada, Yasuharu Sato, Kazunori Nishizaki
Child croup is often managed safely on an outpatient basis, and hospitalization and intubation are only required in 2% and 0.5–1.5%, respectively [8]. On the other hand, as AC patients often present in severe condition [3,6], some reports have indicated that AC should be managed by hospitalization or admission to the Intensive Care Unit (ICU) even for patients who do not need intubation [2,7]. Stridor has been reported as a prognostic factor for severe croup [1]. In the past 14 AC patients, stridor was observed in eight patients. Of these, six patients (75.0%) required airway intervention and three (37.5%) needed tracheostomy. In the present study, stridor was observed in only one case (5.6%), and no cases required airway intervention. Detailed observation of the subglottic region by laryngoscopic examination might help to detect severe cases which requires airway intervention.