535CHAPTER 47 Diseases of the Upper Respiratory Tract and after resolution of airway and facial edema While intubated, a wire cutter should be kept at the patient’s bedside at all times in case emerge[.]
CHAPTER 47 Diseases of the Upper Respiratory Tract A 535 and after resolution of airway and facial edema While intubated, a wire cutter should be kept at the patient’s bedside at all times in case emergency access to the oral cavity is needed In the event of emesis, the patient should be leaned forward or the wires should be emergently cut to prevent aspiration Injury to the airway may also result from blunt or penetrating laryngeal trauma Fortunately, these events are rare in pediatric patients, occurring in only 0.0001% of emergency department trauma patients.104 An increasing trend in laryngeal trauma among young children has been observed due to motor vehicle accidents.105 Other mechanisms include athletic injuries, child abuse, and suicide attempts by hanging Airway trauma occurs most commonly in males, and the average age of affected patients is 10 years old Direct trauma to the larynx can cause a number of injuries, including mucosal edema, hematomas, hyoid and laryngeal fractures, or even laryngotracheal separation.101 Common presenting symptoms include dysphagia, odynophagia, voice changes, hemoptysis, ecchymosis, and subcutaneous emphysema.106 Subcutaneous emphysema following laryngeal trauma often indicates a mucosal tear with communication between the airway lumen with the soft tissue of the neck The degree of subcutaneous emphysema does not correlate with the severity of the injury.107 The safest practice for these patients is an airway evaluation in the operating room Depending on the type of injury, treatment may include observation, endotracheal intubation to allow healing, or surgical reconstruction with tracheostomy placement.105 Voice and swallowing dysfunction may be long-term morbidities Key References B • Fig 47.18 Inspiratory chest radiograph with foreign body present in left mainstem bronchus During inspiration (A), the left lung is slightly hyperinflated but could be considered normal The expiratory radiograph (B) clearly demonstrates that the left lung is hyperinflated because of air trapping by the foreign body (Courtesy Eric Effmann, MD.) of airway compromise from hemorrhage and delayed soft tissue swelling Those treating a trauma patient should consider multiple ways to secure the airway and have supplies available for endotracheal intubation, flexible fiberoptic nasotracheal intubation, and emergent cricothyroidotomy Even after surgical repair of their injuries, patients with facial trauma may have complex airway concerns, such as external fixation devices or jaw wiring These patients should undergo extubation only when fully awake Brigger MT, Hartnick CJ Surgery for pediatric vocal cord paralysis: a meta-analysis Otolaryngol Head Neck Surg 2002;126(4):349-355 Brown OE, Pownell P, Manning SC Choanal atresia: a new anatomic classification and clinical management applications Laryngoscope 1996;106(1):97-101 Derkay CS, Wiatrak B Recurrent respiratory papillomatosis: a review Laryngoscope 2008;118(7):1236-1247 Duval M, Tarasidis G, Grimmer JF, et al Role of operative airway evaluation in children with recurrent croup: a retrospective cohort study Clin Otolaryngol 2015;40(3):227-233 Léauté-Labrèze C, de la Roque ED, Hubiche T, Boralevi F, Thambo JB, Taïeb A Propranolol for severe hemangiomas of infancy N Engl J Med 2008;358(24):2649-2651 Pezzettigotta SM, Leboulanger N, Roger G, Denoyelle F, Garabédian EN Laryngeal cleft Otolaryngol Clin North Am 2008; 41(5):913-933, ix Thompson DM Abnormal sensorimotor integrative function of the larynx in congenital laryngomalacia: a new theory of etiology Laryngoscope 2007;117(suppl 114):1-33 The full reference list for this chapter is available at ExpertConsult.com e1 References Hammer J Acute respiratory failure in children Paediatr Respir Rev 2013;14(2):64-69 Tobias JD Pediatric Airway anatomy may not be what we thought: implications for clinical practice and the use of cuffed endotracheal tubes Paediatr Anaesth 2015;2:9-19 Litman RS, Weissend EE, Shibata D, et al Developmental changes of laryngeal dimensions in unparalyzed, sedated children Anesth Analg 2003;98:41-45 Dalal PG, Murray D, Messner AH, et al Pediatric laryngeal dimensions: an age-based analysis Anesth Analg 2009;108:1475-1479 Wetmore RF, Muntz HR, McGill TJI Pediatric Otolaryngology: Principles and Practice Pathways 2nd ed New York: Thieme; 2012 Ramsden JD, Campisi P, Forte V Choanal atresia and choanal stenosis Otolaryngol Clin North Am 2009;42(2):339-352 Brown OE, Pownell P, Manning SC Choanal atresia: a new anatomic classification and clinical management applications Laryngoscope 1996;106(1):97-101 Samadi DS, Shah UK, Handler SD Choanal atresia: a twenty-year review of medical comorbidities and surgical outcomes Laryngoscope 2003;113(2):254-258 Kwong KM Current updates on choanal atresia Front Pediatr 2015;3:52 10 Corrales CE, Koltai PJ Choanal atresia: current concepts and controversies Curr Opin Otolaryngol Head Neck Surg 2009;17(6): 466-470 11 Burrow TA, Saal HM, de Alarcon A, Martin LJ, Cotton RT, Hopkin RJ Characterization of congenital anomalies in individuals with choanal atresia Arch Otolaryngol Head Neck Surg 2009; 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Int J Pediatr Otorhinolaryngol 2016;87:144-147 92 Adly A, Youssef TA, El-Begermy MM, Younis HM Timing of tracheostomy in patients with prolonged endotracheal intubation: a systematic review Eur Arch Otorhinolaryngol 2018;275(3):679-690 93 Griffiths J, Barber VS, Morgan L, Young JD Systematic review and meta-analysis of studies of the timing of tracheostomy in adult patients undergoing artificial ventilation BMJ 2005;330(7502):1243 94 Holloway AJ, Spaeder MC, Basu S Association of timing of tracheostomy on clinical outcomes in PICU patients Pediatr Crit Care Med 2015;16(3):e52-e58 95 Campisi P, Forte V Pediatric tracheostomy Semin Pediatr Surg 2016;25(3):191-195 96 Bluestone CD, Simons JP, Healy GB Bluestone and Stool’s: Pediatric Otolaryngology 5th ed Shelton, CT: People’s Medical Publishing House; 2014 97 Sidell DR, Kim IA, Coker TR, Moreno C, Shapiro NL Food choking hazards in children Int J Pediatr Otorhinolaryngol 2013;77(12):1940-1946 98 Altkorn R, Chen X, Milkovich S, et al Fatal and non-fatal food injuries among children (aged 0–14 years) Int J Pediatr Otorhinolaryngol 2008;72(7):1041-1046 99 Hughes CA, Baroody FM, Marsh BR Pediatric tracheobronchial foreign bodies: historical review from the Johns Hopkins Hospital Ann Otol Rhinol Laryngol 1996;105(7):555-561 100 Wolach B, Raz A, Weinberg J, Mikulski Y, Ari JB, Sadan N Aspirated foreign bodies in the respiratory tract of children: eleven years experience with 127 patients Int J Pediatr Otorhinolaryngol 1994;30(1):1-10 e3 101 Reid A, Ha JF Inhalational injury and the larynx: a review Burns 2019;45(6):1266-1274 102 Freno D, Sahawneh J, Harrison S, Sahawneh T, Patterson S, Kahn SA Determining the role of nasolaryngoscopy in the initial evaluation for upper airway injury in patients with facial burns Burns 2018;44(3):539-543 103 Kadilak PR, Vanasse S, Sheridan RL Favorable short- and longterm outcomes of prolonged translaryngeal intubation in critically ill children J Burn Care Rehabil 2004;25(3):262-265 104 Gold SM, Gerber ME, Shott SR, Myer CM Blunt laryngotracheal trauma in children Arch Otolaryngol Head Neck Surg 1997;123(1): 83-87 105 Wootten CT, Bromwich MA, Myer CM Trends in blunt laryngotracheal trauma in children Int J Pediatr Otorhinolaryngol 2009;73(8):1071-1075 106 Humar A, Pitters C Emergency department management of blunt cervical tracheal trauma in children Pediatr Emerg Care 1991;7(5):291-293 107 Shires CB, Preston T, Thompson J Pediatric laryngeal trauma: a case series at a tertiary children’s hospital Int J Pediatr Otorhinolaryngol 2011;75(3):401-408 e4 Abstract: Diseases of the upper airway are common in the pediatric population and pose a significant risk of morbidity and mortality Congenital malformations, neoplasms, infections, and iatrogenic disease such as stenosis are the most frequent underlying etiologies Understanding the anatomy and physiology of the region is key to understanding the pathology Airway disease most often manifests with symptoms such as increased work of breathing, tachypnea, stridor, and cyanotic events Treatment consists of supportive respiratory care, which can range from supplemental oxygen to endotracheal intubation It is crucial to utilize a multidisciplinary team when managing airway disease, including members from critical care, anesthesiology, and otolaryngology Key words: upper airway, airway obstruction, airway masses, airway compression, deep neck space infections ... Otorhinolaryngol 2009;73(1):115-118 42 Lesnik M, Thierry B, Blanchard M, et al Idiopathic bilateral vocal cord paralysis in infants: Case series and literature review: Idiopathic Bilateral Laryngeal Palsy Laryngoscope... 2000;33(6):13431351 13 Miller MJ, Martin RJ, Carlo WA, Fouke JM, Strohl KP, Fanaroff AA Oral breathing in newborn infants J Pediatr 1985;107(3):465-469 14 Friedman N, Mitchell R, Bailey C, Albert... Muntz HR, McGill TJI Pediatric Otolaryngology: Principles and Practice Pathways 2nd ed New York: Thieme; 2012 Ramsden JD, Campisi P, Forte V Choanal atresia and choanal stenosis Otolaryngol Clin