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Πέμπτη 30 Μαΐου 2019

Diagnosis, Classification, and Management of Pediatric Tracheobronchomalacia
A Review
Educational Objective
To discuss the existing literature regarding pediatric tracheobronchomalacia, present a novel classification scheme, and facilitate discussion of patients between providers.
Related
Example of Dynamic, 3-Phase Rigid Laryngotracheobronchoscopy
Dynamic, 3-phase Rigid Laryngotracheobronchoscopy in a Patient With Tracheobronchomalacia Before and After Posterior Tracheopexy
1 Credit CME
JAMA Otolaryngology–Head & Neck Surgery
March 1, 2019
Review
Article Information and Disclosures
Sukgi Choi, MD, MBA1; Claire Lawlor, MD1; Reza Rahbar, DMD, MD1; et al Russell Jennings, MD2 Author Affiliations Read article on JAMA Network
MOC/CME Information

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Abstract
Importance  Tracheobronchomalacia (TBM) describes an increased collapsibility of the trachea and bronchi that is greatest on forced expiration. A broad term, TBM encompasses intrinsic tracheal weakness, some forms of tracheal deformation, and extrinsic compression. Tracheobronchomalacia is the most common congenital tracheal anomaly, affecting 1 in 2100 children. Tracheobronchomalacia is often associated with recurrent and prolonged respiratory tract infections, can lead to chronic lung disease, and can be fatal in its most severe form. Tracheobronchomalacia is often associated with other congenital anomalies and syndromes.

Observations  There is a paucity of information on TBM treatment in the modern otolaryngology literature. The primary treatment modalities described include tracheotomy, tracheal stents, and anterior aortopexy. In this review, a new TBM classification scheme and new treatment strategies are introduced to the otolaryngology literature. Diagnosis is made through history and physical examination, dynamic airway computed tomography, and dynamic 3-phase tracheobronchoscopy. Medical management includes nebulizer treatments, minimal use of inhaled corticosteroids, gastroesophageal reflux disease therapy, and continuous positive airway pressure. Surgical techniques, including anterior and posterior tracheobronchopexy and anterior and posterior aortopexy, are described.

Conclusions and Relevance  Tracheobronchomalacia is an entity of relevance to pediatric otolaryngologists and should be considered as being associated with respiratory distress, stridor, cough, recurrent pneumonia, or feeding difficulties, especially in children with syndromes or other congenital anomalies. A multidisciplinary approach to these patients is essential. A classification scheme facilitates discussion of individual patients among health care professionals and guides appropriate management. Novel surgical approaches for the treatment of TBM, including anterior and posterior tracheopexy and aortopexy, may be considered in management of the treatment of children with symptomatic TBM.

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