tracheal stenosis in children - tracheal stenosis in... · 2013-12-24 · tracheoplasty slide...
TRANSCRIPT
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TRACHEAL STENOSIS IN
CHILDREN
DR DOAN THI BAO THUY
RESPIRATORY DEPARTMENT
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Cases report
Introduction
Causes
Diagnosis
Classification
Management
Evident based medicine
Conclusion
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CASES REPORT
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Patient’s name: Pham Thi Thuy D, Female,
10 Years old
Stridor and difficult breathing.
Diagnosis: Tracheal stenosis, aquired after
surgery
Surgery management: resection tracheal
with end-to-end anastomosis
The operation was successful
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CT scan: the
tracheal stenosis,
middle one third of
the trachea . D min
3,6mm, L (TS) 6mm
Bronchoscopy,
narrow more than 80% of diameter
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Patient’s name: Bui Yen L, female, 10
months
Persistant wheeze
Diagnosis: Congenital tracheal stenosis
Surgery management: slide tracheoplasty
The operation was successful
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CT scan: the tracheal
stenosis in middle-
lower of the trachea .
D min 2,5mm, L (TS)
15mm, vascular ring
Bronchoscopy:
stenosis in middle
one third of the
trachea
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Tracheal stenosis (TS): narrowing of the
trachea
Congenital or acquired
Increase acquired TS: increased survival of
low-birth-weight infants and increased use of
intubation
Congenital TS: rare, – 1/64,500 (USA-2012)
not clear, mortality rate 44-79%
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In Respiratory Department
33 cases of abnormal airway (10/2010
8/2013)
19/33 cases TS
17 congenital cases, 2 aquired cases
50% ( 8/17cases congenital) is associated
with cardialvascular anomalies
Rate of M/F : 1.25/1
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Acquired tracheal stenosis
• Endotracheal intubation
• Tracheostomy
• Radiotherapy
• Past surgery
• Gastroesophageal reflux
Congenital tracheal stenosis associated with pulmonary, cardiovascular and gastrointestinal malformations (50% of all cases TS)
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Symptoms
Stridor
Recurring pneumonia
Wheezing
Imaging studies:
Imaging, X-rays and CT or MR imaging.
CT or MRI is recommended (*)
Microlaryngoscopy and bronchoscopy:diagnose the degree and length of TS
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Review Myer-Cotton staging system
+ Grade I lesions have less than 50%
obstruction
+ Grade II lesions have 51% to 70%
obstruction
+ Grade III lesions have 71% to 99%
obstruction
+ Grade IV lesions have no detectable lumen
or complete stenosis(*)
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The location of the stenosis is divided into 5
regions: (*)
Upper one third of the trachea
Middle one third of the trachea
Lower one third of the trachea
Right main bronchus
Left main bronchus (Freitag et al 2007)
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PROGNOSIS
Respiratory status
The site and degree of the stenosis
The age and co-morbidities of patient
Previous treatments and failures.
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Treatments:
Observation treatmeant: milder forms, airway
grows, improve over time.
Endoscopic treatments: Laser excision,
stents placement, Balloon dilation
Tracheal resection
Tracheoplasty: slide, patch
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Laser therapy: burn
off the tissue or tumor,
causing the narrowing
Stents placement:
prevent reclusion
/severely stenotic
airways. Stents for
external obstruction
and tracheo-
esophageal fistulas
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Balloon dilation.
In less severe cases
Balloon is inflated
narrow and open the
airway more
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Tracheal Resection
Scarring within the
trachea
Removing a scarred
portion of the trachea and
end-to-end anastomosis
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Tracheoplasty
Slide tracheoplasty
long-segment tracheal stenosis
Cut the narrow part of the trachea horizontally. Two sections are slide together and sutured so that they overlap, providing a wider tracheal airway.
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SLIDE TRACHEOPLASTY
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A vertical incision is made anteriorly, spanning onl y the stenos is but includ-ing the carina or bro nchi if nece ssary. The patch then is sutured over the
an terior gap, broaden ing the tracheal lumen
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EVIDENT BASED MEDICINE
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Conservative and endosopy management, also has been established for milder cases.
Each patient has individualized institution to choose an approriatetreatment.
RESPIRATORY DEPARTMENT now apply
bronchoscopy for diagnose more TS case.
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THANK YOU FOR YOUR ATTENTION.