Narrowing of Pharynx and Trachea in Children
Janoušek P., Kabelka Z., Marková M.
Klinika ušní, nosní a krční 2. LF UK a FN Motol, Praha, Subkatedra dětské otorinolaryngologie IPVZ, Praha, přednosta doc. MUDr. Z. Kabelka |
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Summary:
Introduction: Narrowing of respiratory pathways is classified according to the duration and the rapidity
it develops to acute and chronic ones; etiology is the basis of classification to inborn and acquired
stenoses. The trauma-related narrowing is called a stricture. The anatomical classification related to
intramural and extramural ones. Based on the differences of treatment in children the authors analyze
the experience with the diagnostics and therapy of chronic intramural subglottic stenoses and chronic
intramural stenoses of cervical part of trachea in a separate communication. The cases are not frequent
and literature describes only groups of patients collected at the specialized workplaces. It is therefore difficult
to take a stand on epidemiology. The main diagnostic procedures include endoscopic examination,
preferably by rigid laryngotracheobronchoscopy in general anesthesia, supplemented with data of imaging
methods. The therapy is governed by the extent and etiology of the narrowing. All patients should be
treated individually from the point of view of age as well as for frequently associated accompanying diseases
and it is therefore impossible to create unambiguously valid “recommended procedures”.
Methods: In the selected five-year period of 2001-2005, 87 patients with the diagnosis of narrowed respiratory
pathways have been treated at our Clinic of Ear, Nose and Neck, 2nd Medical Faculty, Charles
University. In 57 patients the subglottic localization was encountered; 8 of them were congenital, the
others were acquired. The heaviness was evaluated by a classification according to Myer. In 20 patients
there was a narrowing of 1st degree of low significance; malignant tumors were found in three of them
who were then operated on, whereas the other 217 patients were only under observation. The other 67
patients suffered from defect of 2nd to 3rd degree of varied significance. The bougie dilatation was used in
24 patients, and the balloon dilatation was applied in 12 patients. The surgery was indicated in 34 patients,
eight subjects were operated on by endoscopy, whereas the open field operation was used in 26 individuals. Results: In 34 patients operated on, endoscopy revealed only insignificant narrowing of respiratory
pathways or small protrusions. These patients can get on more or less without limitations. There further
prognosis is influence by the basic disease, though. Eight patients continue to be treated – in the program
of balloon dilatation. Twelve patients continue to wear permanent cannulas. Seven patients are planned
to be surgically treated, whereas the other are not due to expected lack of benefit related to the basic disease
(centrally affected breathing, myopathies). Seven patients died from complications of the basic disease
– a severe central affection.
Conclusion: The therapy of chronic stenosing processes of respiratory pathways in children is a complex
chapter of children otorhinolaryngology for the frequent occurrence of co-morbidity as well as from
the need of gradual enlargement of the diameter of respiratory tube, which is in contrast to the tendency
of cicatrice forming. The care of these patients must be therefore secured by interdisciplinary approach
due to other diseases affecting these patients. At our workplace there is a good experience with the
treatment based primarily on dilatation with balloon probes, or by bougie dilatation – especially in stenoses
of medium severity. The surgical therapy is taken into account in casers, where dilatation is not sufficient
to solve the problem.
Key words:
stenosis, stricture, larynx, trachea, children.
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