Postoperative observation of children after endoscopic type 1 posterior laryngeal cleft repair.

Objectives: To report the perioperative management and surgical outcomes in a large series of pediatric patients with endoscopically repaired type 1 posterior laryngeal cleft (PLC).

Study Design: Case series with chart review.

Setting: Urban, tertiary care, free-standing pediatric hospital.

Laryngeal development and anatomy.

Knowledge of laryngeal and tracheobronchial development and anatomy is essential to the pediatric airway endoscopist. Normal and pathologic airway anatomy is discussed in this chapter.

Pulmonary artery sling: current results with cardiopulmonary bypass.

Objective: We have used cardiopulmonary bypass with left pulmonary artery reimplantation for pulmonary artery sling repair since 1985. This review presents our current results with this technique, emphasizing the importance of diagnosis and treatment of frequently associated tracheal stenosis.

Methods: Since 1985, 34 patients have undergone pulmonary artery sling repair using a median sternotomy and cardiopulmonary bypass.

Synchronous airway lesions in children younger than age 3 years undergoing adenotonsillectomy.

Objective: Determine the prevalence of synchronous airway lesions (SALs) in children younger than age 3 years undergoing adenoidectomy or adenotonsillectomy for sleep-disordered breathing (SDB) at Children’s Memorial Hospital.

Design: Case series with chart review.

Setting: Tertiary care pediatric hospital.

Aspiration before and after Supraglottoplasty regardless of Technique.

Objective. To determine the incidence of preoperative and postoperative aspiration in infants who undergo supraglottoplasty. To determine the effect of cold steel and CO(2) laser supraglottoplasty on aspiration in infants with severe laryngomalacia.

A history of pediatric tracheal surgery.

Tracheal stenosis in children is primarily caused by congenital complete cartilage tracheal rings. These infants present with severe respiratory distress early in life. The purpose of this review is to examine the history of surgical intervention for infants and children with congenital tracheal stenosis.

Diagnosis and management of type I posterior laryngeal clefts.

Objectives: We review the diagnosis and management of type I posterior laryngeal clefts (PLCs).

Methods: We performed a retrospective study at a tertiary-care children's hospital of children who were diagnosed with a PLC between January 2003 and August 2008. We studied concurrent airway anomalies, comorbidities, presenting symptoms, age at the time of aspiration resolution, and rate of aspiration resolution.

Supraglottoplasty outcomes in relation to age and comorbid conditions.

Objective: To determine if age and comorbid conditions effect outcomes in children undergoing supraglottoplasty for severe laryngomalacia.

Design: Retrospective study.

Setting: Urban tertiary-care children's hospital.

Tracheal reconstruction in children with unilateral lung agenesis or severe hypoplasia.

Background: Infants with congenital tracheal stenosis may also have unilateral lung agenesis or severe lung hypoplasia. The purpose of this review is to evaluate our results with these patients and compare their presentations and outcomes to those of tracheal stenosis patients with two lungs.

Methods: Our database was queried for patients undergoing tracheal stenosis repair since 1982.

Synchronous airway lesions and outcomes in infants with severe laryngomalacia requiring supraglottoplasty.

Objective: To quantify the prevalence and the impact of synchronous airway lesions identified by endoscopy in infants undergoing supraglottoplasty for severe laryngomalacia (LM).

Design: Retrospective study.

Setting: Tertiary care pediatric hospital.

CT analysis after distraction osteogenesis in Pierre Robin Sequence.

Objectives/hypothesis: Early mandibular lengthening by distraction osteogenesis provides an alternative to traditional methods of airway management in infants with Pierre Robin sequence (PRS). Little evidence in the medical literature quantitatively demonstrates the changes in skeletal, soft tissue, and hypopharyngeal spaces with mandibular distraction.

Study Design: Prospective analysis of a cohort of three patients with PRS.

Primary closure of persistent tracheocutaneous fistula in pediatric patients.

Objective: The aim of the study is to review the safety and efficacy of partial fistulectomy with 3-layered primary closure without postoperative intubation for persistent tracheocutaneous fistula (TCF).

Design: This is a retrospective study.

Setting: The study was conducted in a tertiary care pediatric hospital.

Congenital laryngeal stenosis.

Congenital subglottic stenosis is rare and as a consequence may not be considered in children experiencing respiratory difficulty at birth. Diagnosis after a child already is intubated complicates the recognition and blurs the boundary between congenital and acquired lesions. This article discusses the anatomy of the larynx, its common anatomic variations, and its response to trauma, a thorough understanding of which is required for the accurate diagnosis and treatment of this complicated problem.

Aspiration following CO(2) laser-assisted supraglottoplasty.

Objective: To review the incidence, risk factors, and treatment of aspiration following CO(2) laser-assisted supraglottoplasty for severe laryngomalacia (LM).

Design: IRB approved retrospective study of pediatric patients with severe LM treated with CO(2) laser supraglottoplasty over a 5-year period.

Setting: Tertiary pediatric hospital.

Etiology of stridor in infants.

Objectives: We undertook to identify data that facilitate determination of an accurate diagnosis of the cause of stridor in infants and to develop a framework to conceptualize the problem.

Methods: We reviewed medical records of patients less than 1 year of age with the presenting symptom of stridor who were initially evaluated in the outpatient setting of a tertiary children's hospital. Infants with obvious congenital syndromes, cerebral palsy, or hypotonia were excluded.

Endoscopic management of recurrent congenital tracheoesophageal fistula: a review of techniques and results.

Objective: Recurrent tracheoesophageal fistula (TEF) is a difficult problem in both diagnosis and management. Revision open repair with thoracotomy is challenging and has a significant associated morbidity. Because of the technical difficulty and the substantial morbidity, several authors have suggested and implemented endoscopic management.

Trends in vascular ring surgery.

Objective: We sought to review our experience with infants and children with anatomically complete vascular rings (ie, double aortic arch and right aortic arch with left ligamentum) and define perioperative trends in diagnostic imaging, operative techniques, and clinical outcomes.

Methods: From 1946 through 2003, 209 patients (113 with double aortic arch and 96 with right aortic arch) underwent surgical repair. Mean and median ages at the time of the operation were as follows: double aortic arch, 1.

Inflammatory myofibroblastic tumor (inflammatory pseudotumor) of the neck infiltrating the trachea.

Inflammatory myofibroblastic tumor (IMT), popularly known as inflammatory pseudotumor, is a slow growing quasi-neoplastic lesion with a distinct histologic appearance and benign clinical course. A case of a neck IMT with infiltration into the trachea causing asthmalike symptoms in a 12-year-old girl is described. Both tracheal and neck IMT have been described, but no other case has displayed this infiltration.

Repair of congenital tracheal stenosis.

We have used six different techniques in 61 operations performed at Children's Memorial Hospital (Chicago, IL) between 1982 and 2001 on 54 infants with complete tracheal rings and primary or recurrent tracheal stenosis. Short-term and long-term outcomes are reviewed for all techniques including pericardial tracheoplasty, tracheal autograft, tracheal resection, cartilage tracheoplasty, slide tracheoplasty, and aortic homograft patch tracheoplasty. Patients' ages ranged from 7 days to 72 months; mean age at operation was 6 months.

Otolaryngic Manifestations in Children Presenting with Apparent Life-Threatening Events.

Apparent life-threatening event (ALTE) is a term used to characterize an event of unknown cause after an infant is found limp, cyanotic, bradycardic, and/or requiring resuscitation. Like sudden infant death syndrome (SIDS), ALTE is a general term used until a precise diagnosis can be established. The relationship between ALTE and SIDS has not been clearly defined, although 7 to 15 percent of children with ALTE die of SIDS.