A trachea is a hollow tube that allows air to enter the underlying respiratory tract. Tracheal stenosis leads to difficulty in passing air to the bronchi.
| Tracheal stenosis | |
|---|---|
| ICD-10 | J 38.6 |
| ICD-9 | 519.19 , 748.3 |
| ICD-9-KM | |
| DiseasesDB | 29215 |
| eMedicine | radio / 705 |
| Mesh | D014135 |
Tracheal stenosis in children
Tracheal stenosis is one of the causes of airway obstruction in children and is characterized by narrowing of the airways.
Causes
Pathology can develop with changes in the trachea itself, as well as in nearby organs. The most common causes of stenosis include:
- Congenital pathology of the respiratory tract
- Cicatricial stenosis of the larynx is often acquired and appears as a result of prolonged intubation, or damage to the mucous tissues of the larynx as a result of traumatic intubation through the larynx.
- Compression of adjacent organs, in particular, an enlarged thyroid gland.
- Tracheal neoplasms causing narrowing of the lumen of the breathing tube.
Symptoms and clinical picture
In children with laryngeal stenosis, airway obstruction can manifest itself in different ways. In newborns, stenosis can manifest itself as stridor and heavy breathing after extubation, requiring repeated intubation.
Diagnostics
Diagnosis of the degree of stenosis is performed by means of an endotracheal tube of various diameters. Diagnostics includes direct laryngoscopy and direct bronchoscopy. According to CM classification, Myer and RT Cotton distinguish four main degrees of stenosis, depending on the degree of obstruction: Grade I - obstruction from 0- to 50% Grade II - obstruction from 50% to 71% Grade III - obstruction from 71% to 99% Degree IV - obstruction 100%
Treatment of tracheal stenosis
Treatment of tracheal stenosis is selected depending on the cause of the pathology. The greatest problem is the elimination of pathology caused by malignant neoplasms of the trachea and nearby organs. Ideally, the doctor will be able to eliminate tracheal stenosis while maintaining the integrity of the tube.
There are effective methods to restore the respiratory tract in children, depending on the degree of stenosis. Treatment may include surgery [2] , and in malignant pathologies, this is possible only when the disease is detected at an early stage of development. The solution is tracheal transplantation by replacing tissue damage to the allograft [3] . At the same time, softening of the tracheal wall is one of the main problems of tracheal transplantation.
For stenoses with severe airway constriction — III degree according to the CM Myer and RT Cotton classification, laryngoplasty is used. Laryngoplasty is an operation for laryngeal stenosis using a rib cartilage implant.
If the stenosis has developed due to congenital pathology of the respiratory tract, experts suggest that it should be surgically corrected in the first months or years of the child’s life, depending on the degree of narrowing and preservation of the respiratory function.
Treatment of cicatricial stenosis is endoscopic restoration of the lumen of the trachea. During the operation, the surgeon cuts through the formed scar adhesions and introduces a special dilator, which restores the tracheal patency. If the pathology recurs, then open surgery can be applied to prosthetics the breathing tube.
In case of IV degree stenosis according to CM Myer and RT Cotton, the larynx is resected.
Children with mild stenosis (I and II) do not require surgery.
See also
- Airway obstruction
Links to resources
Notes
- ↑ Monarch Disease Ontology release 2018-06-29sonu - 2018-06-29 - 2018.
- ↑ oncology surgery .
- ↑ Parshin V.D., Lyundup A.V., Tarabrin E.A., Parshin V.V. The long-term result of tracheal transplantation: success and unsolved problems // Surgery. Journal them. N.I. Pirogov. - 2018. - № 11 . - pp . 11-19 . - ISSN 0023-1207 .