AIRWAY-OBSTRUCTION IN NEONATES AND CHILDREN - SURGICAL-TREATMENT

Objective. This review of 54 infants and children with airway obstruct ion who were treated surgically emphasizes the importance of the surgi cal indications with respect to various anomalies causing airway obstr uction, and the surgical approach to their management. Patients. There were 4 etiologic groups of airway obstruction. Group A comprised 12 i nfants with subglottic stenosis; Group B-20 infants with tracheomalaci a; 21 patients (Group C) with anatomic narrowing of the trachea; and 1 infant (Group D) with laceration of a main bronchus. Methods. The sur gical procedures performed included anterior laryngotracheal decompres sion in 12 infants, aortopexy in 19; 1 pulmonary arteriopexy; tracheal stenting with an autologous rib graft in 3 and with Marlex mesh in 1. Tracheal widening, using a free tibia autologous graft, was performed in 3 patients; trans-bronchoscopic excision in 12; anterior tracheal wedge resection in 4, and segmental tracheal resection and anastomosis in 1 patient. The lacerated bt bronchus was repaired with fine Dexon sutures. Results. There were no operative deaths. With respect to the original indications for surgery, there were 3 failures-2 in Group A a nd 1 in Group C. Two patients died from causes unrelated to the proced ures-one 10 days postoperatively, and the other 3 months after surgery . Conclusions. The surgical approach to tracheal obstruction in infant s and children offers effective treatment, with no operative mortality , a low complication rate, and good long term survival.