CONGENITAL AIRWAY ABNORMALITIES REQUIRING TRACHEOTOMY - A PROFILE OF 56 PATIENTS AND THEIR DIAGNOSES OVER A 9-YEAR PERIOD

We reviewed the 9 year experience at the Children's Hospital of Philad elphia with patients requiring tracheotomy for a diagnosis of congenit al airway abnormalities. Of the 56 patients, 28 (50%) had cardiovascul ar, or chromosomal abnormalities, neurologic conditions, or congenital syndromes, 24 (43%) were born prematurely, and 13 (23%) were found to have gastroesophageal reflux. Only 18 (32%) went on to eventual decan nulation of their tracheotomy with a mean tracheotomy duration of 1.75 years. The majority of patients (75%) had multiple presenting signs. Strider was the most common (54%), followed by accessory respiratory e ffort (39%), cyanosis (30%), apnea (29%) and failure to thrive (23%). Twenty eight patients (50%) had multiple airway abnormalities contribu ting to their need of a tracheotomy for airway protection or ventilato r dependence. Laryngeal abnormalities were found in 71% of patients, t racheal abnormalities in 48% of patients, bronchial abnormalities in 1 1%, and upper airway obstruction in 14%. Of the laryngeal abnormalitie s, laryngomalacia was the most common, followed by subglottic stenosis , glottic web, and vocal cord paralysis. Tracheomalacia was the most c ommon tracheal abnormality. The relatively large percentage of patient s with cardiovascular or other major malformations, and prematurity, a ccounts for comorbid factors in the need for prolonged tracheotomy (an d low early decannulation rate). Although gastroesophageal reflux was found in a recognizable portion of the patients, it is unclear whether this represents a comorbid condition. (C) 1997 Elsevier Science Irela nd Ltd.