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  • • Nasal etiologies include:

    • -Choanal atresia

      -Teratoma

      -Encephalocele

    • Oral cavity etiologies include:

    • -Macroglossia

      -Micrognathia

      -Hypoplastic mandible with cleft palate

    • Pharyngeal and laryngeal etiologies include cysts or tumors

    • -Hemangiomas, lymphangiomas, cystic hygromas, and teratomas are most common

    • Acquired etiologies include:

    • -Foreign body aspiration

      -Acute epiglottitis

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Epidemiology

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  • • Epiglottitis occurs most commonly at age 4

    • Congenital lesions usually apparent at birth

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Symptoms and Signs

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  • • Restlessness

    • Tachypnea

    • Dyspnea

    • Chest wall retractions

    • Inspiratory stridor

    • Respiratory arrest

    • Drooling

    • Dysphagia

    • Fever (with epiglottitis)

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Laboratory Findings

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  • • Leukocytosis with epiglottitis

    • Blood gas showing respiratory acidosis

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Imaging Findings

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  • • Lateral cervical plain film showing edema of epiglottis and ballooning of pharynx

    • Chest film showing aspirated foreign body

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  • • Age of presentation

    • Severity of respiratory distress

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Rule Out

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  • • Epiglottitis

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  • • History and physical exam

    • Chest film

    • Lateral cervical film (for suspected epiglottitis)

    • Laryngoscopy (in operating room under anesthesia for suspected epiglottitis)

    • Bronchoscopy (usually for aspirated foreign body)

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Surgery

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  • • Tracheostomy for some obstructions

    • Resection of tumors or cysts causing airway obstruction

    • Bronchoscopy with foreign body extraction or treatment of other congenital endobronchial lesions

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Medications

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  • • Third-generation cephalosporin for epiglottitis

    • Intralesional or systemic corticosteroids for obstructing hemangioma

    • Mechanical ventilation for extreme cases

    • Oropharyngeal suctioning and NG decompression

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Complications

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  • • Recurrent airway obstruction

    • Aspiration pneumonia

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Prevention

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  • Haemophilus influenza type B vaccine

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References

Acosta AC et al: Tracheal stenosis: the long and short of it. J Pediatr Surg 2000;35:1612.  [PubMed: 11083434]
Backer CL et al: Tracheal surgery in children: an 18-year review of four techniques. Eur J Cardiothorac Surg 2001;19:777.  [PubMed: 11404130]
Rutter MJ, Hartley BE, Cotton RT: Cricotracheal resection in children. Arch Otolaryngol Head Neck Surg 2001;127:289.  [PubMed: 11255473]

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