Airway Obstruction, Pediatric

• • 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

Epidemiology

• • Epiglottitis occurs most commonly at age 4

  • Congenital lesions usually apparent at birth

Symptoms and Signs

• • Restlessness

  • Tachypnea

  • Dyspnea

  • Chest wall retractions

  • Inspiratory stridor

  • Respiratory arrest

  • Drooling

  • Dysphagia

  • Fever (with epiglottitis)

Laboratory Findings

• • Leukocytosis with epiglottitis

  • Blood gas showing respiratory acidosis

Imaging Findings

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

  • Chest film showing aspirated foreign body

• • Age of presentation

  • Severity of respiratory distress

Rule Out

• • Epiglottitis

• • 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)

Surgery

• • Tracheostomy for some obstructions

  • Resection of tumors or cysts causing airway obstruction

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

Medications

• • Third-generation cephalosporin for epiglottitis

  • Intralesional or systemic corticosteroids for obstructing hemangioma

  • Mechanical ventilation for extreme cases

  • Oropharyngeal suctioning and NG decompression

Complications

• • Recurrent airway obstruction

  • Aspiration pneumonia

Prevention

• • Haemophilus influenza type B vaccine

References