Airway obstruction in neonates and children: Surgical treatment

Objective. This review of 54 infants and children with airway obstruction who were treated surgically emphasizes the importance of the surgical indications with respect to various anomalies causing airway obstruction, and the surgical approach to their management. Patients. There were 4 etiologic groups of airway obstruction. Group A comprised 12 infants with subglottic stenosis; Group E - 20 infants with tracheomalacia; 21 patients (Group C) with anatomic narrowing of the trachea; and 1 infant (Group D) with laceration of a main bronchus. Methods. The surgical procedures performed included anterior laryngotracheal decompression 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; transbronchoscopic excision in 12; anterior tracheal wedge resection in 4, and segmental tracheal resection and anastomosis in 1 patient. The lacerated 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 and 1 in Group C. Two patients died from causes unrelated to the procedures - one 10 days postoperatively, and the other 3 months after surgery. Conclusions. The surgical approach to tracheal obstruction in infants and children offers effective treatment, with no operative mortality, a low complication rate, and good long term survival.