alyssa brzenski md ent pathology. case a 34 week old premature baby boy was born vaginally to a...
TRANSCRIPT
Alyssa Brzenski MD
ENT PATHOLOGY
CaseA 34 week old premature baby boy was born vaginally to a young mother with chorioamnioitis. At birth the baby was tachypneic and required intubation. Blood cultures were performed and came back positive, so the NICU started the baby on IV Penicillin and Gentamycin for 14 days. He was given surfactant x 3 doses and remained intubated for 7 days. Upon finishing his antibiotic regime, he was allowed to go home with his mother. 2 - 3 weeks later, the mother appears at the pediatricians office with the baby and complains that “the baby turns blue, he’s noisy when he breathes and she has difficulty feeding him.”
“Noisy Breathing” Definition
Differential Diagnosis
Evaluation of Stridor
Laryngomalacia- The Facts• Most common laryngeal anomaly and cause of stridor (54-75%)• DEFINITION:• “Flaccid laryngeal tissue and inward curling of supraglottic
structures during inspiration. There is a fluttering inspiratory stridor that worsens with agitation, crying, feeding or supine.”• Begins in 1st weeks of life and peaks at 6-8 months
Normal Pediatric Anatomy
Laryngomalacia
Treatment
Supraglottoplasty
Before and After
CO2 vs YAG Laser
Type Advantage Disadvantage Other
CO2 Laser Precise; Decreased Post-op Edema
Takes longer for bigger areas
Invisible on it’s own, combined with helium-neon laser
Nd:Yag Laser Great Coagulation
Deep penetration/surrounding tissue damage
Able to go through liquids, can be used in fluid filled areas
Additional Management• Dexamethasone• Possible Post-op Intubation• Racemic Epi• PPI• H2 Blocker
Subglottic Stenosis• Aquired Subglottic Stenosis• From prolonged intubation or high pressure on the tracheal
mucosa
• Congenital Subglottic Stenosis• Cricoid diameter less than 3.5mm• Result of malformation of the cricoid cartilage
Vocal Cord Paralysis• Inspiratory or biphasic stridor, weak cry• Causes• Birth trauma• Central (Arnold-Chiari, Brainstem compression) neurologic
diseases• Thoracic disease or procedures (PDA ligation, aortic arch
surgery)
Posterior glottic web
Anterior Laryngeal Webs
Laryngotracheal Cleft
ENT Pathology and associated Co-morbidities
Sources• Messer A. Congenital Disorders of the Larynx. Cummings Otolaryngology. 5th Ed. 2010. 2866-75.• Boudewyns A, Claes J, Van de Heyning P. An approach to stridor in infants and children. Eur J Pediatr 2010: 169; 135-141.• Richter G, Thompson D. The Surgical Management of Laryngomalacia. Otolaryngol Clin N Am 2008: 41: 837-64.