ENT - Pediatric airway

Question 1

how does the pediatric airway differ from the adult airway? why?

Answer 1

• higher in neck (C1/2 vs C3/4)
• epiglottis sits behind soft palate
• funnel shaped
• CRICOID is the most NARROW point (vs nose)

Question 2

what allows kids to feed and breath at the same time (obligate nasal breathing)?

Answer 2

high location and position of epiglottis

Question 3

is nasal cavity obstruction life threatening at birth?

Answer 3

yes

Question 4

how is nasal cavity obstruction diagnosed?

Answer 4

• nasal canullas passed at birth

- relief with cry

Question 5

what can obstruct the nose at birth?

Answer 5

• choanal atresia
• nasal piriform aperture stenosis
• bilateral nasal lacrimal duct cysts (most common)
• neoplastic (encephalocele, dermoid, glioma)

Question 6

encephalocele, dermoid, glioma are derived from what germ layer?

Answer 6

neuroectoderm

Question 7

bilateral nasal lacrimal duct cysts cause obstruction at what level?

Answer 7

nasal cavity

Question 8

piriform stenosis can represent a form of ____________ and can be associated with a central ____________

Answer 8

• holoprosoencephaly

- mega-incisor

Question 9

what is the most COMMON source of airway (nasal) obstruction?

Answer 9

rhinitis of infancy

Question 10

what is the most LETHAL form of pediatric airway obstruction?

Answer 10

choanal atresia

Question 11

what are the major conditions that affect the oropharynx and hypopharynx airways?

Answer 11

• adenotonsillar hypertrophy
• pharyngeal wall infections
• neoplasms
• vascular malformations

Question 12

what is the most common source of airway problems that occur in the oropharynx and hypopharynx?

Answer 12

adenotonsillar hypertrophy

Question 13

what is the most common cause of pediatric stridor / supraglottic obstruction / general airway problems?

Answer 13

laryngomalacia

then vocal cord paralysis
(then subglottic stenosis)

Question 14

laryngomalacia usually resolves by what age?

Answer 14

1 year

Question 15

what is the best way to diagnose supraglottic structures?

Answer 15

laryngoscopy (endoscopy)

Question 16

thumbprint sign is see in what condition?

Answer 16

epiglottitis

Question 17

in congenital bilateral vocal fold paralysis you should evaluate the ___________ for ______________

Answer 17

• foramen magnum

- chiari malformation

Question 18

what is the most common neoplasm of the vocal fold?

Answer 18

recurrent respiratory papillomatosis

Question 19

subglottic stenosis is diagnosed in absence of airway manipulation because _________

Answer 19

it is congenital

Question 20

biphasic stridor by 6 months is usually due to ___________

Answer 20

subglottic hemangioma

Question 21

most common neoplasm in infant airway is _________

Answer 21

subglottic hemangioma

Question 22

tracheomalacia sometimes associated with __________

Answer 22

TE fistula

Question 23

what questions should be asked for tracheomalacia?

Answer 23

• is it a tracheal problem? (TE fistula)

- is it an external problem? (vascular ring, mediastinal mass)

Question 24

how do you make the diagnosis for tracheomalacia?

Answer 24

• looking
• bronchoscopy (endoscopy but asleep)
• CXR can be important
• swallow study

Question 25

aspiration in foreign body obstruction is most commonly due to _____________

Answer 25

food particles

Question 26

ingestion is most commonly a _______

Answer 26

coin

Question 27

the subglottic edema in croup mimics _________

Answer 27

subglottic stenosis