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Kendigs Respiratory Diseases > Laryngeal Tracheal > Flashcards

Laryngeal Tracheal Flashcards

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1
Q

What is the overall management approach for laryngeal and tracheal airway disorders?

A

Overall management includes surgical airway intervention.

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2
Q

What are the three endoscopic procedures involved in operative assessment?

A
  • Flexible bronchoscopy with bronchoalveolar lavage (BAL)
  • Microlaryngoscopy and rigid bronchoscopy (MLB)
  • Esophagogastroduodenoscopy (EGD) with biopsy
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3
Q

What are advantages of flexible bronchoscopy over rigid bronchoscopy?

A
  • Facilitates identification of airway obstruction areas
  • Provides better assessment of disorders such as glossoptosis, laryngomalacia, tracheomalacia, and bronchomalacia
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4
Q

What is glossoptosis?

A

Downward displacement of the tongue.

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5
Q

What is the primary goal of microlaryngoscopy and rigid bronchoscopy?

A

Identify anatomic levels of airway obstruction from the larynx to the carina.

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6
Q

What conditions are assessed during microlaryngoscopy and rigid bronchoscopy?

A
  • Supraglottic obstruction
  • Vocal fold level obstruction
  • Posterior glottis evaluation
  • Subglottic stenosis (SGS)
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7
Q

What is the Myer-Cotton scale used for?

A

Classification of subglottic stenosis (SGS).

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8
Q

True or False: Operating on an inflamed airway has a high success rate.

A

False.

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9
Q

What are common signs of airway inflammation?

A
  • Cobblestoning of the mucosa
  • Eversion of the laryngeal ventricles
  • Edema of the subglottic mucosa
  • Loss of definition of tracheal rings
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10
Q

What two GI conditions are associated with laryngeal inflammation?

A
  • Eosinophilic esophagitis (EoE)
  • Gastroesophageal reflux disease (GERD)
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11
Q

What are the two most commonly used evaluations of swallowing?

A
  • Videofluoroscopic swallow study (VSS)
  • Fiberoptic endoscopic evaluation of swallowing (FEES)
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12
Q

Fill in the blank: The use of _______ testing may be useful in children who have a tracheotomy.

A

dye

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13
Q

What is a new indication for structural airway surgery?

A

Voice improvement rather than just airway improvement.

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14
Q

What are the prevalent types of bacterial colonization in patients with complex aerodigestive problems?

A
  • Methicillin-resistant Staphylococcus aureus (MRSA)
  • Pseudomonas aeruginosa
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15
Q

What is eosinophilic esophagitis (EoE)?

A

An uncommon disorder that can significantly affect the aerodigestive tract if left untreated.

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16
Q

What are the management recommendations for gastroesophageal reflux disease (GERD) in patients undergoing airway reconstruction?

A
  • Daily PPI
  • Nighttime H2 blocker therapy
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17
Q

What is the role of collaboration with a pediatric pulmonologist in airway management?

A

Important for diagnosis and management of pulmonary disease.

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18
Q

What is laryngomalacia?

A

The most common cause of stridor in newborns.

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19
Q

What is the typical presentation of severe laryngomalacia?

A
  • Apnea
  • Cyanosis
  • Severe retractions
  • Failure to thrive
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20
Q

What surgical procedure is the current choice for laryngomalacia?

A

Supraglottoplasty or epiglottoplasty.

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21
Q

What is the second most common cause of stridor in newborns?

A

Vocal cord paralysis.

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22
Q

What is the typical etiology of congenital vocal cord paralysis?

A

Usually idiopathic or associated with CNS pathology.

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23
Q

What is the typical management for acquired vocal cord paralysis?

A
  • Observation
  • Medialization by temporary injection
  • Speech and voice therapy
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24
Q

What are the potential surgical options for acquired bilateral vocal cord paralysis?

A
  • Laser cordotomy
  • Partial or complete arytenoidectomy
  • Vocal process lateralization
  • Posterior cricoid cartilage grafting
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25
What is the manifestation of laryngeal webs?
* Abnormal cry * Respiratory distress
26
What is the embryogenic cause of laryngeal webs?
Failure of recanalization of the glottic airway.
27
What is laryngeal atresia?
A failure of the laryngeal lumen to recanalize. ## Footnote It is part of a continuum of embryologic failures that includes stenosis and webs.
28
How does recanalization in laryngeal atresia progress?
It commences posteriorly and progresses anteriorly.
29
What are less severe cases of laryngeal atresia characterized by?
Thin anterior glottic web.
30
What are glottic webs typically associated with?
22q11.2 deletion syndrome in 60% of cases.
31
What is the typical appearance of thick glottic webs?
Thickened anteriorly and thinning towards the posterior edge.
32
What are the manifestations of glottic webs?
* Abnormal cry * Respiratory distress
33
How may thick webs impact the subglottic lumen?
They are generally associated with a subglottic 'sail' that compromises the subglottic lumen.
34
What is a potential consequence of thin webs in neonates?
They may evade detection due to neonatal intubation for airway distress potentially lysing the web.
35
What is the required intervention for thick webs?
Open reconstruction with either reconstruction of the anterior commissure or placement of a laryngeal keel.
36
What percentage of patients with thick membranous webs require tracheotomy?
Approximately 40%.
37
What defines congenital subglottic stenosis (SGS) in neonates?
A lumen 4.0 mm in diameter or less at the level of the cricoid.
38
What is congenital SGS often associated with?
Other congenital head and neck lesions and syndromes.
39
What is the most common cause of acquired SGS?
Prolonged neonatal intubation.
40
What are the cofactors associated with acquired SGS?
* Reflux * EoE
41
How is the severity of SGS graded?
According to the Myer-Cotton grading system.
42
What is the mildest form of SGS characterized by?
No obstruction to 50% obstruction.
43
What is the most significant investigation for SGS?
High-kilovoltage airway films.
44
What is the gold standard for assessing SGS?
Endoscopic assessment.
45
What is the risk associated with intubation in congenital SGS patients?
Development of acquired SGS.
46
What are the endoscopic options for mild symptoms of SGS?
* Radial incisions * Laryngeal dilatation * Application of topical or injected steroids
47
What is the reliable surgical approach for severe SGS?
Laryngotracheal reconstruction using costal cartilage grafts.
48
What is vascular compression of the airway commonly associated with?
* Innominate artery compression * Double aortic arch * Pulmonary artery sling
49
What are the symptoms of symptomatic vascular compression?
* Biphasic stridor * Retractions * Brassy cough * 'Dying spells'
50
What diagnostic procedures are used for vascular compression?
* Rigid bronchoscopy * Flexible bronchoscopy * Thoracic imaging
51
What is the surgical management for innominate artery compression?
Thymectomy and aortopexy.
52
What is the consequence of long-standing vascular compression?
Adverse effects on normal cartilaginous development leading to malacia or stenosis.
53
What results from a failure of the laryngotracheal groove to fuse during embryogenesis?
Posterior laryngeal clefts.
54
What are the main clinical features of posterior laryngeal clefts?
Aspiration, apnea, recurrent pneumonia, feeding difficulties, airway obstruction.
55
What is the recommended management for type I and II posterior laryngeal clefts?
Endoscopic repair.
56
What is the hallmark clinical feature of Opitz-Frias syndrome?
Aspiration.
57
What is the most common congenital tracheal anomaly?
Tracheomalacia.
58
What are the common symptoms of tracheomalacia?
* Brassy cough * Wheezing * Respiratory distress when agitated
59
What is the key diagnostic element for tracheomalacia?
Severity and location of malacia.
60
What is the most common intervention for severe tracheomalacia?
Tracheotomy placement.
61
What is a rare and life-threatening anomaly affecting the airway?
Complete tracheal rings.
62
What is the expected respiratory function presentation for complete tracheal rings?
Progressive worsening of respiratory function over the first few months of life.
63
What is the recommended surgical technique for complete tracheal rings?
Slide tracheoplasty.

Kendigs Respiratory Diseases (38 decks)

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