TY - JOUR
T1 - Diagnostic considerations prior to pediatric tracheocutaneous fistula closure
AU - Chorney, Stephen R.
AU - Husain, Solomon
AU - Sobol, Steven E.
N1 - Publisher Copyright:
© 2020 Elsevier B.V.
PY - 2020/11
Y1 - 2020/11
N2 - Introduction: An airway assessment often occurs prior to tracheocutaneous fistula (TCF) closure in children. Bronchoscopy (MLB) with or without fistula-occluded polysomnography (PSG) helps determine candidacy and localize potential obstruction. To date, little has been published on MLB or PSG findings in children before surgically closing a TCF. Methods: A case series with chart review of children between 2017 and 2020 who underwent repair of a TCF after tracheostomy decannulation. Results: Thirty-six children were included for review. Mean age was 5.9 years (95% CI: 4.5–7.3), 58.3% were male, and 50% had chronic lung disease. Surgery occurred 13.3 months (95% CI: 11.9–14.8) after decannulation, with 80.6% by primary closure and 19.4% by secondary intention. There was one unsuccessful closure and two patients (5.6%) presented with a postoperative complication. An MLB was performed in 97.2% of children, where 22.9% identified supraglottic pathology, 11.4% had grade 2 subglottic stenosis, and 11.4% had difficult exposure of the larynx. Further, one child had a non-obstructing subglottic cyst, one had a supraglottoplasty for redundant arytenoid mucosa, and two children had suprastomal granulomas requiring removal. A PSG was obtained in 36.1%, with a mean Apnea-Hypopnea Index of 2.4 events/hour (95% CI: 0.9–3.9), nadir Oxygen saturation of 90.5% (95% CI: 87.9–93.0), and peak end-tidal CO2 of 46.1 mmHg (95% CI: 43.7–48.5). Conclusion: The selection of candidates for pediatric TCF closure requires careful evaluation of the airway. Surgeons should be familiar with the potential findings on MLB and PSG prior to closure.
AB - Introduction: An airway assessment often occurs prior to tracheocutaneous fistula (TCF) closure in children. Bronchoscopy (MLB) with or without fistula-occluded polysomnography (PSG) helps determine candidacy and localize potential obstruction. To date, little has been published on MLB or PSG findings in children before surgically closing a TCF. Methods: A case series with chart review of children between 2017 and 2020 who underwent repair of a TCF after tracheostomy decannulation. Results: Thirty-six children were included for review. Mean age was 5.9 years (95% CI: 4.5–7.3), 58.3% were male, and 50% had chronic lung disease. Surgery occurred 13.3 months (95% CI: 11.9–14.8) after decannulation, with 80.6% by primary closure and 19.4% by secondary intention. There was one unsuccessful closure and two patients (5.6%) presented with a postoperative complication. An MLB was performed in 97.2% of children, where 22.9% identified supraglottic pathology, 11.4% had grade 2 subglottic stenosis, and 11.4% had difficult exposure of the larynx. Further, one child had a non-obstructing subglottic cyst, one had a supraglottoplasty for redundant arytenoid mucosa, and two children had suprastomal granulomas requiring removal. A PSG was obtained in 36.1%, with a mean Apnea-Hypopnea Index of 2.4 events/hour (95% CI: 0.9–3.9), nadir Oxygen saturation of 90.5% (95% CI: 87.9–93.0), and peak end-tidal CO2 of 46.1 mmHg (95% CI: 43.7–48.5). Conclusion: The selection of candidates for pediatric TCF closure requires careful evaluation of the airway. Surgeons should be familiar with the potential findings on MLB and PSG prior to closure.
KW - Bronchoscopy
KW - Polysomnography
KW - Tracheocutaneous fistula
KW - Tracheostomy decannulation
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U2 - 10.1016/j.ijporl.2020.110357
DO - 10.1016/j.ijporl.2020.110357
M3 - Article
C2 - 32911241
AN - SCOPUS:85090346849
SN - 0165-5876
VL - 138
JO - International Journal of Pediatric Otorhinolaryngology
JF - International Journal of Pediatric Otorhinolaryngology
M1 - 110357
ER -