Diagnostic considerations prior to pediatric tracheocutaneous fistula closure

Stephen R. Chorney, Solomon Husain, Steven E. Sobol

Research output: Contribution to journalArticlepeer-review

Abstract

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.

Original languageEnglish (US)
Article number110357
JournalInternational Journal of Pediatric Otorhinolaryngology
Volume138
DOIs
StatePublished - Nov 2020
Externally publishedYes

Keywords

  • Bronchoscopy
  • Polysomnography
  • Tracheocutaneous fistula
  • Tracheostomy decannulation

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Otorhinolaryngology

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