Haytham Kubba

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Paediatric airway for the intercollegiate

• Haytham Kubba
• Consultant Paediatric Otolaryngologist
• Yorkhill

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inspiration expiration

• Inspiratory, positional, intermittent
• Worse with feeds, crying
• Gets worse over first few weeks
• Gets better over 18 months

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Take home message 1laryngomalacia

• MLB if
• FTT
• Apnoeas
• Cutaneous haemangiomas
• History of intubation
• Biphasic/expiratory stridor

• Diagnosis
• awake fibreoptic laryngoscopy
• Treat reflux
• Gaviscon infant
• Ranitidine
• Carobel feed thickener
• 90 need no surgery

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Take home message 2neonatal failure to extubate

• Appropriate tube size
• audible leak at 20cmH20
• Rest
• Steroids
• Cricoid split
• 50-75 avoid tracheostomy

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Take home message 3airway reconstruction surgery

• LTR is robust, reliable procedure with excellent
  results
• Decannulation rates 99 gd 1/2, 86 gd 3/4
• CTR for extreme cases
• Similar techniques adapted for
• Clefts
• Webs

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Take home message 4papillomas

• Vertically acquired from mother (vaccine)
• HPV 611
• Mostly confined to larynx, spont regression
• Debulking surgery haircut
• Avoid trache, intubation
• BP disease usually fatal
• Medical adjuncts
• IFN
• cidofovir

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Take home message 5haemangiomas

• Isolated subglottic haemangiomas
• Single stage open submucosal excision
• Large infiltrating haemangiomas
• Medical treatments may avoid tracheostomy
• Steroids
• Interferon
• Vincristine

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Take home message 6Pierre Robin sequence

• Prone positioning, oxygen
• Nasopharyngeal airway
• Tongue-lip adhesion
• Tracheostomy

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Assessment of stridulous child

• History
• Examination
• Investigations

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History

• Intubation
• Surgery
• Apnoeas, cyanosis
• Feeding
• Nature of stridor

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Examination

• Work of breathing
• Cyanosis, resp rate, accessory muscles
• recession, tracheal tug
• Cutaneous haemangiomas
• Nature of stridor

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Acute stridor

• Adrenaline nebs
• Dexamethasone
• Oxygen
• Airway positioning
• Intubation

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Radiology

• Cincinnati views?
• High kV CXR with brass filter
• air / soft tissue contrast
• Historical interest
• Barium swallow?
• Indentation from great vessel anomaly
• Double aortic arch, aberrant subclavian

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Investigation of stridor

• Definitive investigation is endoscopy
• CXR worthwhile
• MRA for vascular compression

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Take home message 7assessment of stridulous
child

• No substitute for thorough examination
• Every child with stridor deserves a diagnosis
• Endoscopic management whenever possible