Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati College of Medicine, and Division of Pediatric Otolaryngology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio 45267-0528, USA.
Otolaryngol Head Neck Surg. 2011 Feb;144(2):257-61. doi: 10.1177/0194599810390012. Epub 2011 Jan 4.
To determine the success of initial airway management and to characterize late airway-related complications in patients with airway obstruction due to congenital head and neck teratomas.
Case series with chart review.
Tertiary airway referral institution.
Review of consecutive patients with congenital head and neck teratomas from 1988 to 2010. Variables examined include initial airway stabilization at time of birth and perinatal airway management. Outcomes include short- and long-term complications.
Fourteen cases were reviewed. In 12 patients, initial airway management was accomplished on placental support with either intubation or tracheotomy. Two vaginal births required subsequent uncomplicated oral intubation within 24 hours. Nine patients required tracheotomy (3 within the delivery suite, 2 during mass excision on day of life 6 and 24, and the remaining 4 occurred at days 29, 32, 92, and 100). Five deaths occurred, 4 within several days of birth due to complications related to the cervical teratomas and 1 on day of life 32 due to an airway-related complication. Follow-up for surviving patients ranged from 1 month to 18 years. Long-term airway complications ranged from vocal cord paralysis to stenosis requiring laryngotracheoplasty.
This study demonstrates that a multidisciplinary team and a standardized approach in the operating suite have led to successful initial airway stabilization. Furthermore, this study demonstrates the need for continued airway management after delivery. Reassessment of the airway after delivery and an airway management planning meeting with the multidisciplinary team may help decrease morbidity and mortality.
确定先天性头颈部畸胎瘤气道阻塞患者初始气道管理的成功率，并描述晚期与气道相关的并发症。
病例系列回顾研究。
三级气道转诊机构。
回顾 1988 年至 2010 年期间连续就诊的先天性头颈部畸胎瘤患者。检查的变量包括出生时初始气道稳定情况和围产期气道管理。结果包括短期和长期并发症。
共回顾了 14 例患者。在 12 例患者中，通过胎盘支持完成了初始气道管理，方法为插管或气管切开术。2 例阴道分娩在 24 小时内需要随后进行简单的经口插管。9 例患者需要气管切开术（3 例在分娩室进行，2 例在出生后第 6 天和第 24 天进行大块切除时进行，其余 4 例在第 29、32、92 和 100 天进行）。有 5 例死亡，4 例在出生后几天内死亡，与颈段畸胎瘤相关并发症有关，1 例在出生后第 32 天因气道相关并发症死亡。存活患者的随访时间为 1 个月至 18 年。长期气道并发症从声带麻痹到需要行喉气管成形术的狭窄不等。
本研究表明，多学科团队和手术室的标准化方法可成功稳定初始气道。此外，本研究表明分娩后需要继续气道管理。分娩后对气道进行重新评估并与多学科团队进行气道管理计划会议，可能有助于降低发病率和死亡率。
