Sittel C
Klinik für Hals-, Nasen-, Ohrenkrankheiten, Plastische Operationen, Klinikum Stuttgart.
Laryngorhinootologie. 2014 Mar;93 Suppl 1:S70-83. doi: 10.1055/s-0033-1363212. Epub 2014 Apr 7.
Pathologies in the larynx and trachea in the pediatric age can be characterized in 4 main groups: airway stenosis, acute infections, benign neoplasia and foreign body aspiration. In this review main diagnostic strategies and therapeutic options are presented. Laryngomalazia is the most frequent condition of supraglottic stenosis. The term supraglottoplasty summarizes all different techniques used for it's repair using an endoscopic approach. Glottic stenosis is rare in children. Usually a compromise between voice preservation and airway restoration has to be sought. Type of reconstruction and timing are varying considerably in individual cases, endoscopic approaches should be preferred. Subglottic stenosis remains the largest group in paediatric airway pathology, with cicatrial stenosis being predominant. Today, cricotracheal resection is the most successful treatment option, followed by the classical laryngotracheal reconstruction with autologous cartilage. In early infancy subglottic stenosis is particularly demanding. Endoscopic treatment is possible in selected patients, but open reconstruction is superior in more severe cases. Tracheostomy is not a safe airway in early infancy, it's indication should be strict. Foreign body aspiration needs to be managed according to a clear algorhythm. Recurrent respiratory papillomatosis should be treated with emphasis on function preservation. The role of adjuvant medication remains unclear. Infectious diseases can be managed conservatively by a pediatrician in the majority of cases.
小儿年龄阶段喉和气管的病变可分为4大主要类型:气道狭窄、急性感染、良性肿瘤和异物吸入。本综述介绍了主要的诊断策略和治疗选择。喉软化是声门上狭窄最常见的情况。声门上成形术概括了使用内镜方法对其进行修复的所有不同技术。声门狭窄在儿童中较为罕见。通常必须在保留嗓音和恢复气道之间寻求平衡。重建类型和时机在个别病例中差异很大,应首选内镜方法。声门下狭窄仍然是小儿气道病变中最大的一组,瘢痕性狭窄最为常见。如今,环状气管切除术是最成功的治疗选择,其次是经典的自体软骨喉气管重建术。在婴儿早期,声门下狭窄的治疗尤其具有挑战性。部分患者可行内镜治疗,但在病情较重的情况下,开放重建术更具优势。在婴儿早期,气管切开术并非安全的气道,其指征应严格掌握。异物吸入需要按照明确的流程进行处理。复发性呼吸道乳头状瘤病的治疗应注重功能保留。辅助药物的作用仍不明确。在大多数情况下,传染病可由儿科医生进行保守治疗。