Division of Pediatric Pulmonology, Children's Hospital, China Medical University, Taichung, Taiwan.
Department of Pediatrics, Taipei Veterans General Hospital, Taipei, Taiwan.
Pediatr Pulmonol. 2022 Sep;57(9):2122-2127. doi: 10.1002/ppul.25988. Epub 2022 Jun 2.
We report a novel technique of flexible endoscopy with noninvasive ventilation (NIV) and sustained pharyngeal inflation (FE-NIV-SPI) in assessing aeroesophageal tracts (AET) to facilitate early detection of laryngeal clefts in infants.
Medical charts and flexible endoscopy videos of the children who were diagnosed with laryngeal cleft in a tertiary care hospital between January 2000 and December 2020 were retrospectively reviewed and analyzed. The FE-NIV-SPI technique had been applied to all these children.
Totally, 12 infants with laryngeal cleft were identified. This equates to a prevalence of 0.28% in all the children who underwent flexible endoscopy at our institution. Their mean age was 5.0 ± 4.9 months and mean body weight was 4.7 ± 2.3 kg. Nine (75%) infants were referred in without laryngeal cleft diagnosis, which was missed by 11 prior bronchoscopy and 5 computer tomography examinations. With the FE-NIV-SPI technique, the pharyngolaryngeal space could be pneumatically dilated permitting a detailed assessment. All laryngeal cleft types and coexisting AET lesions were visualized at the first FE-NIV-SPI examination with a mean time of 4.2 ± 0.9 min; they were eight Type I, two Type II, and one Type III. Ten (83.3%) infants had coexisting airway malacia.
Routine use of FE-NIV-SPI technique can help in early detection of laryngeal clefts and other associated AET lesions. Further multicenter collaborative investigations are essential to verify the early detection of this rare and occult lesion of the laryngeal cleft with this technique.
我们报告一种新型的内镜技术，即使用无创通气（NIV）和持续性咽部充气（FE-NIV-SPI）来评估食管气道（AET），以促进婴儿喉裂的早期发现。
回顾性分析 2000 年 1 月至 2020 年 12 月期间在一家三级保健医院诊断为喉裂的儿童的病历和内镜视频。所有这些儿童均应用 FE-NIV-SPI 技术。
总共发现 12 例喉裂婴儿，占我院所有接受内镜检查儿童的 0.28%。他们的平均年龄为 5.0±4.9 个月，平均体重为 4.7±2.3kg。9 例（75%）婴儿在没有喉裂诊断的情况下被转诊，而之前的 11 次支气管镜检查和 5 次计算机断层扫描检查均漏诊。使用 FE-NIV-SPI 技术，可以通过气动扩张咽喉腔，从而进行详细评估。所有的喉裂类型和并存的 AET 病变都可以在第一次 FE-NIV-SPI 检查中观察到，平均时间为 4.2±0.9 分钟；其中 8 例为Ⅰ型，2 例为Ⅱ型，1 例为Ⅲ型。10 例（83.3%）婴儿存在气道软化并存症。
常规应用 FE-NIV-SPI 技术有助于早期发现喉裂和其他并存的 AET 病变。进一步的多中心合作研究对于验证该技术早期发现这种罕见且隐匿的喉裂病变是必要的。
