Die Indikationen zur Tracheostomie haben sich in den letzten Jahrzehnten immer mehr vom Bereich der Akutversorgung bei obstruktiven Atemwegsverlegungen hin zum Bereich der Intensivmedizin verlagert. Die Liste der Indikationen zur Tracheotomie wird mittlerweile von intensivmedizinischen Indikationen angefuhrt. Dieses Kapitel steht daher im Zeichen der verschiedenen Fachdisziplinen, die im klinischen Alltag in erster Linie eine Tracheotomie indizieren: Hals-Nasen-Heilkunde, Mund-Kiefer-Gesichts-Chirurgie/Traumatologie, Padiatrie und Neurologie. Ein besonderer Stellenwert kommt in diesem Kapitel den laryngotrachealen Stenosen und beidseitigen Rekurrensparesen zu, fur deren Behandlung neben der herkommlichen Tracheotomieindikation eine Reihe alternativer Behandlungsstrategien zur Verfugung stehen, die hier ausfuhrlich besprochen werden sollen.

Indikationen zur Tracheostomie

Absztrakt: Bevezetes: A veleszuletett csecsemőkori dyspnoe es inspiratorikus stridor leggyakoribb oka a laryngomalacia. Celkitűzes: Jelen osszeallitasban a szerzők egy uj, minimalisan invaziv, ultrapulzacios (ultra dream pulse) lezeres gegesebeszeti modszert mutatnak be, amely joval kisebb karbonizacios zonat hoz letre, mint a korabbi CO2-lezeres beavatkozasok, igy kisebb az esely a posztoperativ gegeodema es hegesedes kialakulasara. Modszer: A szerzők 2012 es 2015 kozott 10, egy evnel fiatalabb, sulyos foku stridort okozo laryngomalacias betegen vegeztek endoszkopos ultrapulzacios-lezeres supraglottoplasticat. Eredmenyek: A beavatkozas utan a stridoros panaszok javultak, a korai posztoperativ időszakban odema egy esetben sem jelentkezett, a kesőbbiek soran hegesedes sem alakult ki, tracheotomiat nem kellett vegezni, reoperaciora nem kerult sor. Kovetkeztetes: A kesői utankoveteses vizsgalatok soran visszaesest egy alkalommal sem tapasztaltunk. Orv Hetil. 2017; 158(33): 1288–1292.

/pdf/a-laryngomalacia-endoszkopos-ultrapulzacios-lezeres-ultra-1dxqydpbvf.pdf

A laryngomalacia endoszkópos ultrapulzációs-lézeres (ultra dream pulse) sebészete. A módszer hazai bevezetése során szerzett tapasztalataink

Die Behandlung von Stenosen der oberen Atemwege kann Arzte und Patienten vor Herausforderungen stellen, und der Leidensdruck der Patienten ist mitunter hoch. Klinische Erfahrung und engmaschige interdisziplinare Zusammenarbeit sind entscheidend fur den Therapieerfolg.

Stenosen der oberen Atemwege bei Kindern und Erwachsenen





Objective: The study aims to review the clinical outcomes of supraglottoplasty in moderate and severe laryngomalacia. Methods: This is a retrospective study. Demographic and clinical data of children diagnosed with moderate and severe laryngomalacia who underwent supraglottoplasty between 2012 and 2021 were retrieved from the computerized patient record system of Hospital Sultanah Bahiyah. The surgical procedure of supraglottoplasty was mainly performed with cold instrument, with occasional assistance from a microdebrider. Study outcome includes complete stridor resolution, weaning from tube feeding, and weaning from respiratory support post supraglottoplasty. Results: 124 children were included in the study. Complete stridor resolution was achieved in 64.51% (n=80) 1-month post-surgery and 86.29% (n=107) 3-months post-surgery. Half of the children with tube feeding pre-operatively could be weaned off to oral feeding within 1-month post-surgery. All the children with oral feeding maintained oral feeding post-surgery. All the children with no or low respiratory support (nasal prong oxygen) pre-operatively were able to be weaned down to room air within 1-month post-surgery. Within the group of children with high respiratory support (high-flow nasal cannula, non-invasive ventilation, and endotracheal intubation) pre-operatively, half were weaned down to room air within 1-month post-surgery. None of the children with isolated laryngomalacia required tracheostomy after supraglottoplasty. All laryngomalacia patients who required tracheostomy after supraglottoplasty were associated with either synchronous airway lesions or medical comorbidities. Only 3 cases (2.42%) required revision supraglottoplasty with a maximum of one revision. Conclusions: We conclude that supraglottoplasty contributes to substantial clinical improvement in moderate and severe laryngomalacia. Supraglottoplasty facilitated weaning down of respiratory support and tube feeding in laryngomalacia with respiratory difficulty and feeding intolerance.





Cold Instruments, Warm Outcomes: A Decade of Supraglottoplasty in Managing Children with Moderate and Severe Laryngomalacia

Atemwegsobstruktion oberhalb der Stimmlippenebene – Diagnostik und Therapie

Laryngomalacia is the most common cause of stridor in infants. The stridor is caused by an inward collapse of supraglottic structures during inspiration resulting in an inspiratory stridor. The exact etiology still remains unclear. The surgical procedure of choice for laryngomalacia is supraglottoplasty. From 2009 to 2016 a total of 71 children were treated by supraglottoplasty in the department for pediatric otorhinolaryngology of the Stuttgart Hospital. The indications for supraglottoplasty were laryngomalacia with severe inspiratory stridor, oxygen desaturation, suprasternal or chest retraction, feeding difficulties and/or failure to thrive. The overall success rate was 86 % but there was a clear difference between children with isolated laryngomalacia and the group with associated comorbidities. The success rate for patients with isolated laryngomalacia was 98 % and for patients with associated comorbidities 57 %. Supraglottoplasty is therefore an effective and safe treatment for symptomatic laryngomalacia and a reduction in the success rate showed a clear correlation with the presence of congenital comorbidities.

[Supraglottoplasty for pediatric laryngomalacia : Results from 71 cases].

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[Supraglottoplasty for pediatric laryngomalacia : Results from 71 cases].