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Laryngorhinootologie 2014; 93(S 01): S49-S69
DOI: 10.1055/s-0033-1363212
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© Georg Thieme Verlag KG Stuttgart · New York

Erkrankungen von Larynx und Trachea im Kindesalter

Pathologies of the Larynx and Trachea in Childhood
C. Sittel
1   Klinik für Hals-, Nasen-, Ohrenkrankheiten, Plastische Operationen, Klinikum Stuttgart
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Publication History

Publication Date:
07 April 2014 (online)

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Zusammenfasung

Im Kindesalter sind Erkrankungen des Larynx und der Trachea 4 Hauptgruppen zuzuordnen: Stenosierungen, akuten Entzündungen, benigne Neubildungen und Fremdköperaspirationen. In dieser Übersicht werden die wichtigsten Krankheitsbilder und Therapieformen vorgestellt. Die konservativen, endoskopischen und operativen Behandlungsverfahren werden dargestellt und gewertet.

Die Laryngomalazie als häufigste Form der ­supraglottischen Stenose kommt vorwiegend im Neugeborenenalter vor. Unter dem Oberbegriff Supraglottoplastik werden minimal-invasive Techniken zur Korrektur dieser Fehlbildungen zusammengefasst.

Glottische Stenosen sind im Kindesalter die seltenste Form der Atemwegsverengung. Meist muss ein Kompromiss zwischen Atmung und Stimmbildung gefunden werden. Zeitpunkt und Art der Rekonstruktion hängen stark vom Einzelfall ab, ein endoskopisches Vorgehen ist anzustreben.

Subglottische Stenosen stellen die größte Gruppe der laryngotrachealen Pathologie dar, meist in Form von Vernarbungen unterschiedlicher Ätiologie. Die cricotracheale Resektion ist heute die erfolgreichste Technik, gefolgt von der laryngotrachealen Rekonstruktion mit autologem Knorpel. Frühkindliche subglottische Stenosen stellen besondere Herausforderungen. Endoskopische Verfahren sind im Einzelfall möglich, bleiben zur Behandlung subglottischer Stenosen jedoch von untergeordneter Bedeutung.

Die Tracheotomie ist im Kleinkindalter kein sicherer Atemweg und sollte streng indiziert werden.

Fremdkörperaspirationen sind häufig und erforden ein systematisches Management. Die rezidivierende respiratorische Papillomatose sollte funktionsorientiert behandelt werden, die Rolle adjuvanter Therapien ist nicht abschließend gesichert. Entzündliche Veränderungen sind meist konservativ beherrschbar und werden primär durch Pädiater behandelt.

Abstract

Pathologies of the Larynx and Trachea in Childhood

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.

Schlüsselwörter

subglottische Stenose - cricotracheale Resektion - laryngotracheale ­Rekonstruktion - kindliche Atemwegsstenose

Key words

pediatric subglottic stenosis - cricotracheal resection - laryngotracheal ­reconstruction - pediatric airway stenosis
 

  • Literatur

  • 1 Berkowitz RG. Natural history of tracheostomy-dependent idiopathic congenital bilateral vocal fold paralysis. Otolaryngology – head and neck surgery: official journal of American Academy of Otolaryngology – Head and Neck Surgery 2007; 136: 649-652
    PubMedGoogle Scholar
  • 2 Bielamowicz S, Villagomez V, Stager SV et al. Intralesional cidofovir therapy for laryngeal papilloma in an adult cohort. The Laryngoscope 2002; 112: 696-699
    CrossrefPubMedGoogle Scholar
  • 3 Carrat X, Verhulst J, Duroux S et al. Postintubation interarytenoid adhesion. The Annals of otology, rhinology, and laryngology 2000; 109: 736-740
    PubMedGoogle Scholar
  • 4 Chadha NK, James A. Adjuvant antiviral therapy for recurrent respiratory papillomatosis. The Cochrane database of systematic reviews 2012; 12 CD005053
    PubMedGoogle Scholar
  • 5 Corbett HJ, Mann KS, Mitra I et al. Tracheostomy – a 10-year experience from a UK pediatric surgical center. Journal of Pediatric Surgery 2007; 42: 1251-1254
    CrossrefPubMedGoogle Scholar
  • 6 Denoyelle F, Mondain M, Gresillon N et al. Failures and complications of supraglottoplasty in children. Archives of otolaryngology – head & neck surgery 2003; 129: 1077-1080 discussion 1080
    PubMedGoogle Scholar
  • 7 Derkay CS. Recurrent respiratory papillomatosis. The Laryngoscope 2001; 111: 57-69
    CrossrefPubMedGoogle Scholar
  • 8 Derkay CS, Volsky PG, Rosen CA et al. Current use of intralesional cidofovir for recurrent respiratory papillomatosis. The Laryngoscope 2013; 123: 705-712
    CrossrefPubMedGoogle Scholar
  • 9 Dikkers FG. Treatment of recurrent respiratory papillomatosis with microsurgery in combination with intralesional cidofovir – a prospective study. European archives of oto-rhino-laryngology: official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS): affiliated with the German Society for Oto-Rhino-Laryngology – Head and Neck Surgery 2006; 263: 440-443
    PubMedGoogle Scholar
  • 10 Fraga JC, Schopf L, Forte V. Thyroid alar cartilage laryngotracheal reconstruction for severe pediatric subglottic stenosis. J Pediatr Surg 2001; 36: 1258-1261
    CrossrefPubMedGoogle Scholar
  • 11 Fraga JC, Schopf L, Forte V. Thyroid alar cartilage laryngotracheal reconstruction for severe pediatric subglottic stenosis. Journal of Pediatric Surgery 2001; 36: 1258-1261
    CrossrefPubMedGoogle Scholar
  • 12 Fraga JC, Souza JC, Kruel J. Pediatric tracheostomy. J Pediatr (Rio J.) 2009; 85: 97-103
    CrossrefPubMedGoogle Scholar
  • 13 Lichtenberger G. Endoscopic microsurgical management of scars in the posterior commissure and interarytenoid region resulting in vocal cord pseudoparalysis. European archives of oto-rhino-laryngology: official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS): affiliated with the German Society for Oto-Rhino-Laryngology – Head and Neck Surgery 1999; 256: 412-414
    PubMedGoogle Scholar
  • 14 Garabedian EN, Nicollas R, Roger G et al. Cricotracheal resection in children weighing less than 10 kg. Archives of otolaryngology – head & neck surgery 2005; 131: 505-508
    PubMedGoogle Scholar
  • 15 George M, Jaquet Y, Ikonomidis C et al. Management of severe pediatric subglottic stenosis with glottic involvement. The Journal of thoracic and cardiovascular surgery 2010; 139: 411-417
    CrossrefPubMedGoogle Scholar
  • 16 Hartnick CJ, Hartley BE, Lacy PD et al. Surgery for pediatric subglottic stenosis: disease-specific outcomes. Ann.Otol.Rhinol.Laryngol. 2001; 110: 1109-1113
    PubMedGoogle Scholar
  • 17 Healy GB, Gelber RD, Trowbridge AL et al. Treatment of recurrent respiratory papillomatosis with human leukocyte interferon. Results of a multicenter randomized clinical trial. The New England journal of medicine 1988; 319: 401-407
    CrossrefPubMedGoogle Scholar
  • 18 Heyer CM, Bollmeier ME, Rossler L et al. Evaluation of clinical, radiologic, and laboratory prebronchoscopy findings in children with suspected foreign body aspiration. Journal of pediatric surgery 2006; 41: 1882-1888
    CrossrefPubMedGoogle Scholar
  • 19 Hoff SR, Schroeder Jr. JW, Rastatter JC et al. Supraglottoplasty outcomes in relation to age and comorbid conditions. Int J Pediatr Otorhinolaryngol 2010; 74: 245-249
    CrossrefPubMedGoogle Scholar
  • 20 Holinger LD. Etiology of stridor in the neonate, infant and child. The Annals of otology, rhinology, and laryngology 1980; 89: 397-400
    PubMedGoogle Scholar
  • 21 Holinger LD, Konior RJ. Surgical management of severe laryngomalacia. The Laryngoscope 1989; 99: 136-142
    PubMedGoogle Scholar
  • 22 Horn DL, Maguire RC, Simons JP et al. Endoscopic anterior cricoid split with balloon dilation in infants with failed extubation. The Laryngoscope 2012; 122: 216-219
    CrossrefPubMedGoogle Scholar
  • 23 Javia LR, Zur KB, Jacobs IN. Evolving treatments in the management of laryngotracheal hemangiomas: will propranolol supplant steroids and surgery?. International journal of pediatric otorhinolaryngology 2011; 75: 1450-1454
    CrossrefPubMedGoogle Scholar
  • 24 Koitschev A, Sittel C. Laryngomalazie. Wann ist eine Operation sinnvoll? [Laryngomalacia. When does surgery make sense?]. HNO 2012; 60: 573-580
    CrossrefPubMedGoogle Scholar
  • 25 Krashin E, Ben-Ari J, Springer C et al. Synchronous airway lesions in laryngomalacia. Int J Pediatr Otorhinolaryngol 2008; 72: 501-507
    CrossrefPubMedGoogle Scholar
  • 26 Lee JH, Smith RJ. Recurrent respiratory papillomatosis: pathogenesis to treatment. Current opinion in otolaryngology & head and neck surgery 2005; 13: 354-359
    CrossrefPubMedGoogle Scholar
  • 27 Merkenschlager A, Sanktjohanser L, Hundt C et al. Diagnostische Wertigkeit der Rontgenthoraxaufnahme bei tracheobronchialen Fremdkorpern im Kindesalter. [Diagnostic value of a plain radiograph of the chest in suspected tracheobronchial foreign body aspiration in children]. Pneumologie (Stuttgart, Germany) 2009; 63: 325-328
    Article in Thieme ConnectPubMedGoogle Scholar
  • 28 Monnier P, George M, Monod ML et al. The role of the CO2 laser in the management of laryngotracheal stenosis: a survey of 100 cases. European archives of oto-rhino-laryngology: official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS): affiliated with the German Society for Oto-Rhino-Laryngology – Head and Neck Surgery 2005; 262: 602-608
    PubMedGoogle Scholar
  • 29 Monnier P, Lang F, Savary M. Partial cricotracheal resection for severe pediatric subglottic stenosis: update of the Lausanne experience. The Annals of otology, rhinology, and laryngology 1998; 107: 961-968
    PubMedGoogle Scholar
  • 30 Monnier P, Savary M, Chapuis G. Partial cricoid resection with primary tracheal anastomosis for subglottic stenosis in infants and children. The Laryngoscope 1993; 103: 1273-1283
    PubMedGoogle Scholar
  • 31 Naiman AN, Ceruse P, Coulombeau B et al. Intralesional cidofovir and surgical excision for laryngeal papillomatosis. The Laryngoscope 2003; 113: 2174-2181
    CrossrefPubMedGoogle Scholar
  • 32 Nicolai T. Akute Atemwegsobstruktion bei Kindern. Pädiatrische Intensivmedizin 2009; 9
    PubMedGoogle Scholar
  • 33 Nicollas R, Triglia JM. The anterior laryngeal webs. Otolaryngologic clinics of North America 2008; 41: 877-888 viii
    CrossrefPubMedGoogle Scholar
  • 34 Olney DR, Greinwald Jr. JH, Smith RJ et al. Laryngomalacia and its treatment. The Laryngoscope 1999; 109: 1770-1775
    CrossrefPubMedGoogle Scholar
  • 35 Pasquale K, Wiatrak B, Woolley A et al. Microdebrider versus CO2 laser removal of recurrent respiratory papillomas: a prospective analysis. The Laryngoscope 2003; 113: 139-143
    CrossrefPubMedGoogle Scholar
  • 36 Patel N, Rowe M, Tunkel D. Treatment of recurrent respiratory papillomatosis in children with the microdebrider. The Annals of otology, rhinology, and laryngology 2003; 112: 7-10
    PubMedGoogle Scholar
  • 37 Pransky SM, Albright JT, Magit AE. Long-term follow-up of pediatric recurrent respiratory papillomatosis managed with intralesional cidofovir. The Laryngoscope 2003; 113: 1583-1587
    CrossrefPubMedGoogle Scholar
  • 38 Reddy DK, Matt BH. Unilateral vs. bilateral supraglottoplasty for severe laryngomalacia in children. Archives of otolaryngology – head & neck surgery 2001; 127: 694-699
    PubMedGoogle Scholar
  • 39 Reilly J, Thompson J, Macarthur C et al. Pediatric aerodigestive foreign body injuries are complications related to timeliness of diagnosis. The Laryngoscope 1997; 107: 17-20
    CrossrefPubMedGoogle Scholar
  • 40 Rutter MJ, Cohen AP, De Alarcon A. Endoscopic airway management in children. Current opinion in otolaryngology & head and neck surgery 2008; 16: 525-529
    CrossrefPubMedGoogle Scholar
  • 41 Schraff S, Derkay CS, Burke B et al. American Society of Pediatric Otolaryngology members’ experience with recurrent respiratory papillomatosis and the use of adjuvant therapy. Archives of otolaryngology – head & neck surgery 2004; 130: 1039-1042
    PubMedGoogle Scholar
  • 42 Schroeder Jr. JW, Bhandarkar ND, Holinger LD. Synchronous airway lesions and outcomes in infants with severe laryngomalacia requiring supraglottoplasty. Archives of otolaryngology – head & neck surgery 2009; 135: 647-651
    PubMedGoogle Scholar
  • 43 Schultz-Coulon HJ. Management von Postintubationsstenosen bei Kindern. [The management of postintubation stenoses in children]. HNO 2004; 52: 363-377 quiz 378
    CrossrefPubMedGoogle Scholar
  • 44 Sittel C. Subglottische Stenosen im 1. Lebensjahr. Besonderheiten und Therapieoptionen. [Subglottic stenosis in the first year of life. Characteristics and treatment options]. Hno 2012; 60: 568-572
    CrossrefPubMedGoogle Scholar
  • 45 Snoeck R, Andrei G, De Clercq E. Specific therapies for human papilloma virus infections. Current opinion in infectious diseases 1998; 11: 733-737
    CrossrefPubMedGoogle Scholar
  • 46 Tanna N, Sidell D, Joshi AS et al. Adult intralesional cidofovir therapy for laryngeal papilloma: a 10-year perspective. Archives of otolaryngology – head & neck surgery 2008; 134: 497-500
    PubMedGoogle Scholar
  • 47 Tjon Pian Gi RE, Ilmarinen T, Van Den Heuvel ER et al. Safety of intralesional cidofovir in patients with recurrent respiratory papillomatosis: an international retrospective study on 635 RRP patients. European archives of oto-rhino-laryngology: official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS): affiliated with the German Society for Oto-Rhino-Laryngology – Head and Neck Surgery 2013; 270: 1679-1687
    PubMedGoogle Scholar
  • 48 Toynton SC, Saunders MW, Bailey CM. Aryepiglottoplasty for laryngomalacia: 100 consecutive cases. The Journal of Laryngology and Otology 2001; 115: 35-38
    PubMedGoogle Scholar
  • 49 Unal M. The successful management of congenital laryngeal web with endoscopic lysis and topical mitomycin-C. Int J Pediatr Otorhinolaryngol 2004; 68: 231-235
    CrossrefPubMedGoogle Scholar
  • 50 Vollrath M, Freihorst J, Von Der Hardt H. Die Chirurgie der erworbenen laryngotrachealen Stenosen im Kindesalter. Erfahrungen und Ergebnisse von 1988 bis 1998. Teil I: Die Laryngotracheale Rekonstruktion. [Surgery of acquired laryngotracheal stenoses in childhood. Experiences and results from 1988-1998. II: The laryngotracheal reconstruction]. HNO 1999; 47: 457-465
    CrossrefPubMedGoogle Scholar
  • 51 Werner JA, Lippert BM, Dunne AA et al. Epiglottopexy for the treatment of severe laryngomalacia. European archives of oto-rhino-laryngology: official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS): affiliated with the German Society for Oto-Rhino-Laryngology – Head and Neck Surgery 2002; 259: 459-464
    PubMedGoogle Scholar
  • 52 Wierzbicka M, Jackowska J, Bartochowska A et al. Effectiveness of cidofovir intralesional treatment in recurrent respiratory papillomatosis. European archives of oto-rhino-laryngology: official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS): affiliated with the German Society for Oto-Rhino-Laryngology – Head and Neck Surgery 2011; 268: 1305-1311
    PubMedGoogle Scholar
  • 53 Yuen HW, Tan HK, Balakrishnan A. Synchronous airway lesions and associated anomalies in children with laryngomalacia evaluated with rigid endoscopy. Int J Pediatr Otorhinolaryngol 2006; 70: 1779-1784
    CrossrefPubMedGoogle Scholar
  • 54 Zalzal GH, Collins WO. Microdebrider-assisted supraglottoplasty. Int J Pediatr Otorhinolaryngol 2005; 69: 305-309
    CrossrefPubMedGoogle Scholar
  • 55 Zoorob R, Sidani M, Murray J. Croup: an overview. American family physician 2011; 83: 1067-1073
    PubMedGoogle Scholar