Abstract
Tracheomalacia involving the whole of the trachea is uncommon and difficult to manage. We report a child with oesophageal atresia and tracheo-oesophageal fistula who presented in the immediate postnatal phase with severe respiratory embarrassment that was relieved by endotracheal intubation with a long tube. The trachea, which was totally devoid of cartilage, was reconstructed to simulate normal tracheal anatomy. Eleven free autologous costal cartilage grafts were consecutively disposed in ring fashion between the cricoid cartilage and the carina. No tracheostomy was required. We recommend consideration of this technique for tracheal reconstruction without tracheostomy in the neonate with extensive or severe tracheomalacia, primarily or following failure of other procedures.
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References
Applebaum H, Woolley MM (1990) Pericardial flap aortopexy for tracheomalacia. J Pediatr Surg 25: 30–32
Benjamin B (1984) Tracheomalacia in infants and children. Ann Otol Rhinol Laryngol 93: 438–442
Benjamin B, Cohen D, Glasson M (1976) Tracheomalacia in association with congenital tracheoesophageal fistula. Surgery 79: 504–508
Blair GK, Cohen r, Filler RM (1986) Treatment of tracheomalacia: eight years experience. J Pediatr Surg 21: 781–785
Cohen RC, Filler RM, Konuma K, Bahoric A, Kent G, Smith C (1986) A new model of tracheal stenosis and its repair with free periosteal grafts. J Thorac Cardiovasc Surg 92: 296–304
Cox WL, Shaw RR (1965) Congenital chondromalacia of the trachea. J Thorac Cardiovasc Surg 49: 1033–1039
Davenport M, Bianchi A (1990) Early experience with oesophageal flap oesophagoplasty for repair of oesophageal atresia. Pediatr Surg Int (1990) 5: 332–335
Dykes EH, Bahoric A, Smith C, Kent G, Filler RM (1990) Reduced tracheal growth after reconstruction with pericardium. J Pediatr Surg 25: 25–29
Ein SH, Friedberg JF, Williams WG, Rearron B, Barker GA, Mancer K (1982) Tracheoplasty — a new operation for complete congenital tracheal stenosis. J Pediatr Surg 17: 872–878
Filler MR, Buck JR, Bahoric A, Steward DJ (1982) Treatment of segmental tracheomalacia and bronchomalacia by implantation of an airway splint. J Pediatr Surg 17: 597–603
Greenholz SK, Karrer FM, Lilly JR (1986) Contemporary surgery of tracheomalacia. J Pediatr Surg 21: 511–514
Kimura K, Mukohara N, Tsugawa C, Matsumoto Y, Sugimura C, Murata H, Itoh H (1982) Tracheoplasty for congenital stenosis of the entire trachea. J Pediatr Surg 17: 869–871
Saad SA, Groff DB (1978) Tracheostomy in children without heart disease. Am Surg 44: 296–299
Schwartz MZ, Filler RM (1980) Tracheal compression as a cause of apnea following repair of tracheoesophageal fistula: Treatment by aortopexy. J Pediatr Surg 15: 842–848
Vaishnar A, McKinnon AE (1986) A new cervical approach for tracheopexy. Br J Surg 73: 441–442
Vinograd I, Filler RM, England SJ, Smith C, Poenarm D, Bahoric A, Kent G (1987) Tracheomalacia: an experimental animal model for a new surgical approach. J Surg Res 42: 597–604
Wailoo MP, Emery JL (1979) The trachea in children with tracheoesophageal fistula. Histopathology 3: 329–338
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Bianchi, A., Greenhough, S.G. Repair of long-segment tracheomalacia with free autologous cartilage ring grafts. Pediatr Surg Int 7, 236–239 (1992). https://doi.org/10.1007/BF00175853
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DOI: https://doi.org/10.1007/BF00175853