الفهرس 
HISTORY & BACKGROUNDOnly 14 pages are availabe for public view
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Abstract
Management of Airway Obstruction in Children:
A- Endoscopic:
The role of endoscopy in the mangament of airway obestruction in childern include diagnosis and treatment
In diagnosis Detailed endoscopic assessment is the cornerstone of the evaluation of the compromised airway in infants and children. As rule, an endoscopic evaluation should always precede intubation or tracheotomy in order to establish the site and cause of the airway obstruction.
Awake transnasal fibre-optic laryngoscopy (TNFL) plays a crucial part in the assessment of vocal cord mobility, Asleep transnasal TNFL is a technique that serves to visualise all extralaryngeal obstruction sites and the Direct laryngotracheoscopy using a bare 0° telescope is essential in the assessment of the location, extent, and degree of subglottic stenosis and tracheostoma.
In treatment :The endoscopy plays an essential role in treatment diffrant types of stenosis in pediatric airway through muliple methods and techniques
(1) Stents:
The most common indication for stenting is to recanalise an obstructed airway. Any pathology, which results in a stenosis greater than 50% of the normal calibre may be an indication for stenting.
Two major groups of stents are currently in use –silicone and metallic stents. Metallic stents are gaining popularity because of their ease of insertion. Silicon stents have good tissue compatibility and can be removed even after prolonged periods they appear very attractive in pediatric applications. Both have differant types with advantages and disadvantages according to the case so the surgent has to decide which type to use according to each case. Experience is necessary to select the proper size and type of stent.
Tecnique of insertion of stent using endoscope vary according to type of stent some of them need special equipment to facilitat the entrance and proper positioing of stent.Follow up of stent is essential to achieve the optimal benefit for these patients. The most meaningful clinical endpoints for follow up will be the improvement or absence of dyspnoea and respiratory infections
(2) Balloon Dilatation:
The balloon dilatation is an endoscopic procedure, Such technique is being used to treat stenosis secondary to prolonged intubation, re-stenosis after laryngotracheal reconstructions and after cricotracheal resections with end-to-end anastomosis, with promising results. Dilatation may be carried out under direct visuali¬zation with laryngoscopy or bronchoscopy, using the rigid bronchoscopy to guide the dilation procedure known long time ago but using of the Flexible fiberoptic bronchoscopy with balloon dilation was descovered more recent.
A large variety of balloons have already been tested. The goal of balloon dilatation is to mechanically interrupt the process of mature scar formation The application of topical steroids may contribute to the inhibition of restenosis following dilatation. Because of the small deflated balloon diameter, it can be passed through extremely narrow areas, without causing trauma.
The success rate is satisfactory, while dependent on proper patient selection, Severity of the stenosis, length of stenotic segment, and pulmonary status seem to be important predictors of success. Balloon dilatation seems to be more effective than the other means of dilatation, because the entire force employed is radial, towards the stenosis area.
(3) Laser:
Laser is an acronym for “Light Amplification by Stimulated Emission of Radiation”. In simpler language, lasers are devices that produce light that gets transformed into heat upon interacting with living tissue. The effect of laser on the tissue depends on several factors, such as the power settings and wavelength employed, distance of the laser tip from the target, duration of impact certain physical characteristics of the tissue, mainly its color, surface, and water content.
The use of lasers in otolaryngology is increasing due to its precision, ablative and coagulative properties, and minimal thermal damage to adjacent healthy tissue. . Different types of lasers have been used including potassium-titanyl-phosphate (KTP), carbon dioxide, neodymium-yttrium-aluminumgarnet (Nd:YAG), argon, and pulsed dye lasers.
The endoscopic application of the flexible CO2 laser fiber for the management of pediatric airways lesions (proximal and distal) provides good outcomes in selected patients.
B- Open:
Modern surgical management of paediatric laryngo-tracheal stenosis includes a wide variety of surgical procedures. 30 years ago, endoscopic management was the mainstay of airway disease, open airway reconstruction dominated the subsequent 3 decades but currently endoscopic and open airway management are seen as complimantary.
Obstructive lesions of the pediatric airway can occur at any level, from the nose and nasopharynx, through the pharynx and supraglottis, to the glottis, subglottis, trachea, and lower airway structures, diagnostic and therapeutic endoscopies under general anaesthesia. TNFL in spontaneous respiration through the face mask facilitates the assessment of the dynamic features of the laryngeal obstruction, permitting, at the same time, the exclusion of synchronous congenital anomalies, such as impaired vocal cord function, subglottic stenosis, and tracheo (broncho) malacia.
Airway inspection below the vocal cords using flexible endoscopes is mandatory.Rigid bronchoscopy is then performed to rule out other airway anomalies for example, laryngeal clefts. This technique is more accurate than TNFL for diagnosing minor additional airway lesions.