الفهرس 
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Abstract
Flexible bronchoscopy(F.O.B) is an important, safe and essential diagnositic tool for structural and functional assessment of airways, and in the diagnosis of congenital and acquired pulmonary disorders of paediatric patients.
The use of the flexible endoscope is indispensable if functional assessment of the airway is required,especially for the upper airway. The clinical application of bronchoscopy dates back to 1897 when Killian removed a pork bone from the right main bronchus in a farmer. Flexible fibreoptic bronchoscope was introduced in 1967 by Dr. Shigeto Ikeda.Due to technical limitations its use was initially restricted to adults.
With advances in technology it has been possible to reduce the size of the fibreoptic bronchoscope thus allowing its use in infants and children. The use of flexible bronchoscopy in children has expanded from assisting visual diagnosis to include diagnostic procedures such as bronchoalveolar lavage (BAL) and trans-bronchial biopsy (TBB). The different parts of the flexible broncho-scope are: (i) the eye piece; (ii) angulation control lever; (iii) angulation lock; (iv) working channel; (v) suction connector; (vi) insertion tube: at the distal end has objective lens, light guides and instrument channel (which is also the suction channel) and has a bending section at the tip of the endoscope; and (vii) universal cord which connects to the light guide connector section. The various sizes of flexible broncho-scopes (representing outer diameter) commonly available for pediatric flexible bronchoscope (PFB) range from 2.2 mm to 4.9 mm,we use flexible bronchoscope 2.8 mm in diameter.We use a special camera to attach the bronchoscope to a video system, which allows an enhanced image to be viewed on a monitor while performing the procedures. We also perform video recording of most procedures, as they are useful for archiving purposes and also allow discussion of the findings with the family and the referring doctor.
The majority of the entities leading to upper airway obstruction in childrens are dynamic, the signs and symptoms of obstruction are therefore state dependent,varying with inspiratory flow rates and pressure gradient ,muscle tone and position of the head and neck.Fixed obstruction also occur (e.g.subglottic stenosis,etc),in which case there may also be significant expiratory phenemona as well.
Flexible bronchoscopy allows the examination of the adenoids ,and the larynx and hypopharynx in most physiological conditions and often when the stridor is audible.This feature of F.O.B gives the opportunity to study the laryngeal structures and function during inspiration and expiration and to define the physiological impact of the obstruction.
In our study which is a prospective cohort observational study done in sohag university hospital from (1/12/2012 to 30/11/2013) in infants who diagnosed as having upper airway obstruction presented to the paediatric emergency department,or admitted to the inpatient department or the intermediate care unit with no response to medical treatment.
We performed aclinical analysis and reviewing the data of Forty five infants who underwent fiberoptic bronchoscopy.We found that Laryngomalacia is the most common cause of congenital stridor in infants.
Based on this study we conclude that paediatricians should keep in mind the possibility of malacia disorders and other congenital and acquired upper airway abnormalities in children with chronic respiratory problems.Diagnosis of underlying diseases as soon as possible permits the withdrawal of antibiotics or anti ashmatic drugs often used un necessarily for long periods to treat these childrens.
Flexible and\or rigid bronchoscopy remains the gold standard investigation for evaluation of airway obstruction.the use of aflexible fiberoptic bronchoscpe in investigating this group of childrens is safe,practical and cost effective if performed by askilled and experienced operator.