Decannulation of tracheostomized infants after choanoplasty

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BACKGROUND: The paper outlines stages of decannulation in tracheostomized infants with congenital choanal atresia following a stentless surgery using upper septal flaps fixed with fibrin glue.

AIM: The aim of the study was to optimize preparation, timing, and prognostic factors for successful decannulation in infants after choanoplasty.

MATERIALS AND METHODS: The study included 11 tracheostomized children under 1 year of age with congenital choanal atresia. The treatment group included tracheostomized children who undergone standard choanoplasty with stents (n = 5). The comparison group included tracheostomized children admitted for primary surgery (n = 6). Endoscopic examination and tracheobronchoscopy were performed to evaluate treatment outcomes, and saturation was measured with a closed tracheostomy.

RESULTS: In group 1, endoscopic examination of the nasal cavity and nasopharynx revealed that neochoanae were too small (less than 50% of the norm) for decannulation; revision surgery was required using a stentless technique. In group 2, patients after the stentless choanoplasty showed no signs of re-stenosis during the follow-up period (3–6 months). They underwent successful decannulation at different time points after surgery. Over the one-year follow-up, no re-stenosis was observed in either group. In 9 patients, successful decannulation was performed at various time points after surgery. In 2 patients, decannulation was delayed.

CONCLUSIONS: Long-term mechanical ventilation is unsuitable in patients with bilateral choanal atresia, and tracheostomy is a common solution for respiratory failure. However, tracheostomy can have many early and late postoperative complications, so decannulation should be performed as soon as possible after nasal breathing is restored. The proposed endoscopic approach using a vascularized mucosal flap and fibrin glue appears to be the method of choice for choanoplasty in tracheostomized children. The process of decannulation in children, even with the restoration of nasal breathing after choanaplasty, is extremely complex and is associated with many risks.

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作者简介

Olga Breeva

Veltischev Research and Clinical Institute for Pediatrics and Pediatric Surgery of the Pirogov Russian National Research Medical University

编辑信件的主要联系方式.
Email: breevaluka77@mail.ru
ORCID iD: 0009-0007-5147-5750
SPIN 代码: 4120-7902

MD

俄罗斯联邦, 2 Taldomskaya St., Moscow, 125412

Mihail Polunin

Veltischev Research and Clinical Institute for Pediatrics and Pediatric Surgery of the Pirogov Russian National Research Medical University; Morozov Children's Municipal Clinical Hospital of the Moscow City Health Department

Email: mmpoiunin@gmail.com
ORCID iD: 0000-0002-5929-1469
SPIN 代码: 1199-4723

MD, Dr. Sci. (Medicine)

俄罗斯联邦, 2 Taldomskaya St., Moscow, 125412; Moscow

Alan Asmanov

Veltischev Research and Clinical Institute for Pediatrics and Pediatric Surgery of the Pirogov Russian National Research Medical University

Email: alan-asmanov@yandex.ru
ORCID iD: 0000-0002-3116-6447
SPIN 代码: 1650-4608

MD, Cand. Sci. (Medicine)

俄罗斯联邦, 2 Taldomskaya St., Moscow, 125412

参考

  1. Warren JB, Anderson JM. Newborn respiratory disorders. Pediatr Rev. 2010;31(12):487–495; quiz 496. doi: 10.1542/pir.31-12-487
  2. Saidulaeva AI. Reconstructive surgery of congenital choanal atresia and scar processes of the nasal cavity in children [dissertation]. Moscow; 2015. 140 p. (In Russ.)
  3. Edwards MO, Kotecha SJ, Kotecha S. Respiratory distress of the term newborn infant. Paediatr Respir Rev. 2013;14(1):29–36; quiz 36–37. doi: 10.1016/j.prrv.2012.02.002
  4. Newman JR, Harmon P, Shirley WP, et al. Operative management of choanalatresia: a 15-year experience. JAMA Otolaryngol Head Neck Surg. 2013;139(1):71–75. doi: 10.1001/jamaoto.2013.1111
  5. Hawkins DB, Williams EH. Tracheostomy in infants and young children. Laryngoscope. 1976;86(3):331–340. doi: 10.1288/00005537-197603000-00002
  6. Greene NM. Fatal cardiovascular and respiratory failure associated with tracheotomy. N Engl J Med. 1959;261:846–848. doi: 10.1056/nejm195910222611705
  7. Gergin O, Adil E, Kawai K, et al. Routine airway surveillance in pediatric tracheostomy patients. Int J Pediatr Otorhinolaryngol. 2017;97:1–4. doi: 10.1016/j.ijporl.2017.03.020
  8. Liu CC, Soares J, Johnson KE, et al. Surveillance endoscopy after tracheostomy placement in children: findings and interventions. Laryngoscope. 2019;130(5):1327–1332. doi: 10.1002/lary.28247
  9. Ha T, Goyal M, Ongkasuwan J. Duration of tracheostomy dependence and development of tracheocutaneous fistula in children. Laryngoscope. 2017;127(12):2709–2712. doi: 10.1002/lary.26718
  10. Lee DJ, Yang W, Propst EJ, et al. Tracheo-innominate fistula in children: a systematic review of literature. Laryngoscope. 2019;130(1):217–224. doi: 10.1002/lary.27765
  11. Onder SS, Ishii A, Sandu K. Surgical options in suprastomal collapse-induced severe airway obstruction. Eur Arch Otorhinolaryngol. 2020;277(12):3415–3421. doi: 10.1007/s00405-020-06339-3
  12. Marston AP, White DR. Subglottic stenosis. Clin Perinatol. 2018;45(4):787–804. doi: 10.1016/j.clp.2018.07.013
  13. Genther DJ, Thorne MC. Utility of routine postoperative chest radiography in pediatric tracheostomy. Int J Pediatr Otorhinolaryngol. 2010;74(12):1397–1400. doi: 10.1016/j.ijporl.2010.09.017
  14. Sachdev A, Ghimiri A, Gupta N, Gupta D. Pre-decannulation flexible bronchoscopy in tracheostomized children. Pediatr Surg Int. 2017;33(11):1195–1200. doi: 10.1007/s00383-017-4152-x
  15. Takahashi N, Takano K, Mitsuzawa H, et al. Factors associated with successful decannulation in pediatric tracheostomy patients. Acta Otolaryngol. 2017;137(10):1104–1109. doi: 10.1080/00016489.2017.1326064
  16. Lind M, Lopez JJ, Merrill T, et al. Impact of functional status and medical comorbidities on tracheostomy decannulation in pediatric patients. J Pediatr Rehabil Med. 2017;16(10):89–94. doi: 10.3233/PRM-170437
  17. Kumar S, Gupta S, Naglot S, Sahni JK. Bilateral choanal atresia: Is it really a surgical emergency? Indian J Otolaryngol Head Neck Surg. 2013;65(Suppl 2):205–209. doi: 10.1007/s12070-011-0304-9
  18. Alsubaie HM, Almosa WH, Al-Qahtani AS, Margalani O. Choanal atresia repair with stents and flaps: a systematic review article. Allergy Rhinol (Providence). 2021;12:21526567211058052. doi: 10.1177/21526567211058052
  19. Patent RU 2789967 C1 / 2023.02.14. Application: 2021133852. 11/22/2021. Breeva OA, Asmanov AI, Bogomilskij MR. Method for adhesive fixation of septal mucosal flaps in choana in patients with choanoplasty. EDN: YKSJLJ
  20. van Schaik CGR, Paasch S, Albrecht T, Becker S. Treatment of choanal atresia in a cohort of 29 patients: Determinants for success or failure. Int J Pediatr Otorhinolaryngol. 2022;160:111240. doi: 10.1016/j.ijporl.2022.111240
  21. Wilcox LJ, Smith MM, de Alarcon A, et al. Use of steroid-eluting stents after endoscopic repair of choanal atresia: a case series with review. Ann Otol Rhinol Laryngol. 2020;129(10):1003–1010. doi: 10.1177/0003489420928374

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2. Fig. 1. Non-functional choana after previous tube-stent choanoplasty

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3. Fig. 2. Formed junctional neochoana using fibrin glue immediately after surger

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4. Fig. 3. Functional neohoana 1 month after surgery

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