Upper Airway Obstruction among the Paediatric Population in the University of Port Harcourt Teaching Hospital: The Place of Tracheostomy in the Management

Background: The paediatric age group has very peculiar anatomic and physiologic airways therefore, obstructionwhich commonly occurs in this population, can pose serious challenges in this age group.Aim: To study the pattern and aetiologyof acute upper airway obstruction in the paediatric age groupin University of Port Harcourt teaching hospital and to determine the place of tracheostomy in the management.Patients and Methods: It is a descriptive hospital based study of all paediatric patients; aged 0-15years with upper airway obstruction that presented to the ear, nose and throat department and the children emergency ward of university of Port Harcourt teaching hospital within the period of Original Research Article January 2014 to December 2019. Data on demographics, clinical presentations, causes and management were obtained using a Proforma. The diagnosis of upper airway obstruction is made in a child with any degree of respiratory difficulty with or without associated stridor or stertor arising from lesions above the thoracic inlet. Children with respiratory difficulty other than that from an upper airway obstruction were excluded from the study.Data obtained were analyzed with the IBM statistical package for social sciencesSPSS version 20. Results were presented in simple descriptive forms with tables.Results: One hundred and sixty paediatric patients with upper air way obstruction with age ranging from 0-15 years were studied. The prevalence of upper airway obstruction was 1.87%. There were more males than females; male to female ratio was 1.2:1. Age group 4-7 years were the most affected, 43.75%. Foreign body aspiration was the commonest cause. Majority of the patients had tracheostomy done, 48.75%. Mortality was n=1(0.625%).Conclusion: Upper air way obstruction among the paediatric age group is still common with foreign body aspiration as a very important cause in our setting. The very young are the most affected and tracheostomy appears to still be the main option of securing airway in these cases in our environment.

Implement of flexible bronchoscopy in diagnosis and management of pediatric upper airway obstruction / 中国小儿急救医学

Acute upper airway obstruction is a very common urgent situation in pediatric emergency.It includes several types of disease, mostly classified as infectious and noninfectious.Children are dying with delayed diagnosis and airway clear.Except traditional techniques and rigid bronchoscopy, flexible bronchoscopy would be a very convenient and handable way in diagnosis and management of upper airway obstruction in children.Herence, we presented etiologies of upper airway obstruction and how could flexible bronchoscopy reveal and(or) manage them.

Split cricoídeo posterior endoscópico con injerto de cartílago costal / Endoscopic posterior cricoid split with costal cartilage graft

RESUMEN A pesar de los avances en cirugía de vía aérea, tanto abierta como endoscópica, la inmovilidad bilateral de cuerdas vocales continúa representando un desafio significativo para los cirujanos de vía aérea. Entre las alternativas quirúrgicas existen tanto abordajes endoscópicos como transcervicales, no obstante, la mayoría de estas técnicas modifican estructuralmente regiones de la cuerda vocal y/o aritenoides de manera permanente. La traqueostomía ha sido el tratamiento de elección en niños con inmovilidad bilateral de cuerdas vocales severamente sintomática, sin embargo, el procedimiento ideal debiese establecer una vía aérea adecuada evitando la necesidad de realizar una traqueostomía, y a la vez no generar un deterioro de la función fonatoria. La capacidad de expandir el aspecto glótico posterior sin modificación estructural de aritenoides y/o ligamento vocal ha convertido a la sección cricoidea posterior endoscópica con injerto de cartílago costal en una alternativa quirúrgica atractiva para estos casos. En este trabajo se realiza una revisión de la literatura y presenta un caso tratado mediante esta técnica en el Hospital Guillermo Grant Benavente de Concepción, Chile.

ABSTRACT Despite advances in both open and endoscopic airway surgery, bilateral vocal cord immobility still poses a significant challenge for airway surgeons. Among the surgical alternatives there are both endoscopic and transcervical approaches. However, most of these techniques structurally modify certain regions of the vocal cord and/or arytenoids permanently. Tracheostomy has been the treatment of choice in severely symptomatic children with bilateral immobility of vocal cords. Nevertheless, the ideal procedure should establish an adequate airway, avoiding the need to perform a tracheostomy, and at the same time not causing a deterioration of the phonatory function. The ability to expand the posterior glottis without structural modification of the arytenoids and/or vocal ligament has converted the posterior endoscopic cricoid split with costal cartilage graft into an attractive surgical alternative for these cases. In this article we review the literature and present a case treated by this technique in the Guillermo Grant Benavente Hospital in Concepción, Chile.

Prevalencia y factores de riesgo del fracaso de extubación en una Unidad de Cuidados Intensivos Pediátricos de alta complejidad / Prevalence of extubation and associated risk factors at a tertiary care pediatric intensive care unit

Introducción. El fracaso de la extubación (FE) está asociado a mayor riesgo de neumonía, estadía hospitalaria y mortalidad. Objetivo. Determinar la prevalencia del FE e identificar factores asociados en nuestra población. Materiales y métodos. Diseño observacional y retrospectivo. Ingresaron todos los pacientes mayores de 1 mes hasta 18 años que, en el período 2012-2016, requirieron asistencia respiratoria mecánica más de 12 h, y al menos tuvieron una extubación programada durante su internación. Se registraron los aspectos relacionados con la ventilación y las causas de fracaso. Resultados. Se extubaron 731 pacientes y la prevalencia de FE fue del 19,3 %. Las causas de fracaso fueron la obstrucción alta de la vía aérea (51,4 %), fatiga muscular (20,1 %), depresión del centro respiratorio (14,6 %) e incapacidad de proteger la vía aérea (9,7 %). Los factores independientes para explicar el FE según el análisis multivariado fueron afección crónica compleja neurológica (odds ratio -#91;OR-#93;= 2,27; intervalo de confianza del 95 % -#91;IC-#93;= 1,21-4,26); infección respiratoria aguda baja en el paciente con una secuela previa (OR= 1,87; IC 95 %= 1,113,15); lesión neurológica aguda (OR= 1,92; IC 95 %= 1,03-3,57); extubación no planeada (OR= 2,52; IC 95 %= 1,02-6,21) y la presencia de estridor (OR= 5,84; IC 95%= 3,66-9,31). Conclusión. La principal causa de FE fue la obstrucción alta de la vía aérea. La secuela neurológica y la afección neurológica aguda, la extubación no planeada y la presencia de estridor posextubación fueron identificadas como factores de riesgo asociados al FE.

Introduction. Extubation failure (EF) is associated with a higher risk for pneumonia, hospital stay, and mortality. Objective. To determine the prevalence of EF and identify the associated factors in our population.Materials and methods. Observational and retrospective design. All patients aged 1 month old to 18 years old who required mechanical ventilation for more than 12 hours and underwent at least one scheduled extubation during their stay in the 2012-2016 period were included. The aspects related to ventilation and the causes of failure were recorded. Results. Seven hundred and thirty-one patients were extubated and the prevalence of EF was 19.3 %. The causes of failure included upper airway obstruction (51.4 %), muscle fatigue (20.1 %), respiratory center depression (14.6 %), and inability to protect the airways (9.7%). As per the multivariate analysis, the independent factors that accounted for EF were neurological complex chronic condition (odds ratio [OR] = 2.27; 95 % confidence interval [CI] = 1.21-4.26); acute lower respiratory tract infection in a patient with prior sequelae (OR = 1.87, 95 % CI = 1.11- 3.15); acute neurological injury (OR = 1.92, 95 % CI=1.03-3.57); unplanned extubation (OR =2.52, 95 % CI = 1.02-6.21), and presence of stridor (OR = 5.84, 95 % CI = 3.66-9.31). Conclusion. The main cause of EF was upper airway obstruction. Neurological sequelae, acute neurological injury, unplanned extubation, and the presence of postextubation stridor were identified as risk factors associated with EF

Three Cases of Pierre Robin Sequence with Upper Airway Obstruction Relieved by Nasopharyngeal Airway Insertion

Pierre Robin sequence (PRS), also called Robin sequence, is a congenital anomaly characterized by a triad of micrognathia, glossoptosis, and upper airway obstruction. Infants with PRS can present with varying degrees of respiratory difficulty secondary to upper airway obstruction. There has been no consensus for the treatment of upper airway obstruction in infants with PRS, but recent studies recommend attempting non-surgical interventions before surgical treatment. In this case report, we present 3 cases of infants diagnosed with PRS who showed persistent respiratory difficulties after birth. Before considering surgical intervention, insertion of a nasopharyngeal airway was attempted in these infants. Following this procedure, symptoms of upper airway obstruction were relieved, and all infants were discharged without surgical interventions; the nasopharyngeal airway was removed 1 to 2 months later. To date, no infant has shown signs of upper airway obstruction. Nasopharyngeal airway insertion is a highly effective and less invasive treatment option for infants with PRS. However, it is not widely known and used in Korea. Nasopharyngeal airway insertion can be preferentially considered before surgical intervention for upper airway obstruction in such infants.

Awake fibre Optic Intubation with Dexmedetomidine for Ludwig Angina with Severe Trismus

@#Ludwig angina is a submandibular space cellulitis secondary to oral cavity infection. It is strongly associated with difficult intubation due to limitation in the mouth opening. The presentation of Ludwig angina varies according to the severity of the infection. The extreme presentations include upper airway obstruction and respiratory failure. We present a female teenager with right submandibular abscess as the consequence of Ludwig angina, who was planned for incision and drainage. Successful awake fibre optic intubation was performed as a method of induction due to trismus, deferring the need for tracheostomy.

Application of CLT guiding offline extubation in patient with tracheal intubation of mechanical ventilation / 中国医学装备

Objective: To explore the application of the cuff-leak test(CLT)guiding offline extubation in patients with tracheal intubation of mechanical ventilation.Methods: 64 patients with tracheal intubation who underwent mechanical ventilation were divided into CLT-negative group(47 cases)and CLT-positive group(17 cases)according to leakage situation of CLT.The CLT guiding offline extubation were adopted in the study and some basic situations,such as body mass index(BMI),APACHE-Ⅱ and so on,of the two groups were compared.And the relative situation of intubation,blood gas analysis index,vital signs,the occurrence rate of upper airway obstruction(UAO)post removing intubation and re-intubation rate between the two groups also were compared,and then the risk factors of influencing UAO were further analyzed.Results: The BMI of CLT-negative group was significantly smaller than that of CLT-positive group(t=2.44,P＜0.05).The occurrence rate of UAO and re-intubation rate of CLT-negative group(6.38％and 2.13％)were significantly lower than that of CLT-positive group(35.29％and 17.65％)(x2=8.63,x2=5.13,P＜0.05),respectively.The differences of BMI,APACHE-Ⅱ scores,intubation time,air sac pressure,PaO2and SpO2between patients with UAO and patients without UAO were significant(t=5.63,t=2.65,t=4.27,t=3.35,t=2.37,t=2.66,P＜0.05).The results of Logistic regression analysis showed that the BMI,APACHEⅡ score,intubation time,air sac pressure were independent risk factors for occurring UAO post extubation.Conclusion: The CLT guiding offline extubation in patient with tracheal intubation of mechanical ventilation can effectively reduce the re-intubation rate.For these patients with obesity,high APACHE-Ⅱ score,long intubation time and big air sac pressure,the risk of occurring UAO is higher.Therefore,the number of intubation pre extubation should be reduced for them,and their physiological status should be comprehensively assessed so as to decrease the occurrence rate of UAO.

Clinical Features and Outcomes of Patients in Neonatal Intensive Care Requiring Laryngologic Consultation for Airway Disorders / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Airway problems frequently occur in neonatal patients requiring intensive care due to high prevalence of intubation history and congenital conditions that are linked to craniofacial or upper aerodigestive tract anomalies. However, many investigations on airway disorders have examined large populations of hospitalized children without focusing on those treated in the intensive care unit (ICU). Here we present the clinical features and outcomes in infants hospitalized with airway-related problems at the neonatal ICU. SUBJECTS AND METHOD: A total 69 patients were studied from May 2005 to December 2012, with each examined by an otolaryngologist while in neonatal ICU (NICU) for possible airway problems. Descriptive analysis was used in evaluating illnesses suffered and subsequent upper airway treatments. Factors associated with tracheostomy were identified by multivariate analysis. RESULTS: The median age of infants was 30 days (range, 1-237 days), with a male-to-female ratio of 1.38. The median gestational age was 35⁺³ weeks, and the mean birth weight was 2.35±0.89 kg. Overall, 40 patients had histories of intubation (median duration, 36 days; range, 1-204 days). The most common diagnosis in the upper airway exam was laryngomalacia (n=12), followed by subglottic stenosis (n=10) and micrognathia (n=8). Tracheostomy was performed in 38 patients (55.1%). In multivariate analysis, intubation history was identified as the only variable demonstrating a significant independent association with tracheostomy (p=0.006). CONCLUSION: Upper airway problems in NICU patients are due to a variety of disorders. Precise diagnosis and treatment is achievable through bedside and intraoperative assessments. Patients with a history of intubation are at increased risk of tracheostomy.

Nasogastric Tube Syndrome: Why Is It Important in the Intensive Care Unit? / 대한중환자의학회지

Although the nasogastric tube (NGT) is widely used in critically ill patients, most intensivists do not give much thought to it or its possible complications. NGT syndrome is a rare but fatal complication characterized by throat pain and vocal cord paralysis in the presence of NGT. Recently, we experienced a case of NGT syndrome developed in an 86-year-old female twelve days after NGT insertion. We immediately removed the NGT and secured the airway by tracheostomy. She was treated successfully with an intravenous antibiotic, steroid and proton pump inhibitor and the syndrome did not recur after reinsertion of the NGT.

Nasogastric Tube Syndrome: Why Is It Important in the Intensive Care Unit? / 대한구급학회지

Although the nasogastric tube (NGT) is widely used in critically ill patients, most intensivists do not give much thought to it or its possible complications. NGT syndrome is a rare but fatal complication characterized by throat pain and vocal cord paralysis in the presence of NGT. Recently, we experienced a case of NGT syndrome developed in an 86-year-old female twelve days after NGT insertion. We immediately removed the NGT and secured the airway by tracheostomy. She was treated successfully with an intravenous antibiotic, steroid and proton pump inhibitor and the syndrome did not recur after reinsertion of the NGT.

Negative pressure pulmonary edema / 国际儿科学杂志

Negative pressure pulmonary edema is a common pediatric disease,but also often to be ignored,which occurs from the upper airway obstruction caused by the change in the absolute value of negative intrathoracic pressure increase,resulting in a corresponding respiratory physiology,hemodynamic changes,common causes include laryngitis,whooping cough,foreign body,such as obstructive sleep apnea.Therefore,it is important to know the common causes of negative pressure pulmonary edema and to treat the patients in time.

Etiology analysis of upper airway obstruction in 54 newborn infants / 中华实用儿科临床杂志

Objective To explore the etiology of neonatal upper airway obstruction(UAO) in order to perform early diagnosis and treatment,and to improve the prognosis.Methods Retrospectively analysis of the clinical data of 54 cases of neonatal UAO in Shengjing Hospital of China Medical University from Jan.2005 to Dec.2011 was performed.All patients received CT three dimensional reconstruction reconstruction,30 patients received the direct laryngoscopy,5 cases received the video laryngoscope,8 cases received pathological examination.All the cases received the determination of serum total calcium and ionized calcium,6 cases received upper gastrointestinal imaging,8 cases received chromosome inspection and 20 cases received echocardiography.Results CT scan:abnormal in 21 cases,among them 15 cases of congenital cyst,5 cases of tongue fall blocking airway,and 1 case of choanal atresia(bilateral) ;another 33 patients were normal.Direct laryngoscopy results:abnormal in 13 cases,among them 12 cases of congenital cyst,and 1 case of glossoptosis;another 17 cases were normal.Electronic laryngoscopy results:5 cases were diagnosed as congenital laryngomalacia.Pathological examination results:7 cases of cyst wall by squamous epithelium composition,and 1 case of cyst wall by columnar epithelium composition.Serum total calcium and ion calcium level results:all patients were in the normal range.Chromosome examination results were normal.Upper gastrointestinal imaging results:1 normal case,5 cases of mild gastroesophageal reflux.Echocardiography results:4 cases were normal,10 cases of patent foramen ovale,2 cases of patent ductus arteriosus,4 cases of congenital heart disease (2 cases of atrial septum defect,1 case of ventricular septal defect,and 1 case of interatrial septum merger ventricular septal defect).Conclusions In the etiology of neonatal UAO,there is a lot of organic diseases except for congenital laryngomalacia.For the UAO induced by laryngeal stridor or undefinitely cause,CT scan should be taken as soon as possible.

Progress in diagnosis and treatment of neonatal upper airway obstruction / 国际儿科学杂志

The most common etiology of neonatal upper airway obstruction is congenital abnormalities,including choanal atresia,Pierre Robin sequence,occupational lesions,laryngomalacia,and so on.Some patients are after birth with dyspnea,severe cases with suffocation,and even death.Due to lack of specific clinical manifestations in early neonatal periode,it is usually misdiagnosed as other respiratory diseases.Therefore,early identification of the etiology,as soon as possible to relieve the obstruction,is particularly critical in the prevention of suffocation for the upper airway obstruction in the neonatal period.

Linfangioma cervical fetal: diagnóstico prenatal y resultado perinatal

Se presenta el caso de un linfangioma cervical fetal, tumor de presentación infrecuente y potencial emergencia perinatológica, en relación al compromiso de las vías aéreas fetales. La ecografía y la resonancia nuclear magnética (RMN) son las herramientas para establecer el diagnóstico y pronóstico perinatal de los fetos portadores de linfangioma cervical, así como de otros tumores cervicales. El procedimiento EXIT coordinado con un equipo multidisciplinario debe ser planificado en casos en que el feto presenta un riesgo alto de obstrucción de la vía aérea.

A case of fetal cervical lymphangioma is reported, tumor of infrequent presentation and potential perinatologic emergency in relation to superior fetal airways compromise. Ultrasound and nuclear magnetic resonance are the main tools to establish diagnosis and perinatal prognosis of fetuses carrying cervical lymphangioma as well as other cervical tumors. EXIT procedure coordinated with a multidisciplinary equipment must be planned in cases when the fetus displays a high risk of upper airway obstruction.

Acute pulmonary edema secondary to upper airway obstruction by bilateral vocal cord paralysis after total thyroidectomy: A case report / 대한마취과학회지

This paper reports the case of a 65-year-old woman with a history of mild arterial hypertension who presented with acute pulmonary edema immediately after a total thyroidectomy. The edema was found to have been caused by an acute upper airway obstruction secondary to bilateral vocal cord paralysis. Her pulmonary edema resolved with treatment including reintubation, mechanical ventilation with positive end-expiratory pressure, diuretics, morphine, and fluid restriction. This report discusses the possible pathogenesis of this rare clinical situation. This case highlights the possibility of an acute upper airway obstruction caused by bilateral vocal cord paralysis after a total thyroidectomy and the need for prompt treatment to prevent the development of pulmonary edema.

Vía aérea difícil / Difficult airway

Difficult airway is a life-threatening situation which compromises the permeability of the upper airway and thus adequate ventilation and oxygenation. Multiple factors, acute and chronic such as: infectious, neoplastic and trauma have been associated with critical airway. Morbidity and mortality related to a difficult airway management remains as a significant problem in children, so is essential for the pediatric health team to be trained to recognize and anticipate situations that in clinical practice might determine a critical airway. The aim of this review is to provide concepts and guidance to assess patients with potentially difficult airway.

Una vía aérea difícil condiciona una situación con riesgo vital, ya que pone en peligro la permeabilidad de la vía aérea superior y con esto la capacidad de mantener una adecuada ventilación y oxigenación. Múltiples factores, tanto agudos como crónicos, entre ellos factores anatómicos propios del niño/a, complicaciones infecciosas, neoplásicas y/o traumáticas se han asociado con una vía aérea crítica. La morbilidad y mortalidad asociada al manejo inadecuado de esta condición continua siendo un problema significativo en la edad pediátrica; siendo fundamental que el equipo de salud se encuentre entrenado en reconocer y anticipar situaciones que en la práctica clínica podrían asociarse con una vía aérea difícil o crítica. El objetivo de la presente revisión es otorgar conceptos y una orientación en el enfrentamiento de los pacientes con una vía aérea potencialmente difícil.

Evaluation of Airway Obstruction at Soft Palate Level in Male Patients with Obstructive Sleep Apnea/Hypopnea Syndrome: Dynamic 3-Dimensional CT Imaging of Upper Airway / 华中科技大学学报（医学）（英德文版）

This study examined the dynamic characteristics of upper airway collapse at soft palate level in patients with obstructive sleep apnea/hypopnea syndrome (OSAHS) by using dynamic 3-Dimensional (3-D) CT imaging.A total of 41 male patients who presented with 2 of the following symptoms,i.e.,daytime sleepiness and fatigue,frequent snoring,and apnea with witness,were diagnosed as having OSAHS.They underwent full-night polysomnography and then dynamic 3-D CT imaging of the upper airway during quiet breathing and in Muller's maneuver.The soft palate length (SPL),the minimal cross-sectional area of the retropalatal region (mXSA-RP),and the vertical distance from the hard palate to the upper posterior part of the hyoid (hhL) were compared between the two breathing states.These parameters,together with hard palate length (HPL),were also compared between mild/moderate and severe OSAHS groups.Association of these parameters with the severity of OSAHS [as reflected by apnea hypopnea index (AHI) and the lowest saturation of blood oxygen (LSaO2)] was examined.The results showed that 31 patients had severe OSAHS,and 10 mild/moderate OSAHS.All the patients had airway obstruction at soft palate level.mXSA-RP was significantly decreased and SPL remarkably increased during Muller's maneuver as compared with the quiet breathing state.There were no significant differences in these airway parameters (except the position of the hyoid bone) between severe and mild/moderate OSAHS groups.And no significant correlation between these airway parameters and the severity of OSAHS was found.The position of hyoid was lower in the severe OSAHS group than in the mild/moderate OSAHS group.The patients in group with body mass index (BMI)≥26 had higher collapse ratio of mXSA-RP,greater neck circumference and smaller mXSA-RP in the Muller's maneuver than those in group with BMI＜26 (P＜0.05 for all).It was concluded that dynamic 3-D CT imaging could dynamically show the upper airway changes at soft palate level in OSAHS patients.All the OSAHS patients had airway obstruction of various degrees at soft palate level.But no correlation was observed between the airway change at soft palate level and the severity of OSAHS.The patients in group with BMI≥26 were more likely to develop airway obstruction at soft palate level than those with BMI＜26.

Clinical value of bronchovideoscope in the diagnosis of pediatric upper airway obstruction / 中国小儿急救医学

Objective To investigate the diagnostic value and safety of bronchovideoscope in the pediatric upper airway obstruction.Methods Bronchovideoscope was performed in 91 pediatric patients with upper airway obstruction.The etiology was analyzed and summarized.Results (1) Our study showed that the etiology of pediatric upper airway obstruction were as follow in turn:congenital laryngo-trachemalacia (45 cases),subglottic foreign body (13 cases),laryngotracheal occupying lesion (9 cases),vocal area edema (6 cases),tracheal stenosis (5 cases),laryngopharyngeal lesion (3 cases of retropharyngeal abscess,2 cases of tumor),vocal area hyperplasia (3 cases),subglottic stenosis (2 cases),glottic paralysis (2 cases),laryngeal web (1 case).(2) The common etiology of pediatric upper airway obstruction was different with age.Neonatal period:glottic paralysis,laryngomalacia in turn;1~6 month:laryngo-trachemalacia,tracheal stenosis,subglottic foreign body in turn;1~3 year:subglottic foreign body,vocal area edema,laryngo-trachemalacia in turn,>3 year:laryngeal papilloma.(3) Specific disease had predominant age:laryngo-trachemalacia predominated in infants less than 6 month;tracheal foreign body was most common in child aged 1~3 years old;epiglottic cyst was most common in infant less than 3 month.(4) Complication:during procedure,16 patients had transient decrease of saturation of blood oxygen and 11 patients had tracheobronchial spasm.After procedure,8 patients had transient fever and 6 patients had transient aggravation of laryngeal stridor.Conclusion Bronchovideoscope plays an important role in the diagnosis of pediatric upper airway obstruction.It can directly identify position and nature of disease,and then guide treatment.

Laryngeal papilomatosis presenting with acute upper airway obstruction.

A six year old boy who presented with sudden onset of difficulty in breathing following a week’s history of cough and a sensation of foreign body in the throat. On clinical examination he was in severe respiratory distress with markedly diminished breath sounds bilaterally. Respiratory distress was positional with some relief observed with change in position. A CT scan done showed normal thoracic inlet and a chest X-ray showed hyperinflation of the lungs bilaterally. Direct laryngoscopy under general anesthesia revealed an extensive mass of papilomatous growth occluding the glottis; this was excised and processed in the histopathology Laboratory. Patient recovered fully and was discharged from the hospital two days after surgery in excellent condition. A monthly follow up for six months after discharge was uneventful, with no recurrence.

Laringocele: uma causa de obstrução de vias aéreas superiores / Laryngocele: a cause of upper airway obstruction

Laringoceles são dilatações anormais do sáculo do ventrículo de Morgani da laringe, localizando-se entre a falsa prega vocal e a face interna da cartilagem tireóide. Relevância clínica é rara, sendo o achado de laringoceles assintomáticas em necropsia muito alto. Algumas vezes, pode se apresentar já como uma grande massa cervical, levando à obstrução de vias aéreas e necessitando de intervenção de urgência. Neste trabalho, os autores relatam um caso de laringocele levando à obstrução de vias aéreas superiores, necessitando de traqueostomia de urgência e fazem uma revisão da literatura sobre o tema. Complicações de laringocele incluem infecção (formação de piocele), aspiração de patógenos e subseqüente bronquite e pneumonia, infecção do espaço lateral da faringe (depois de ruptura) e obstrução de vias aéreas superiores, como no caso apresentado. A laringocele, apesar de ser uma doença benigna, é uma causa potencial de obstrução respiratória que pode ameaçar a vida do paciente. O correto diagnóstico e manejo adequado precoce podem evitar que situações de emergência, como a do paciente do caso relatado, levem à morte.

Laryngoceles are abnormal dilatations of the laryngeal saccule, which rises between the ventricular folds, the base of the epiglottis and the inner surface of the thyroid cartilage. Clinical symptoms are rare, and the find of asymptomatic laryngoceles in pathology studies are frequent. Sometimes it is presented as cervical swelling causing airway obstruction in need of emergency intervention. In this study, we report a case of upper airway obstruction due to laryngocele treated by emergency tracheotomy and we review of the literature. Laryngocele complications include infection (pyocele formation), pathogens aspirations with subsequent bronchitis and pneumonia and upper airway obstruction, as in the case reported. Despite being benign tumors, laryngoceles cause relevant airway obstruction. Correct diagnosis and proper treatment can preclude emergencies as it happened to our patient hereby reported.