Pediatric Airway

• Nasal vestibule, piriform aperature, choanae
• Oral cavity (macroglossia, glossoptosis)
• Oropharynx (lingual thyroid, dermoid, vallecular cyst, hemangioma, lymphangioma)
• Larynx (supraglottic, glottic, subglottic abnormalities)
• Tracheobroncheal anomalies

• High position in the neck (tip of epiglottis is at C2/3)
• Larynx is more anterior
• Subglottis/cricoid is narrowest portion of airway
• Membranous portion of VC is 2/3 of true cord
• Epiglottis is omega shaped
• Pharyngeal structures are closer together

• Vocal cords are 6 to 8 mm long
• Vocal processes of the arytenoid cartilage extend 3 - 4 mm
• Posterior glottis has a transverse length of 4 mm
• Subglottis has a diameter of 5 to 7 mm
• Trachea is 4 cm long; diameter of 3.6 mm
• Ratio of cartilaginous to membranous trachea is 4.5 to 1

35%

• Preparatory
• Oral
• Pharyngeal
• Esophageal

Swallowing reflex is regulated by the brainstem in the newborn

• Infant swallowing undergoes orderly maturation process
• Prior to 34th week of gestation, poor coordination and insufficient suckling response
• Neuromuscular maturation thereafter allows full-term infants to suckle at birth

• Hard palate is closer to the skull base
• Larynx is higher
• Adenoid pad, tonsils and tongue are relatively larger
• Nasopharyngeal closure requires less angulation of the soft palate
• Tonsils and tongue assist in oropharyngeal propulsion

• 1. Oropharyngeal swallow mechanisms (e.g. nasopharyngeal closure, palatopharyngeal strucutures direct the food into the hypopharynx; pharynx and larynx elevate
• 2. Laryngeal "sphincter": epiglottis, aryepiglottic olds, and arytenoid cartilages, false folds, true vocal folds
• 3. Mucociliary clearance and cough reflex

• SPECS-R
• severity, progression, eating difficulties (swallowing, GER, aspiration), cyanosis +/- ALTE, sleep disturbances/SDB, radiologic findings

• posterior glottic edema
• arytenoid edema
• enlargement of the lingual tonsils
• granular exudate on TVC surface
• Irregular contact edges
• Deep shelf of posterior laryngeal tissue/induration
• Posterior interarytenoid rugae

• Most common cause of stridor during infancy
• Symptoms present weeks to months after birth
• Resolve by 12 to 1 months of age
• Stridor is usually low-pitched with a fluttering quality

Type I - aryepiglottic folds are tightened or foreshortened

Type II - redundant soft tissue in any area of the supraglottic region

Type III - associated with NMD or GER

• The epiglottis, arytenoid cartilages or both
• If epiglottis - elongated, walls fold in on themselves; omega-shaped

HPV 6, 11, 16, 18

• First born, male
• Maternal or paternal genital condylomata
• Lower socioeconomic class
• Multiple sexual partners
• Younger maternal age

Juvenile onset (JORPP) <12 yrs of age

Adult onset (AORPP) >12 yrs of age

0.24 to 1.11 per 100,000

• Vertical transmission from anogenital tract afected with condylomata (active or inactive)
• Active = Risk of 231 x
• Long labour increases risk 2x
• Other factors: patient immunity, volume of viral exposure, lenght of exposure, local traumas

• Ages 4 months to 41 years
• Chronic sputum production
• Nasal symptoms
• Cough
• Sinusitis
• Otitis media

• Newborn rhinitis
• Dextrocardia
• Situs inversus
• Esophageal atresia
• Biliary atresia
• Hydrocephalus
• Positive family history

• Atypical asthma
• Severe GERD
• Rhinosinusitis +/- polyps
• Bronchiectasis
• Chronic and severe secretory otitis media
• Chronic otorrhea with tympanostomy tubes

• Infertility
• Immotile sperm

• CXR
• CT-Chest
• Sweat test
• IgG, IgE
• RF, ANA,
• Alpha-1 antitrypsin levels
• Esophageal monitoring
• Fiberoptic bronchoscopy

• Screening for PCD
• Measure of mucociliary clearance
• Saccharin is placed on inferior turbinate
• If time to tasting is >60 minutes, positive