Search

This paper reviews current concepts and results in the management of congenital tracheal stenosis (CTS). Diagnostic options are considered and the requirements for successful management defined. Chief amongst these is a multi-disciplinary approach with individualised patient management. Severe long-segment CTS represents the biggest challenge to clinicians and the worst problems for affected families. Near-death episodes are frequent in affected infants and some cannot be ventilated and require ECMO. Associated cardiovascular anomalies are frequent. Patients require immediate resuscitation and transfer to a specialist unit. After careful assessment, accurate diagnosis and discussion, primary resection and end-to-end repair with a slide technique should always be the first option, with concomitant repair of associated cardiac anomalies. If this is impossible because of the severity of the lesion, some form of patch tracheoplasty will be indicated. Cardiopulmonary bypass is often required. Patches include pericardium, autograft trachea, carotid artery, cartilage, and allograft trachea. Mortality ranges from 0 to 30% in the literature, which largely comprises single-centre long-term experience. Recurrence is common and can be managed by stenting and tracheal homograft implantation. Long-term quality of life of survivors is little reported but seems good. Physiological data are lacking. To improve results, we suggest a treatment algorithm to rationalise care. [Copyright &y& Elsevier]

Abstract: Objective: Venous vascular malformations in the head and neck region present a difficult management challenge. We describe our experience of using sodium tetradecyl sulphate injection sclerotherapy to treat children presenting with venous malformations of the oral and pharyngeal region. Methods: We performed a retrospective case note review of consecutive children treated at our institution between 2004 and 2011. Patient notes were analysed for demographic details, site and size of lesion, number and duration of treatments, treatment response and complications. Results: Twelve patients were included (7 boys and 5 girls, mean age 7 years). Sites of lesions included tongue, floor of mouth, pharynx, tonsillar fossae, parapharyngeal space and soft palate. All patients were treated with 3% sodium tetradecyl sulphate (STS) foam injected trans-orally or percutaneously under ultrasound or fluoroscopic guidance. The lesions had a mean volume of 4ml (range 2–14ml). An average of 3 treatments was required (range 1–9). In 4 patients a single treatment was sufficient. For those patients requiring multiple treatments, a mean of 4 treatments were required over an average period of 28 months. The overall response rate was 83% (10/12). Complete resolution was achieved in 4 cases (33%) with a significant reduction in size in a further 6 cases (50%). Larger lesions generally require more treatments than low volume lesions. Two cases recurred despite treatment. One patient suffered minor bleeding following transcutaneous injection. Conclusions: Injection sclerotherapy using STS foam offers an effective treatment option when managing children presenting with venous malformations in the oral and pharyngeal. A single treatment may be adequate for small lesions but the procedure may be safely repeated until a satisfactory result is obtained. [Copyright &y& Elsevier]