title: Treatment of severe tracheobronchomalacia: Ten-year experience.
abstract: BACKGROUND
  Paediatric tracheobronchomalacia is a rare but potentially serious condition. Severe tracheobronchomalacia requires intervention or operation. This is an evaluation of a ten-year experience at an institution.
  
  
  METHODS
  In this retrospective study all patients were included that required an intervention for severe tracheobronchomalacia from 2003 to 2012. Symptoms, aetiology, comorbidities, localisation of the malacia, age at diagnosis, therapeutic measures and associated complications were evaluated.
  
  
  RESULTS
  Forty-four patients with severe tracheobronchomalacia underwent intervention/operation. The predominant aetiology was vascular compression in 48%. The majority of patients had complex comorbidities, most importantly cardiac pathology in 66%. The median age at diagnosis was 3 months. A total of 17 aortopexies, 21 tracheostomies and 25 stent placements were performed. The mean follow-up was 2.6 years. Severe complications occurred in 12 patients. The most common complications were stent obstruction/fracture and tracheostomy tube obstruction.
  
  
  CONCLUSIONS
  The management of severe tracheobronchomalacia is complex and the population of patients is very heterogeneous. Therefore the treatment has to be adapted for each patient individually. The decision strategies are discussed in this article. The surgical techniques for placement and safe removal of expandable bare metallic stents employed in our institution are presented. A multidisciplinary team of ENT surgeons, Intensivists, Cardiologists and Cardiac surgeons is of great importance.
authors.affiliation: Department of Paediatric Otolaryngology, Evelina London Children's Hospital, Guy's and ST Thomas' NHS Foundation Trust, Westminster Bridge Road, London SE1 7EH, United Kingdom. Electronic address: detrey@hotmail.com.
authors.forename: Lorraine A
authors.initials: LA
authors.lastname: de Trey
authors.affiliation: Department of Paediatric Otolaryngology, Evelina London Children's Hospital, Guy's and ST Thomas' NHS Foundation Trust, Westminster Bridge Road, London SE1 7EH, United Kingdom.
authors.forename: Julia
authors.initials: J
authors.lastname: Dudley
authors.affiliation: Department of Otolaryngology, Southampton Children's Hospital, University Hospital Southampton NHS Foundation Trust, Tremona Road, Southampton SO16 6YD, United Kingdom.
authors.forename: Hasnaa
authors.initials: H
authors.lastname: Ismail-Koch
authors.affiliation: Paediatric Intensive Care Unit, Evelina London Children's Hospital, Guy's and ST Thomas' NHS Foundation Trust, Westminster Bridge Road, London SE1 7EH, United Kingdom.
authors.forename: Andrew
authors.initials: A
authors.lastname: Durward
authors.affiliation: Department of Cardiology and Cardiac Surgery, Evelina London Children's Hospital, Guy's and ST Thomas' NHS Foundation Trust, Westminster Bridge Road, London SE1 7EH, United Kingdom.
authors.forename: Hannah
authors.initials: H
authors.lastname: Bellsham-Revell
authors.affiliation: Department of Paediatric Otolaryngology, Evelina London Children's Hospital, Guy's and ST Thomas' NHS Foundation Trust, Westminster Bridge Road, London SE1 7EH, United Kingdom.
authors.forename: Sean
authors.initials: S
authors.lastname: Blaney
authors.affiliation: Department of Paediatric Otolaryngology, Evelina London Children's Hospital, Guy's and ST Thomas' NHS Foundation Trust, Westminster Bridge Road, London SE1 7EH, United Kingdom.
authors.forename: Ian
authors.initials: I
authors.lastname: Hore
authors.affiliation: Department of Cardiology and Cardiac Surgery, Evelina London Children's Hospital, Guy's and ST Thomas' NHS Foundation Trust, Westminster Bridge Road, London SE1 7EH, United Kingdom.
authors.forename: Conal B
authors.initials: CB
authors.lastname: Austin
authors.affiliation: Department of Paediatric Otolaryngology, Evelina London Children's Hospital, Guy's and ST Thomas' NHS Foundation Trust, Westminster Bridge Road, London SE1 7EH, United Kingdom.
authors.forename: Gavin A
authors.initials: GA
authors.lastname: Morrison
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D011183:Postoperative Complications / Q000453:epidemiology; D012189:Retrospective Studies; D015607:Stents / Q000009:adverse effects*; D055089:Tracheobronchomalacia / Q000150:complications / Q000601:surgery*; D014139:Tracheostomy / Q000009:adverse effects / Q000379:methods*
keywords: Expandable metallic stent; Pediatric bronchomalacia; Pediatric tracheobronchomalacia; Pediatric tracheomalacia