title: Surgical Treatment of Tracheobronchomalacia: A novel approach.
abstract: Tracheobronchomalacia, as a whole, is likely misdiagnosed and underestimated as a cause of respiratory compromise in pediatric patients. Currently, there is no standardized approach for the overall evaluation of pediatric tracheobronchomalacia (TBM) and the concept of excessive dynamic airway collapse (EDAC); no grading score for the evaluation of severity; nor a standardized means to successfully approach TBM and EDAC. This paper describes our experience standardizing the approach to these complex patients whose backgrounds include different disease etiologies, as well as a variety of comorbid conditions. Preoperative and postoperative evaluation of patients with severe TBM and EDAC, as well as concurrent development of a prospective grading scale, has allowed us to ascertain correlation between surgery, symptoms, and effectiveness on particular tracheal-bronchial segments. Long-term, continued collection of patient characteristics, surgical technique, complications, and outcomes must be collected given the overall heterogeneity of this particular population.
authors.affiliation: Department of Pediatric Surgery, Boston Children's Hospital, Boston, MA 02115.
authors.forename: Sigrid
authors.initials: S
authors.lastname: Bairdain
authors.affiliation: Department of Pediatric Surgery, Boston Children's Hospital, Boston, MA 02115; Department of Anesthesia, Boston Children's Hospital, Boston MA 02115.
authors.forename: David
authors.initials: D
authors.lastname: Zurakowski
authors.affiliation: Department of Cardiovascular Surgery, Boston Children's Hospital, Boston MA 02115.
authors.forename: Christopher W
authors.initials: CW
authors.lastname: Baird
authors.affiliation: Department of Pediatric Surgery, Boston Children's Hospital, Boston, MA 02115. Electronic address: Russell.jennings@childrens.harvard.edu.
authors.forename: Russell W
authors.initials: RW
authors.lastname: Jennings
mesh_terms: D000402:Airway Obstruction / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery; D001999:Bronchoscopy; D002675:Child, Preschool; D015897:Comorbidity; D003937:Diagnosis, Differential; D003952:Diagnostic Imaging; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D010348:Patient Care Team; D055089:Tracheobronchomalacia / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*
keywords: Aortopexy; Excessive dynamic airway collapse (EDAC); Lower airway obstruction; Tracheobronchomalacia (TBM); Tracheopexy; Upper airway obstruction