Obstructive Abnormalities of the Upper Airway

Definition
An anatomical or functional blockage of the airway that can lead to significant respiratory distress requiring a tracheostomy.

This obstruction may be congenital or acquired.

Obstructive abnormalities may be at a specific site of the upper airway.

Nose/nasopharynx Choanal stenosis or atresia Infants are obligate nose breathers Injury to the nasopharyngeal area Poor muscle control of the nasopharyngeal area Oral/oropharynx Blockage by the tongue and small jaw Pierre Robin sequence Down’s syndrome Cranial facial syndromes Collapse of pharyngeal muscles Laryngomalacia Hypotonia from brain injury Glottis Bilateral vocal cord paralysis Usually involves the larnygeal abductors May be caused by CNS abnormality, neuromuscular disorder, injury/trauma, or idiopathic changes Subglottis Stenosis or narrowing of the smallest part of the airway usually due to long term intubation Trachea Tracheomalacia or softening of the tissue causing collapse of the trachea Stenosis or narrowing of the trachea

Obstructive abnormalities may be caused by blockage of masses anywhere in the upper airway

Hemangiomas (benign vascular tumor) Polyps Tumors Cystic hygromas (benign lympathic lesions)

The type and site of the obstruction can affect the care the child needs.

• The obstruction may be isolated or part of a syndrome or multi-system disorder
• Children who are very dependent on a tracheostomy due to an inadequate airway are at much higher risk for life threatening events. Some children may be able to be decannulated as they get older and others will continue to need the tracheostomy for life