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Laryngoscopy image showing significant laryngomalacia. Note the curled appearance of the airway with obstruction of the glottis. The image on right demonstrates the same patient immediately after supraglottoplasty.
Source publication
Neonatal airway abnormalities are commonly encountered by the neonatologist, general pediatrician, maternal fetal medicine specialist, and otolaryngologist. This review article discusses common and rare anomalies that may be encountered, along with discussion of embryology, workup, and treatment. This article aims to provide a broad overview of neo...
Contexts in source publication
Context 1
... 4 weeks gestation, the larynx first develops in the embryo, and by 8 weeks all major cartilage structures are present [6]. There are several defects noted to contribute to congenital laryngomalacia, including redundant supraglottic mucosa, an elongated epiglottis that collapses inward and posteriorly (the classic "omega-shape"), and foreshortened aryepiglottic folds seen in Figure 1 [5]. Children 2022, 9, x FOR PEER REVIEW 2 of 18 4 weeks gestation, the larynx first develops in the embryo, and by 8 weeks all major cartilage structures are present [6]. ...
Context 2
... 2022, 9, x FOR PEER REVIEW 2 of 18 4 weeks gestation, the larynx first develops in the embryo, and by 8 weeks all major cartilage structures are present [6]. There are several defects noted to contribute to congenital laryngomalacia, including redundant supraglottic mucosa, an elongated epiglottis that collapses inward and posteriorly (the classic "omega-shape"), and foreshortened aryepiglottic folds seen in Figure 1 [5]. Physicians should be aware of the clinical presentation of an infant with laryngomalacia as its frequency is as high as 1 in 2000 the general population [3]. ...
Context 3
... distinctive feature is paradoxical cyanosis, wherein the patient resolves their cyanosis when crying, as air flow is temporarily reestablished [110,111]. Unilateral atresia normally presents later in life with symptoms of obstruction and unilateral rhinorrhea (see Figure 10), and may have several instances of otitis media in the ipsilateral ear [112]. Some patients are diagnosed after failure to pass a nasogastric tube or suction catheter. ...
Context 4
... distinctive feature is paradoxical cyanosis, wherein the patient resolves their cyanosis when crying, as air flow is temporarily reestablished [110,111]. Unilateral atresia normally presents later in life with symptoms of obstruction and unilateral rhinorrhea (see Figure 10), and may have several instances of otitis media in the ipsilateral ear [112]. Some patients are diagnosed after failure to pass a nasogastric tube or suction catheter. ...
Citations
... Choana means any funnelshaped cavity, or pair of openings between the nasal cavity and nasopharynx, also called choanae ossae and posterior nares. 2 Atresia means a congenital absence or closure of normal body orifices or tubular organs. 3 In infants with bilateral choanal atresia, the patient may develop cyanosis and respiratory failure, as the infant must breathe through the nose to suck the nipple effectively. Bilateral choanal atresia is an emergency and should be treated immediately. ...
Choanal atresia is a disorder in which there is a congenital membrane or bone in one or both choanas due to the failure of the buconasalis membrane to divide from the embryonic period. Currently, there is still controversy about the effectiveness of various surgical techniques and the need for post-surgical use of stents and anti-neoplastic agents. Provides information regarding the diagnosis and management of choanal atresia. A 15-year-old female with bilateral choanal atresia. The patient underwent endonasal choanoplasty. Choanal was patented until the 8th week of post-operative evaluation. Management of choanal atresia. Making a neo-unicoana with a mucosal mesh is one of the effective surgical techniques for treating choanal atresia
... The best way to show the relationship between neighbouringparasellar structures and the lateral expansion of pituitary macroadenomas, particularly the internal carotid arteries, which are most susceptible to damage after surgery, is using MRI postcontrast coronal sections [16]. KNOSP provided a very useful and straightforward grading system that has been utilized to date to forecast parasellartumour development into the cavernous sinus [17].A categorization system called SIPAP was presented [18], attempting to merge the KNOSP-HARDY-WILSON categories. They were able to precisely describe tumour development in all directions using this combination, including lateral, upward, and downward orientations as well as forward and backward extensions. ...
BACKGROUND: All pituitary adenomas, with the probable exception of prolactinoma, must initially undergo surgery. As a result, choosing the best surgical strategy and ensuring the safest possible outcome during excision need a straightforward and reproducible MRI classification based on the primary routes of cancer growth. Based on the KNOSP-STEINER categorization of parasellar development, which now includes a classification for posterior, superior, anterior, and inferior tumour extension, the SIPAP MRI categorization for pituitary adenomas was developed.Magnetic resonance imaging (MRI), which is the recommended technique, is often used to identify pituitary adenomas. OBJECTIVE: The SIPAP classification in the standardized reporting format for pituitary adenomas in order to offer the best imaging definition of the tumour's delineation, connection totumour size and juxtasellar structure. METHODS: The study was carried out at Mayo Hospital from December 1, 2021, to November 30, 2022. Stata version 15 was used to analyze the data. Cohen's Kappa was used to determine interobserver variability. The Chi-square test was used to evaluate grades before and after therapy. In statistics, P values ≤ 0.05 were regarded as significant.49 patients with histopathology pituitary macroadenoma had their imaging retrospectively examined by two radiologists, who used the SIPAP approach to evaluate the outcomes. RESULTS:All Kappa statistical values exceeding 0.7 (p-value less than 0.001) indicated strong inter-observer agreement for the inferior, anterior, posterior, and superior extents.The patient population was 63% male and 37% female. 71.82 cm3 and 49.50 cm3 respectively were the largest preoperative and postoperative volumes. With a mean of 14.1 and a standard deviation of 17.7 compared to a mean et al/ A SIPAP CLASSIFICATION STUDY PITUITARY MACROADENOMA GRADING USING MAGNETIC RESONANCE IMAGING eISSN1303-5150 www.neuroquantology.com of 4.5 and a standard deviation of 10.4, pre-and postoperative volumes were significantly different, with a p-value of less than 0.001. The length that differed most noticeably between pre-and post-operative lengths had a mean value of 2.4 and a standard deviation of 1.1 compared to a mean value of 1.3 and a standard deviation of 1.1, with a p-value less than 0.001. The pre-and post-operative SIPAP grading of each tumour extension varied significantly, with the exception of the anterior extension. Prior to surgery, 67.3% of patients had grade 3 suprasellar extension, but thereafter, 63.3% had grade 0. Prior to surgery, grade 2 was present in 51.0% of patients with intrasellar extension, whereas grade 0 was present in 71.4%. Grade 0 anterior, posterior, and parasellar extensions occurred more often postoperatively as compared to preoperatively. CONCLUSIONS:We suggest adopting the straightforward and objective SIPAP categorization into standard MR reporting for the identification of the optimal pituitary tumour, its association with juxtasellar structures, and the tumour size.
... The symptoms can exacerbate by lying on the back, distress, and feeding [4]. The infant can also regurgitate, gag reflex, and fail to succeed [5,6]. The structures above true vocal cords, the supraglottis, are estimated to happen optional to the remarkable embryologic improvement of the laryngeal framework. ...
Laryngomalacia is the term most broadly used to portray the "internal breakdown of structures of supraglottis of the larynx at the time of inspiration. It is often associated with stridor during inspiration, which is of a high pitch at the time of birth and comes into notice by 14 days. When there is an increase in breathing, stridor worsens, and it is usually position-dependent. Laryngomalacia means the weakening of the larynx resulting in a collapse of the laryngeal cartilages, especially the epiglottis, into the airway. This partially occludes the upper airway during inspiration and causes inspiratory stridor. The exact etiology of the condition is not known. It is a well-known cause of noisy breathing in neonates and infants. The common presentation is a neonate with flushing and high-pitched inspiratory stridor that is usually noticed before 14 days of age. This worsens with breathing and supine positioning and improves in a prone position. Less commonly, it can present with hypoxia, feeding problems, aspiration, and failure to thrive. The condition may increase in severity during early life but usually self-resolves by two years of age. The hiccup-like squeak of laryngomalacia during inspiration is due to unsettled air flowing through the laryngeal passage. The condition is diagnosed with laryngoscopy, and the treatment varies with presentation and severity. Neonates with the uncomplicated disease can be treated expectantly. Those presenting with feeding problems and gastroesophageal reflux will require acid suppression. Severe complications like aspiration, severe airway obstruction, and hypoxia will require surgical treatment, including supraglottoplasty. In cases where the surgical treatment failed, noninvasive ventilation can be advised. The article reviews the various medical and surgical interventions and the management of severe laryngomalacia.
Objective
Fetal head and neck masses can result in critical airway obstruction. Our study aimed to evaluate prenatal factors associated with the decision for a definitive airway, including ex‐utero intrapartum treatment (EXIT), at birth among at‐risk fetuses.
Methods
A single‐institution retrospective review evaluated all fetal head and neck masses prenatally diagnosed from 2005 to 2023. The primary outcome was the decision for a definitive airway at birth, including intubation, tracheostomy, or EXIT.
Results
Thirty four patients were included, with 23 deliveries occurring at our institution. 8/23 (35%) patients received a definitive airway at birth, six underwent an EXIT procedure, and two required intubation only. Patients who received a definitive airway had higher rates of polyhydramnios (50% vs. 7%, p = 0.03), tracheal narrowing on ultrasound (US) (50% vs. 0%, p = 0.01), tracheal displacement on US (63% vs. 0%, p < 0.01), abnormal fetal breathing on US (50% vs. 0%, p = 0.01), tracheal narrowing or displacement on magnetic resonance imaging (MRI) (75% vs. 7%, p < 0.01), and larger mass maximum diameter (7.9 vs. 4.3 cm, p = 0.02). In our series, 100% of patients with polyhydramnios, tracheal narrowing or displacement on either US or MRI, and abnormal fetal breathing on US received a definitive airway at birth.
Conclusion
Prenatal findings of tracheal narrowing or displacement, polyhydramnios, and abnormal fetal breathing are strongly associated with the decision for a definitive airway at birth and warrant mobilization of appropriate resources.
The neonatal airway is often difficult to secure, whether the practitioner responsible for managing the airway is a neonatologist, pediatrician, anesthesiologist, another specialist or an advanced practice provider [...]
