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ENT Pathology

ENT Pathology. Alyssa Brzenski MD. Case.

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ENT Pathology

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  1. ENT Pathology Alyssa Brzenski MD

  2. Case A 34 week old premature baby boy was born vaginally to a young mother with chorioamnioitis. At birth the baby was tachypneic and required intubation. Blood cultures were performed and came back positive, so the NICU started the baby on IV Penicillin and Gentamycin for 14 days. He was given surfactant x 3 doses and remained intubated for 7 days. Upon finishing his antibiotic regime, he was allowed to go home with his mother. 2 - 3 weeks later, the mother appears at the pediatricians office with the baby and complains that “the baby turns blue, he’s noisy when he breathes and she has difficulty feeding him.”

  3. “Noisy Breathing” Definition

  4. Differential Diagnosis

  5. Evaluation of Stridor

  6. Laryngomalacia- The Facts • Most common laryngeal anomaly and cause of stridor (54-75%) • DEFINITION: • “Flaccid laryngeal tissue and inward curling of supraglottic structures during inspiration. There is a fluttering inspiratory stridor that worsens with agitation, crying, feeding or supine.” • Begins in 1st weeks of life and peaks at 6-8 months

  7. Normal Pediatric Anatomy

  8. Laryngomalacia

  9. Treatment

  10. Supraglottoplasty

  11. Before and After

  12. CO2 vs YAG Laser

  13. Additional Management • Dexamethasone • Possible Post-op Intubation • Racemic Epi • PPI • H2 Blocker

  14. Subglottic Stenosis • Aquired Subglottic Stenosis • From prolonged intubation or high pressure on the tracheal mucosa • Congenital Subglottic Stenosis • Cricoid diameter less than 3.5mm • Result of malformation of the cricoid cartilage

  15. Vocal Cord Paralysis • Inspiratory or biphasic stridor, weak cry • Causes • Birth trauma • Central (Arnold-Chiari, Brainstem compression) neurologic diseases • Thoracic disease or procedures (PDA ligation, aortic arch surgery)

  16. Posterior glottic web

  17. Anterior Laryngeal Webs

  18. Laryngotracheal Cleft

  19. ENT Pathology and associated Co-morbidities

  20. Sources • Messer A. Congenital Disorders of the Larynx. Cummings Otolaryngology. 5th Ed. 2010. 2866-75. • Boudewyns A, Claes J, Van de Heyning P. An approach to stridor in infants and children.Eur J Pediatr 2010: 169; 135-141. • Richter G, Thompson D. The Surgical Management of Laryngomalacia.OtolaryngolClin N Am 2008: 41: 837-64.

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