Tracheotomy was performed in seven patients during a ten-year period (1992-2001) at our department. The indication of the trachostomies, consisted of 6 patients who were long-term intratracheal intubation cases, and one was a pseudocroup case. Recently the number of tracheostomies has tended to increase. Complications after tracheotomy were 3 cases with tracheal granulation, but move of the seven cases suffered from any severe complication. The tracheotomy tubes were cut to the desired length to avoid abjasion of the carina or other structures within the mainstem bronchus. The specially designed fenestrated tracheotomy tube with one-way valves allowed voice to be produced.
We reported 2 cases with micrognathiaw ho died suddenlyb ecause of c ardiopulmonarya rrest in early infancy. The first case was diagnosed in life as Pierre Robin sequence and the cause of death was thought to be aspiration pneumonia and/or brainstem dysfunction related to sudden infant death syndrome. The second case was diagnosed as Treacher Collins syndrome, and had tracheostenosis and postnasal obstruction. She was intubated endotracheally on the day of birth, but was accidentary extubated and finally failed to resuscitate. Both cases had several findings such as micrognathia, depressiono f the root of the tongue, cleft palate, and laryngomalaciaI. nfants with micrognathia have multiple risk factors leading to fatal respiratory disturbances. Therefore, risk management and preventive care from respiratory disturbances should be considered.
Division of Otorhinolaryngology, Chiba Children's Hospital Obstructive sleep apnea syndrome (OSAS) in children caused by ad enotonsillar hypertrophy is sometimes associated with severe sequelae. Adenotonsillectomy is the first-line treatment for OSAS, but careful pre- and post-operative management are important in severe cases. We report three cases of nasal airway application for OSAS in children. An obese 5-year-old-boy w, ho had shown snoring and narcoleptic traits, was admitted to our hospital in coma. By insertion of a nasal airway, he recovered from unconsciousness on the first night of admission. Nasal airway and sequential adenotonsillectomy relieved him of severe OSAS. A 1-year-old-boy complicated with Dandy-Walker syndrome, who had shown severe snoring and an unstable sleeping pattern, was examined by polysomnography (PSG) with a nasal airway. While conventional PSG showed a severe OSA pattern, PSG under insertion of a nasal airway showed no OSA pattern. From the result of PSG we judged that adenotonsillectomy was the first-line treatment for his condition. A 6-year-old-girl with cerebral palsy, who had been diagnosed as a mixed type of sleep apnea syndrome by former PSG, was relieved of sleep apnea by the insertion of a nasal airway. We instructed the staff and family to use a nasal airway as a home management option. In conclusion, a nasal airway is useful for the management and diagnosis of OSAS in children.
Most obstructive sleep apnea in children is due to adenoid and tonsil hypertrophy that is initially managed by adenoidectomy and tonsillectomy. However, the 8 cases presented here show insufficient efficacy of surgical treatment for obstructive sleep apnea (OSAS). Some children complicated with OSAS require tracheostomy. Adenoidectomy and tonsillectomy successfuly eliminated OSAS in 6 of 8 cases. Tracheostomy needs careful attention and should follow adenoidectomy and tonsillectomy which should be the first line of treatment for complicated and uncomplicated children.