Laryngotracheale Stenosen im Kindesalter

 

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Zusammenfassung

Verengungen der oberen Atemwege sind aufgrund der besonderen Anatomie im Kindesalter häufiger und schneller symptomatisch. Die Ätiologie ist vielgestaltig. Dementsprechend differenziert muss die Therapie erfolgen.

In dieser Arbeit werden die wichtigsten Formen der laryngotrachealen Stenosen im Kindesalter erörtert. Die konservativen, endoskopischen und operativen Behandlungsverfahren werden dargestellt und gewertet.

Die Laryngomalazie als häufigste Form der supraglottischen Stenose kommt vorwiegend im Neugeborenenalter vor. Unter dem Oberbegriff Supraglottoplastik werden minimal-invasive Techniken zur Korrektur dieser Fehlbildungen zusammengefasst.

Glottische Stenosen sind im Kindesalter die seltenste Form der Atemwegsverengung. Meist muss ein Kompromiss zwischen Atmung und Stimmbildung gefunden werden. Zeitpunkt und Art der Rekonstruktion hängen stark vom Einzelfall ab, ein endoskopisches Vorgehen ist anzustreben.

Subglottische Stenosen stellen die größte Gruppe der laryngotrachealen Pathologie dar, meist in Form von Vernarbungen unterschiedlicher Ätiologie. Die cricotracheale Resektion ist heute die erfolgreichste Technik, gefolgt von der laryngotrachealen Rekonstruktion mit autologem Knorpel. Frühkindliche subglottische Stenosen stellen besondere Herausforderungen. Endoskopische Verfahren sind im Einzelfall möglich, bleiben zur Behandlung subglottischer Stenosen jedoch von untergeordneter Bedeutung. Laryngotracheale Stenosen im Kindesalter erfordern besondere Erfahrung in Diagnostik und Therapie. In Anbetracht der geringen Inzidenz ist die zentrumsgebundene Behandlung sinnvoll.

Abstract

Paediatric Laryngotracheal Stenosis

Laryngotracheal stenosis in infancy and childhood is challenging in many aspects. Diagnosis and therapy require specific expertise and must be tailored to the individual case. The most important presentations of airway pathology in children are presented in this paper. Conservative, endoscopic and surgical treatment options are discussed.

Laryngomalazia is the most frequent condition of supraglottic stenosis. The term supraglottoplasty summarizes all different techniques used for it’s repair using an endoscopic approach.

Glottic stenosis is rare in children. Usually a compromise between voice preservation and airway restoration has to be sought. Type of reconstruction and timing are varying considerably in individual cases, endoscopic approaches should be preferred.

Subglottic stenosis remains the largest group in paediatric airway pathology, with cicatrial stenosis being predominant. Today, cricotracheal resection is the most successful treatment option, followed by the classical laryngotracheal reconstruction with autologous cartilage. In early infancy subglottic stenosis is particularly demanding. Endoscopic treatment is possible in selected patients, but open reconstruction is superior in more severe cases.

Subglottic stenosis in children requires expertise and experience in diagnosis and treatment. Considering the limited incidence these cases should be managed in a referral center.

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