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(Pediatrics in Review. 2006;27:e33-e35.)
© 2006 American Academy of Pediatrics

In Brief

Laryngomalacia and Tracheomalacia: Common Dynamic Airway Lesions

The first 20% of the full text of this article appears below.

Tracheomalacia and Bronchomalacia in Children: Pathophysiology, Assessment, Treatment and Anaesthesia Management. Austin J, Ali T. Paediatr Anaesthes. 2003;13 :3 –11 Clinical Characteristics of Children With Tracheobronchial Anomalies. Sanchez I, Navarro H, Mendez M, Holmgren N, Caussade S. Pediatr Pulmonol. 2003;35 :288 –291 Extraesophageal Reflux in Pediatric Patients With Upper Respiratory Symptoms. Rosbe KW, Kenna MA, Auerbach AD. Arch Otolaryngol Head Neck Surg. 2003;129 :1213 –1219 Laryngomalacia and Its Treatment. Olney DR, Greinwald JH, Smith RJH, Bauman NM. Laryngoscope. 1999;109 :1770 –1775 Effect of Altering Smooth Muscle Tone on Maximal Expiratory Flows in Patients with Tracheomalacia. Panich HB, Keklikian EN, Motley RA, Wolfson MR, Schidlow DV. Pediatr Pulmonol. 1990;9 :170 –176

During the normal respiratory cycle, rhythmic expansion and contraction of the thorax leads to dynamic changes in thoracic pressures, allowing air to flow into and out of the lungs (Fig. 1). On inspiration, the thoracic cavity expands, resulting in negative intrathoracic and airway pressures (relative to atmospheric pressure) and allowing air to flow into the lungs. Extrathoracic airway lesions are most likely to cause obstruction during the inspiratory phase. In contrast, expiration is accomplished by contracting the volume of the thoracic cavity, thus creating positive pressures in the thorax, which are transmitted to the intrathoracic airways. Consequently, it is during expiration that intrathoracic airway lesions can cause obstruction. Laryngomalacia and tracheomalacia are two commonly diagnosed dynamic airway lesions. Although the airflow obstruction resulting from both abnormalities can range from mild to severe, their causes, presentations, and treatments differ.

View larger version (23K):   Figure 1. Airway pressures during respiratory cycle. During inspiration, expansion of the thorax creates negative pressure within the thoracic cavity and airways (black arrows), allowing inflow of air (blue arrow). . . . [Full Text of this Article]

Alfin G. Vicencio, MD
Sanjay Parikh, MD
Albert Einstein College of Medicine and Children’s Hospital at Montefiore
Bronx, NY

Henry M. Adam, MD, Editor, In Brief

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