RESUMEN
A 12-month-old child with a history of prematurity, severe respiratory compromise and failure to thrive required laser supraglottoplasty for severe laryngotracheobronchomalacia. Maintaining adequate oxygenation intraoperatively proved very difficult. Our usual technique with no endotracheal tube was not possible and CO2 lasering was commenced with a polyvinylchloride endotracheal tube in the operative field. The endotracheal tube was struck by the laser but did not ignite. Concern about the very serious morbidity from a laser-induced fire in the airway prompted a search for possible solutions. No commercially available laser-resistant tube is available in small enough diameter to use in an infant. An aluminium foil tape (3M #425) was evaluated and found to be potentially very useful to protect against an airway fire in this uncommon situation.
Asunto(s)
Aluminio , Incendios/prevención & control , Complicaciones Intraoperatorias/prevención & control , Intubación Intratraqueal/instrumentación , Terapia por Láser/efectos adversos , Broncoscopía , Femenino , Retardadores de Llama/uso terapéutico , Humanos , Lactante , Complicaciones Intraoperatorias/etiología , Enfermedades de la Laringe/cirugía , Enfermedades de la Tráquea/cirugíaRESUMEN
A neonate is reported here, who was born with severe mandibular hypoplasia, complete absence of the tongue, unilateral choanal atresia, contralateral choanal stenosis and developed severe airway obstruction at birth. Arrested development of the ventral first branchial arch most likely underlies the clinical deficits. Most reported cases of agnathia have been lethal but the infant reported here has survived into infancy with a tracheostomy and feeding gastrostomy. Her clinical features, assessment and management are discussed.
