Table Of ContentProgress in Pediatric Surgery
Volume 21
Executive Editors
W.Ch.Hecker . J.Prevot . L.Spitz
U.G.Stauffer' P.Wurnig
SeniorEditor
P.P.Rickham
Editors
A.H.Bill, Seattle/USA J.A.Haller, Baltimore
J.Boix-Ochoa, Barcelona M.Kasai, Sendai
C.C.Ferguson, Winnipeg O.Knutrud, Oslo
R.K.Ghandi, Bombay J.Lister, Liverpool
S.L.Gans, Los Angeles N.A.Myers, Melbourne
Assistant Editor
T.A.Angerpointner, Munich
Trachea and Lung Surgery
in Childhood
Volume Editor
P. Wurnig, Vienna
With 75 Figures
Springer-Verlag
Berlin Heidelberg NewYork
London Paris Tokyo
PrimariusProfessorDr.PETERWURNIG
ChirurgischeAbteilungdes
MautnerMarkhof'schenKinderspitals
derStadtWien
Baumgasse75, A-1030Wien
Volumes1-17ofthisserieswerepublishedbyUrban& Schwarzenberg,
Baltimore-Munich
ISBN-13: 978-3-642-71667-6 e-ISBN-13: 978-3-642-71665-2
001: 10.1007/978-3-642-71665-2
Library of Congress Cataloging-in-Publication Data. Trachea and lung surgery in childhood.
(Progressinpediatricsurgery;v.21).Includesindex.1.Trachea- Stenosis- Surgery.2.Trachea
- Surgery. 3. Lungs - Surgery. I. Wurnig, Peter. II. Series. [DNLM: 1. Lung - surgery. 2.
Trachea- surgery.3.TrachealStenosis- ininfancy&childhood.WIPR677KAv.21/WF490
T7588]
RD137.AIP7 vol.21 [RF516] 617'.98s 86-31420
ISBN0-387-17232-7(U.S.) [617.533059]
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Preface
Withimprovementsinrespiratortherapyandintensivecare, congenital
malformations and various acquired pathologic deformities of the
trachea or bronchi are more often observed than used to be the case.
For a while it seemed that tracheostomy would be unnecessary, but it
has since become quite clear that severe disturbance of the trachea
would be the outcome owing to primary or secondary pathologic
changes that had not been given adequate consideration previous.
These changes can lead to urgent life-threatening episodes or definite
mutilation for the rest of the child's life. Tracheal surgery thus repre
sents a new and special challenge for the pediatricsurgeon. A solution
totheseseriousproblemsmustbefound andmeritsdiscussion. Further
more, it seems worthwhile to review cases of surgical pulmonary dis
eases,exceptforthealreadywidelydiscussedproblemsofempyemasor
bronchiectasis.
P.WURNIG, Vienna
Contents
Pathophysiology of Subglottic Tracheal Stenosis in Childhood.
B.MINNIGERODEand H.G.RICHTER. With2Figures 1
Subglottic Stenosis in Newborns After Mechanical Ventilation.
M.MARCOVICH, F.POLLAUF, and K.BURIAN. With3Figures ... 8
Treatment of Congenital Cricoid Stenosis. R.N.P.BERKOVITS,
E.J.VANDERSCHANS, andJ.C.MOLENAAR. With7Figures . . .. 20
Surgical Correction of Laryngotracheal Stenoses in Children.
E.HOF. With6Figures . . . . . . . . . . . . . . . . . . . . .. 29
Surgical Treatment of Congenital Laryngotracheo-oesophageal
Cleft. R.N.P.BERKOVITS, N.M.A.BAX, and E.J.VANDERSCHANS.
With4Figures 36
Free Periosteal Grafts in Tracheal Reconstruction: An Experi
mentalStudy. S.E.HAUGEN,T.KUFAAS, andS.SVENNINGSEN. With
2Figures 47
Tumour-InducedIntraluminalStenosesoftheCervicalTrachea
Tumour Excision and Tracheoplasty. R.DAUM, H.J.DENECKE,
and H.ROTH. With6Figures . . . . . . . . . . . . . . . . . .. 50
CardiopulmonaryBypassinTrachealSurgeryinInfantsandSmall
Children. I.LOUHIMOand M.LEIJALA. With 1Figure . . . . . .. 58
Resection ofan IntrathoracicTracheal Stenosis in a Child. T.A.
ANGERPOINTNER, W.STELTER, K.MANTEL, and W.CH.HECKER.
With 12Figures 64
TreatmentofTrachealStenosesbyResectioninInfancyandEarly
Childhood. G.M.SALZER, H.HARTL, andP.WURNIG . . . . . .. 72
Long-DistanceResectionoftheTracheawithPrimaryAnastomo-
sisin SmallChildren. H.HALSBAND. With3Figures 76
ClinicalSymptomsandTreatmentofLungSeparation.K.GDANIETZ,
K.VORPAHL, G.PIEHL, and A.HOCK. With7Figures . . . . . ., 86
Extralobar Sequestration of the Lung in Children. M.LEIJALA
andI.LOUHIMO. With 4Figures 98
VIII Contents
Scimitar Syndrome and Associated Pulmonary Sequestration:
Report of a Successfully Corrected Case. E. HORCHER and
F.HELMER. With5Figures . . . . . . . . . . . . . . . . . .. 107
CongenitalCysticAdenomatoidMalformationofthe Lung.
M.R.BECKER, F.SCHINDERA, and W.A.MAIER. With5Figures 112
Experience in Surgical Treatment of Pulmonary and Bronchial
Tumours in Childhood. W.TiSCHER, H.REDDEMANN, P.HERZOG,
K.GDANIETZ, J.WITT, P.WURNlG, and A.REINER. With 4 Figures 118
Endotrachealand EndobronchialTumoursinChildhood.
N.AuGUSTIN, S.HOFMANN-V.KAP-HERR, and P.WURNIG. With 4
Figures . . . . . . . . . . . . . . . . . . . . . .. 136
SubjectIndex 145
List of Editors and Contributors
Editors
Angerpointner, T.A., Dr., Kinderchirurgische Klinik im Dr. von
Haunerschen Kinderspital der UniversiHit Munchen, Lindwurm
straBe4, D-8000Munchen2
Hecker, W.Ch., Prof. Dr., Kinderchirurgische Klinik im Dr. von
Haunerschen Kinderspital der UniversiHit Munchen, Lindwurm
straBe4, D-8000Munchen2
Rickham, P.P., Prof. Dr. M.D., M.S., F.R.C.S., F.R.C.S.I.,
F.R.A.C.S., D.C.H., F.A.A.P., UniversiHitskinderklinik, Chirur
gische Abteilung, SteinwiesstraBe75, CH-8032Zurich
Prevot, J., Prof., Clinique Chirurgical Pediatrique, H6pital d'Enfants
de Nancy, F-54511 Vandrevre Cedex
Spitz, L., Prof., PhD. FRCS, Nuffield Professor ofPediatric Surgery,
Institute of Child Health, University of London, Hospital for Sick
Children, Great Ormond Street, 30 Guilford Street, GB-London
WCIN lEH
Stauffer, U.G., Prof. Dr., Universitatskinderklinik, Kinderchirur
gische Abteilung, SteinwiesstraBe75, CH-8032Zurich
Wurnig, P., Prof. Dr., Kinderchirurgische Abteilung des Mautner
MarkhofschenKinderspitals, Baumgasse75, A-I030Wien
x ListofEditorsandContributors
Contributors
Youwillfindtheaddressesatthebeginningoftherespectivecontribution
Angerpointner,T.A. 64 Louhimo,1. 58,98
Augustin, N. 136 Maier, W.A. 112
Bax, N.M.A. 36 Mantel, K. 64
Becker, M.R. 112 Marcovich, M. 8
Berkovits, R.N.P. 20,36 Minnigerode, B. 1
Burian, K. 8 Molenaar, J.C. 20
Daum, R. 50 Piehl, G. 86
Denecke, H.J. 50 Pollauf, F. 8
Gdanietz, K. 86, 118 Reddemann, H. 118
Halsband, H. 76 Reiner, A. 118
Hartl, H. 72 Richter, H.G. 1
Haugen, S.E. 47 Roth, H. 50
Hecker, W.Ch. 64 Salzer, G.M. 72
Helmer, F. 107 Schindera, F. 112
Herzog, P. 118 Stelter, W. 64
Hock, A. 86 Svenningsen, S. 47
Hof, E. 29 Tischer, W. 118
Hofmann-v.Kap-herr, S. 136 vanderSchans, E.V. 20,36
Horcher, E. 107 Vorpahl, K. 86
Kufaas, T. 47 Witt, J. 118
Leijala, M. 58, 98 Wumig, P. 72,118,136
Pathophysiology ofSubglottic Tracheal Stenosis
in Childhood
B.MINNIGERODE1and H.G.RICHTER1
Thesubglotticspaceisaregionoftheairwaythatisnotwelldefinedanatomically,
extending inits widestdefinitionfrom the vocal cord down to thesmallestbronchi.
Inthispaperthetermisusedtomeanonlyasthespatiumsubglotticum,thespace
enclosed ventrally and laterallyby the elasticcone, which bearsthe cricoid plate
in its posteriorwall and which thenwithout abreakbecomesthecervicaltrachea
atthe caudalendofthe cricoidcartilage.
There is avarietyofcausesofstenosesinthissegmentoftheairway,onlytwo
particularlyproblematictypesofwhichwillbediscussed: (1)Disturbedembryonic
development, typicallygiving rise to primarylesions, and (2) trauma, whichleads
mainly tosecondarylesions.
1. Embryonicdevelopmentaldisturbancesinthis area resultinso-calledhardand
soft stenoses of the subglottic space (Minnigerode and Richtering 1969; Min
nigerode 1969, 1971). This means a narrowing ofthe normal shape ofthe infra
glottic conus with a pad-like swelling of the mucosa, reducing the lumen to less
than4mminmostinstances.Thebasisisprobablyametabolicdisturbanceduring
the 9th embryonicweek, i.e., during the break-offofthe physiologicalepithelial
occlusion (Kallius 1897; Minnigerode 1962), which involves all three sections of
the larynx. During this developmental stage the epithelium is actually an inter
mediate layer, a diathelium in the statically and dynamically defined metabolic
field between liquid-rich connective tissue and embryonic amniotic fluid. A dis
turbanceofthe normalcontinuousreorganizationwhich typicallyalsotakesplace
in the development ofother hollow organs in the humanorganism (Singer 1933)
results in uneven growth of the tissues making up this airway region, an over
growth ofthe mesenchymal tissuecontrastingwith normalgrowthorhypotrophy
ofthe epithelium. The epitheliumisthen damaged bythe pressureofthe mesen
chymal pads, and the mesenchymal tissues of both sides may advance and even
grow together in an interlockingpattern through the epithelial defects. The kind
of stenosis resulting from this depends on whether the maximum of this growth
disturbance is more ventrally or more dorsally located, i.e., within the region of
the chondrification centre of the cricoid area (Heineken 1952; Walender 1955;
Smith andBain 1965).
Clinically,thiskindofstenosispresentsasaninspiratorystridorfrombirthon,
initially without obvious impairment of respiration. Impairment of respiration,
1UniversityHospitalforOtorhinolaryngology,D-4300Essen,FRG.
ProgressinPediatricSurgery,Vol.21
Ed.byP.Wumig
©Springer-VerlagBerlinHeidelberg1987
