eMedicine Specialties > Thoracic Surgery > Miscellaneous

Tracheomalacia: Follow-up

Author: Daniel S Schwartz, MD, FACS, Assistant Clinical Professor of Cardiothoracic Surgery, Mount Sinai School of Medicine; Chief of Thoracic Surgery, Huntington Hospital
Coauthor(s): Sat Sharma, MD, FRCPC, Professor and Head, Division of Pulmonary Medicine, Department of Internal Medicine, University of Manitoba; Site Director, Respiratory Medicine, St Boniface General Hospital
Contributor Information and Disclosures

Updated: Aug 6, 2009

Outcome and Prognosis

With conservative measures, the symptoms often resolve spontaneously by age 18-24 months.2

Tracheostomy has been used to stent the airway until natural maturation of cartilage occurs. This often imposes a heavy penalty on the child; therefore, treatment alternatives should be explored.

Aortopexy has proven to be a safe, expedient way to relieve the problem of tracheomalacia in most patients. The success of aortopexy has been reported at about 75% in several small studies. Aortopexy has less long-term morbidity than tracheostomy. While not altering the structural characteristics of the tracheal wall, it widens the anterior-posterior tracheal dimension to maintain a patent lumen. The only treatment failures with aortopexy were patients with diffuse or proximal tracheal involvement.

Future and Controversies

Current recommendations for treatment of tracheomalacia include the following:

  • Forms of milder primary tracheomalacia are best treated by nonsurgical means.7
  • For distal tracheomalacia that is idiopathic, pulsatile, or associated with tracheoesophageal fistula or vascular anomalies, aortopexy with concomitant intraoperative bronchoscopy appears to be the procedure of choice.
  • For proximal or diffuse tracheomalacia, tracheostomy, despite its related high morbidity, still may be necessary to stent the airway.
  • As experience accumulates, a direct surgical approach to treating tracheomalacia may replace tracheostomy in the management of proximal and diffuse tracheomalacia. These procedures include prosthetic stenting, tracheoplasty, and tracheal resection with end-to-end anastomosis.
  • In one study, silicone stents were inserted into the trachea or left main-stem bronchus in 14 children (aged 2-69 mo) for tracheomalacia or airway kinking (7 cases), vascular compression (5 cases), and surgically-corrected congenital tracheal stenoses (2 cases). The best results were obtained in tracheomalacia. Six cases out of 14 (43%) were considered successful, and 5 cases were considered failures, primarily because of stent migration.15

 


More on Tracheomalacia

Overview: Tracheomalacia
Workup: Tracheomalacia
Treatment: Tracheomalacia
Follow-up: Tracheomalacia
Multimedia: Tracheomalacia
References
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References

  1. Beasley SW, Qi BQ. Understanding tracheomalacia. J Paediatr Child Health. Jun 1998;34(3):209-10. [Medline].

  2. Carden KA, Boiselle PM, Waltz DA, Ernst A. Tracheomalacia and tracheobronchomalacia in children and adults: an in-depth review. Chest. Mar 2005;127(3):984-1005. [Medline].

  3. Jaquiss RD. Management of pediatric tracheal stenosis and tracheomalacia. Semin Thorac Cardiovasc Surg. Fall 2004;16(3):220-4. [Medline].

  4. Boogaard R, Huijsmans SH, Pijnenburg MW, et al. Tracheomalacia and bronchomalacia in children: incidence and patient characteristics. Chest. Nov 2005;128(5):3391-7. [Medline].

  5. Anton-Pacheco JL, Garcia-Hernandez G, Villafruela MA. The management of tracheobronchial obstruction in children. Minerva Pediatr. Feb 2009;61(1):39-52. [Medline].

  6. Adliff M, Ngato D, Keshavjee S, et al. Treatment of diffuse tracheomalacia secondary to relapsing polychondritis with continuous positive airway pressure. Chest. Dec 1997;112(6):1701-4. [Medline].

  7. McNamara VM, Crabbe DC. Tracheomalacia. Paediatr Respir Rev. Jun 2004;5(2):147-54. [Medline].

  8. Baroni RH, Feller-Kopman D, Nishino M, et al. Tracheobronchomalacia: comparison between end-expiratory and dynamic expiratory CT for evaluation of central airway collapse. Radiology. May 2005;235(2):635-41.

  9. Collard P, Freitag L, Reynaert MS, et al. Respiratory failure due to tracheobronchomalacia. Thorax. Feb 1996;51(2):224-6. [Medline].

  10. Kikuchi S, Kashino R, Hirama T, et al. Successful treatment of tracheomalacia associated with esophageal atresia without a tracheoesophageal fistula by aortopexy: report of a case. Surg Today. 1999;29(4):344-6. [Medline].

  11. Gotway MB, Golden JA, LaBerge JM, et al. Benign tracheobronchial stenoses: changes in short-term and long-term pulmonary function testing after expandable metallic stent placement. J Comput Assist Tomogr. Jul-Aug 2002;26(4):564-72. [Medline].

  12. Dave S, Currie BG. The role of aortopexy in severe tracheomalacia. J Pediatr Surg. Mar 2006;41(3):533-7. [Medline].

  13. Wright CD. Tracheomalacia. Chest Surg Clin N Am. May 2003;13(2):349-57, viii. [Medline].

  14. Zinman R. Tracheal stenting improves airway mechanics in infants with tracheobronchomalacia. Pediatr Pulmonol. May 1995;19(5):275-81. [Medline].

  15. Fayon M, Donato L, de Blic J, et al. French experience of silicone tracheobronchial stenting in children. Pediatr Pulmonol. Jan 2005;39(1):21-7.

  16. Backer CL, Mavroudis C, Dunham ME, Holinger LD. Pulmonary artery sling: results with median sternotomy, cardiopulmonary bypass, and reimplantation. Ann Thorac Surg. Jun 1999;67(6):1738-44; discussion 1744-5. [Medline].

  17. Feist JH, Johnson TH, Wilson RJ. Acquired tracheomalacia: etiology and differential diagnosis. Chest. Sep 1975;68(3):340-5. [Medline].

  18. Ferretti A, Judd JT, Taylor PR, et al. Modulating influence of dietary lipid intake on the prostaglandin system in adult men. Lipids. May 1989;24(5):419-22. [Medline].

  19. Johnson TH, Mikita JJ, Wilson RJ, Feist JH. Acquired tracheomalacia. Radiology. Dec 1973;109(3):576-80. [Medline].

  20. Paston F, Bye M. Tracheomalacia. Pediatr Rev. Sep 1996;17(9):328. [Medline].

  21. Peters CA, Altose MD, Coticchia JM. Tracheomalacia secondary to obstructive sleep apnea. Am J Otolaryngol. Nov-Dec 2005;26(6):422-5. [Medline].

  22. Yalcinbas YK, Erek E, Salihoglu E. A rare cause of respiratory distress in infants: tracheal compression due to anomalous course of innominate artery. Turk J Pediatr. Jan-Mar 2006;48(1):93-5. [Medline].

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Further Reading

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Keywords

tracheomalacia, esophageal atresia, tracheobronchomalacia, bronchomalacia, tracheoesophageal fistula, swallowing, swallowing difficulty, flaccid tracheal cartilage, wide posterior membranous wall, reduced anterior-posterior airway caliber, tracheal collapse, abnormal tracheal cartilage, airway obstruction, abnormally increased compliance of the trachea, percutaneous tracheostomy, aortopexy, GERD, gastroesophageal reflux, intubation complication, extended intubation, chronic intubation, intubation problem, tracheal injury, trachea, relapsing polychondritis, cartilage inflammation, treatment, diagnosis, medications, disorder

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Contributor Information and Disclosures

Author

Daniel S Schwartz, MD, FACS, Assistant Clinical Professor of Cardiothoracic Surgery, Mount Sinai School of Medicine; Chief of Thoracic Surgery, Huntington Hospital
Daniel S Schwartz, MD, FACS is a member of the following medical societies: American College of Chest Physicians, American College of Surgeons, Society of Thoracic Surgeons, and Western Thoracic Surgical Association
Disclosure: Nothing to disclose.

Coauthor(s)

Sat Sharma, MD, FRCPC, Professor and Head, Division of Pulmonary Medicine, Department of Internal Medicine, University of Manitoba; Site Director, Respiratory Medicine, St Boniface General Hospital
Sat Sharma, MD, FRCPC is a member of the following medical societies: American Academy of Sleep Medicine, American College of Chest Physicians, American College of Physicians-American Society of Internal Medicine, American Thoracic Society, Canadian Medical Association, Royal College of Physicians and Surgeons of Canada, Royal Society of Medicine, Society of Critical Care Medicine, and World Medical Association
Disclosure: Nothing to disclose.

Medical Editor

Richard Thurer, MD, B and Donald Carlin Professor of Thoracic Surgical Oncology, Miller School of Medicine, University of Miami
Richard Thurer, MD is a member of the following medical societies: American Association for Thoracic Surgery, American College of Chest Physicians, American College of Surgeons, American Medical Association, American Thoracic Society, Florida Medical Association, Society of Surgical Oncology, and Society of Thoracic Surgeons
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

Shreekanth V Karwande, MBBS, Chair, Professor, Department of Surgery, Division of Cardiothoracic Surgery, University of Utah School of Medicine and Medical Center
Shreekanth V Karwande, MBBS is a member of the following medical societies: American Association for Thoracic Surgery, American College of Chest Physicians, American College of Surgeons, American Heart Association, Society of Critical Care Medicine, Society of Thoracic Surgeons, and Western Thoracic Surgical Association
Disclosure: Nothing to disclose.

CME Editor

Timothy D Rice, MD, Associate Professor, Departments of Internal Medicine and Pediatrics and Adolescent Medicine, Saint Louis University School of Medicine
Timothy D Rice, MD is a member of the following medical societies: American Academy of Pediatrics and American College of Physicians
Disclosure: Nothing to disclose.

Chief Editor

Mary C Mancini, MD, PhD, Professor and Chief, Cardiothoracic Surgery, Department of Surgery, Louisiana State University Health Sciences Center-Shreveport
Mary C Mancini, MD, PhD is a member of the following medical societies: American Association for Thoracic Surgery, American College of Surgeons, American Surgical Association, Phi Beta Kappa, Society of Thoracic Surgeons, and Southern Surgical Association
Disclosure: Nothing to disclose.

 
 
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