Characteristics and Outcomes of Surgical Treatment for Bronchial Anomalies

Derek D Kao; Yann Fuu-Kou; Cynthia S Wang; David Lehenbauer; Sara Zak; Dan Benscoter; David Ls Morales; Alessandro de Alarcon; Michael J Rutter

doi:10.1002/lary.30737

Characteristics and Outcomes of Surgical Treatment for Bronchial Anomalies

Laryngoscope. 2023 Dec;133(12):3334-3340. doi: 10.1002/lary.30737. Epub 2023 May 9.

Authors

Derek D Kao^{1

2}, Yann Fuu-Kou³, Cynthia S Wang^{1

4}, David Lehenbauer⁵, Sara Zak^{6

7}, Dan Benscoter^{6

7}, David Ls Morales⁵, Alessandro de Alarcon^{1

4}, Michael J Rutter^{1

4}

Affiliations

¹ Division of Pediatric Otolaryngology-Head and Neck Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.
² Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
³ Department of Otolaryngology-Head and Neck Surgery, Division of Pediatric Otolaryngology, University of Texas Southwestern Medical Center, Dallas, Texas, USA.
⁴ Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA.
⁵ Division of Cardiothoracic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.
⁶ Division of Pulmonary Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.
⁷ Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA.

PMID: 37159210
DOI: 10.1002/lary.30737

Abstract

Objectives: Bronchial anomalies are rare but challenging conditions to treat in children, encompassing a variety of structural abnormalities that could compromise airway patency. This includes complete rings, absent cartilage, traumatic avulsions, bronchoesophageal fistulas, and cartilaginous sleeves. The objective of this study is to describe the characteristics and outcomes of a series of pediatric cases of bronchial anomalies that were treated by slide tracheobronchoplasty.

Methods: This is a single-institution retrospective case series of pediatric patients with bronchial anomalies who underwent surgical treatment between February 2004 and April 2020. Data extracted from electronic medical records included patient demographics, comorbidities, and surgical outcomes.

Results: There were a total of 29 patients included in the study, of which 14 had complete bronchial rings, 8 had absent bronchial rings, 4 had traumatic bronchial avulsions, 2 had bronchoesophageal fistulas, and one had a cartilaginous sleeve. Median follow-up time was 13 months (with a range of 0.5-213 months). The overall mortality rate was 17.2% (5 patients), all of whom had complete bronchial rings. Patients with complete bronchial rings also had a higher rate of not only cardiac (85.7%) and pulmonary comorbidities (85.7%) but also secondary airway lesions (78.6%).

Conclusion: This is the largest series to date describing surgical treatment for bronchial anomalies. Complete bronchial rings were the most common anomaly treated, followed by absent rings and trauma. Surgical treatment can be successful but mortality rates are higher in patients with complete bronchial rings, possibly due to higher rates of pulmonary and cardiac comorbidities.

Level of evidence: 4 Laryngoscope, 133:3334-3340, 2023.

Keywords: bronchial anomalies; bronchial rupture; bronchoesophageal fistula; cartilaginous sleeve; complete bronchial rings; complete tracheal rings; slide tracheoplasty.

MeSH terms

Child
Fistula* / surgery
Humans
Infant
Plastic Surgery Procedures*
Retrospective Studies
Trachea / abnormalities
Trachea / surgery
Tracheal Stenosis* / surgery
Treatment Outcome