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Regenerative medicine offers hope of a sustainable solution for severe airway disease by the creation of functional, immunocompatible organ replacements. When considering fetuses and newborns, there is a specific spectrum of airway pathologies that could benefit from cell therapy and tissue engineering applications. While hypoplastic lungs associated with congenital diaphragmatic hernia (CDH) could benefit from cellular based treatments aimed at ameliorating lung function, patients with upper airway obstruction could take advantage from a de novo tissue engineering approach. Moreover, the international acceptance of the EXIT procedure as a means of securing the precarious neonatal airway, together with the advent of fetal surgery as a method of heading off postnatal co-morbidities, offers the revolutionary possibility of extending the clinical indication for tissue-engineered airway transplantation to infants affected by diverse severe congenital laryngotracheal malformations. This article outlines the necessary basic components for regenerative medicine solutions in this potential clinical niche., (Copyright © 2016. Published by Elsevier Inc.)

Objective: To present the indications, techniques, results, and limitations of endoscopic surgical treatment of laryngotracheal cleft., Design: Retrospective case note study (2005-2009)., Setting: Department of Otolaryngology-Head and Neck Surgery, Armand Trousseau Children's Hospital, Paris, France., Patients: Eleven patients who underwent endoscopic cleft closure as a primary (n = 8) or secondary (n = 3) procedure among 22 patients treated for laryngotracheal clefts. We report patients' demographics, symptoms leading to the diagnosis, endoscopic evaluation method, medical examination results, and surgical techniques., Intervention: Endoscopic closure of the cleft under spontaneous ventilation via 2-layer interrupted sutures after excision of the mucosal edge using a carbon dioxide laser in 10 patients and a thulium laser in 1., Main Outcome Measures: Analysis of postoperative complications, revision surgery, need for intensive care unit admission, closure of the cleft, and long-term symptom results., Results: Successful closure of the 11 clefts (with revision surgery in 3 patients) without the need for intubation or intensive care unit admission enabled the elimination of aspiration in 10 patients and significant improvement in 1 patient with bilateral vocal cord paralysis. There were no significant postoperative complications., Conclusions: Endoscopic closure of laryngotracheal clefts is a reliable technique that significantly reduces perioperative and postoperative morbidity. The results of this technique are entirely satisfactory, and we suggest that it is suitable as a primary procedure for the treatment of type I, II, and III clefts extending to the cervical trachea, including in neonates.

Purpose of Review: Pathologic airway conditions in pediatric patients include congenital or acquired subglottic stenosis, glottic stenosis, laryngotracheal stenosis, laryngeal webs or atresia, and tracheal lesions. Acute airway management via tracheotomy is often required with later surgical intervention for reconstruction and expansion of the airway. The effect of the surgical interventions used to expand the airway may impact upon the laryngeal functions of phonation and airway protection during swallowing. Overall, the specific outcomes of airway surgery have focused on airway restoration. Outcomes in regard to voice and swallowing parameters have been largely unexplored, though recent reports have begun to emerge that provide some research data specific to both voice and airway protection/swallowing postoperatively., Recent Findings: Research regarding outcomes following laryngotracheal reconstruction over the last year reveals the use of more systematic approaches to collection of voice data and recognition of postoperative dysphagia. There continues to be a dearth of available research regarding longer term swallowing outcomes or treatment of voice disorders in this population., Summary: Research findings that contribute to the base of knowledge regarding the effectiveness of surgical methodology for establishment of airway patency with preservation of laryngeal functions of voice and swallowing are beginning to accumulate. Increased evidence regarding types of reconstructive approaches and effect on laryngeal functions will assist surgeons and clinicians in designing specific treatment approaches.

Medical-genetic examination covered 24 families of patients with congenital defects of the larynx and trachea. These developmental defects can be attributed to multiple unestablished defects (66.7%) or can be part of some congenital-hereditary syndromes (25%) such as chromosomal, genetic, teratogenic, of unknown etiology. The percentage of isolated developmental laryngeal and tracheal defects is relatively small--8.3%.

+33 cases of vascular tumors, 15 of congenital membranes, 12 of papillomatosis, 5 of cysts, 12 of abnormal laryngeal cartilages, 3 of tracheomalacia, 9 of stridor, 1 of fibrous polyp and 1 of mucous membrane folding in the interarytenoid region are reported. Operative interventions primarily endoscopic laser surgery were performed in children with congenital vascular tumors, membranes, cysts. Removal of papillomas in congenital papillomatosis conducted with the use of micro-instruments and CO2-laser was combined with immunomodulation. Children with laryngeal cartilage anomalies, tracheomalacia and stridor were subjected to prolonged nasotracheal intubation of even tracheotomy only in case of severe respiratory failure..

Congenital laryngeal and tracheal anomalies found in 1980-1995 in 91 children consisted of vascular tumors, laryngeal membranes, laryngeal cartilage anomaly, tracheomalacia, laryngeal papillomatosis, cysts, stridor (36.2%, 16.5%, 13.2%, 3.3%, 13.2%, 5.5%, 9.9%, respectively). Other causes are responsible for the defects in 2.2% of cases. Early symptoms of the above diseases are detailed. This information contributes to valid preliminary diagnosis and to optimal planning of further examination and treatment.

The fifth case of diffuse laryngeal and tracheal cartilage calcification in infancy is reported. The previously reported cases are briefly described. Differential diagnosis and potential etiologies are discussed. It is thought that these patients represent a rare but distinct clinical entity.

For a successful medical attendance of congenital as well as of peri- or postnatal acquired threatening stenoses of the respiratory tract of different genesis in neonates an exact endoscopic diagnosis of the locus and the character of the disease or rather the lesion is a prerequisite of any case. Based on experiences with 319 laryngo-tracheo-bronchoscopies with newborn children within the first three months of their lives, there is a retrospective analysis of indications, diagnoses and complications and a report on an approved method of endoscopic examination. Detailed instructions are given relative to the choice of instruments, the method of anaesthesia and to the expedient technical procedure. Basic rules are set up for general consideration.