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Introduction: Paediatric tracheobronchomalacia is a rare but potentially serious condition. Severe tracheobronchomalacia requires intervention or operation. This is an evaluation of a ten-year experience at an institution., Methods: In this retrospective study all patients were included that required an intervention for severe tracheobronchomalacia from 2003 to 2012. Symptoms, aetiology, comorbidities, localisation of the malacia, age at diagnosis, therapeutic measures and associated complications were evaluated., Results: Forty-four patients with severe tracheobronchomalacia underwent intervention/operation. The predominant aetiology was vascular compression in 48%. The majority of patients had complex comorbidities, most importantly cardiac pathology in 66%. The median age at diagnosis was 3 months. A total of 17 aortopexies, 21 tracheostomies and 25 stent placements were performed. The mean follow-up was 2.6 years. Severe complications occurred in 12 patients. The most common complications were stent obstruction/fracture and tracheostomy tube obstruction., Conclusion: The management of severe tracheobronchomalacia is complex and the population of patients is very heterogeneous. Therefore the treatment has to be adapted for each patient individually. The decision strategies are discussed in this article. The surgical techniques for placement and safe removal of expandable bare metallic stents employed in our institution are presented. A multidisciplinary team of ENT surgeons, Intensivists, Cardiologists and Cardiac surgeons is of great importance., (Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.)

Objective: To describe the management of a 15-year-old girl with repeated life-threatening complications of her tracheostomy secondary to muscle dystonia and thoracolumbocervical lordosis., Method: This paper reports a retrospective case review., Results: Regular microlaryngoscopy and bronchoscopy, treatment with systemic steroids and a soft tracheostomy tube, in addition to better control of the dystonia, resulted in control of the patient's airway. This minimised tracheal inflammation and granulation tissue formation., Conclusion: The need for a tracheostomy in patients with thoracolumbocervical lordosis and severe dystonia should be considered only after all other options of airway management have been explored. Every attempt should be made to minimise tracheal trauma caused by excessive movement of a tracheostomy tube.

Background: Individuals diagnosed as having primary neurological disorders have a high incidence of abnormal speech and language development. However, results in cohorts where this group are excluded are controversial. With no coexisting neurological impairment, some suggested that tracheostomy has little influence on speech development, whilst others showed a clear pattern of language disability. The aim of this study is to evaluate the influence of tracheostomy on speech and language development., Method: Retrospective study using standardised outcome measures., Results: A series of 39 paediatric tracheostomies was studied. In the group where children had neurological disorders, 94% showed no language or delayed language development. In contrast, of the group of children without a neurological impairment, 60.9% had normal speech and language development. The median age at the decannulation in those children with delayed speech was 23 months, whilst in those children with normal speech it was 14.5 months., Conclusion: Tracheostomy affects speech and language development in those with and without neurological disorders. Crucial factors affecting speech and language development within the neurologically normal group are age at the tracheostomy, and the duration of the tracheostomy until decannulation. Achieving earliest decannulation improves the chance of a normal speech and language development.

Over a five-year period during which 99 children underwent successful ward decannulation, 14 other children were deemed unsuitable and underwent surgical decannulation. The technique of surgical decannulation involves excision of the tracheostomy tract with any granuloma and splinting of the anterior tracheal wall by the use of an indwelling nasotracheal tube for 48 hours post-operatively. It is indicated in carefully selected patients whose tracheostomies are complicated by large suprastomal granulomas, anterior tracheal wall collapse or previous anterior rib graft collapse into the airway. Nine of the 14 decannulations were successful. Success is dependent upon accurate prior endoscopic assessment and satisfactory previous reconstruction surgery in cases of subglottic stenosis. The five failures (4.42 per cent of all decannulations) represent some of the most demanding airway problems encountered.