Laryngomalacia and tracheomalacia are the most common upper airway Airway ABCDE Assessment conditions that produce stridor in newborns. Laryngomalacia and tracheomalacia tend to present in the 1st 2 weeks of life, with symptoms ranging from stridor to respiratory distress. The symptoms are caused by narrowing of the airway Airway ABCDE Assessment, which may be due to weakened cartilage Cartilage Cartilage is a type of connective tissue derived from embryonic mesenchyme that is responsible for structural support, resilience, and the smoothness of physical actions. Perichondrium (connective tissue membrane surrounding cartilage) compensates for the absence of vasculature in cartilage by providing nutrition and support. Cartilage: Histology, redundant tissue, external compression External Compression Blunt Chest Trauma, or hypotonia Hypotonia Duchenne Muscular Dystrophy of the affected area. Most cases are congenital Congenital Chorioretinitis, but tracheomalacia can be acquired in children or adults. Diagnosis is based on history, clinical findings, and confirmation by laryngoscopy or bronchoscopy. Treatment is supportive or surgical, depending on the severity. The majority of cases are self-limiting Self-Limiting Meningitis in Children and resolve by 2–3 years of age, but some tracheomalacia cases can persist into adulthood.
Last updated: 8 Jan, 2021
Laryngomalacia is softening of or redundancy of supraglottic structures leading to collapse and narrowing of the airway Airway ABCDE Assessment during inspiration Inspiration Ventilation: Mechanics of Breathing.
Tracheomalacia is an abnormality in tracheal compliance Compliance Distensibility measure of a chamber such as the lungs (lung compliance) or bladder. Compliance is expressed as a change in volume per unit change in pressure. Veins: Histology caused by a variety of factors, resulting in the dynamic airway Airway ABCDE Assessment narrowing.
Laryngomalacia:
Tracheomalacia:
Laryngomalacia (not exactly known) presumed causes:
Tracheomalacia:
Anatomic recreation of a
vascular ring
Vascular Ring
Pediatric Chest Abnormalities compared to normal anatomy:
Double
aortic arch
Aortic arch
Mediastinum and Great Vessels: Anatomy causes
compression
Compression
Blunt Chest Trauma of the
trachea
Trachea
The trachea is a tubular structure that forms part of the lower respiratory tract. The trachea is continuous superiorly with the larynx and inferiorly becomes the bronchial tree within the lungs. The trachea consists of a support frame of semicircular, or C-shaped, rings made out of hyaline cartilage and reinforced by collagenous connective tissue.
Trachea: Anatomy and
esophagus
Esophagus
The esophagus is a muscular tube-shaped organ of around 25 centimeters in length that connects the pharynx to the stomach. The organ extends from approximately the 6th cervical vertebra to the 11th thoracic vertebra and can be divided grossly into 3 parts: the cervical part, the thoracic part, and the abdominal part.
Esophagus: Anatomy.
Vascular rings
Vascular Rings
Pediatric Vomiting often compress the
trachea
Trachea
The trachea is a tubular structure that forms part of the lower respiratory tract. The trachea is continuous superiorly with the larynx and inferiorly becomes the bronchial tree within the lungs. The trachea consists of a support frame of semicircular, or C-shaped, rings made out of hyaline cartilage and reinforced by collagenous connective tissue.
Trachea: Anatomy, leading to a degree of tracheomalacia.
Laryngomalacia:
Anatomic and physiologic differences between a healthy larynx Larynx The larynx, also commonly called the voice box, is a cylindrical space located in the neck at the level of the C3-C6 vertebrae. The major structures forming the framework of the larynx are the thyroid cartilage, cricoid cartilage, and epiglottis. The larynx serves to produce sound (phonation), conducts air to the trachea, and prevents large molecules from reaching the lungs. Larynx: Anatomy and laryngomalacia
Image by Lecturio.Tracheomalacia:
Cross-sectional view of anatomic changes during
inspiration
Inspiration
Ventilation: Mechanics of Breathing and
expiration
Expiration
Ventilation: Mechanics of Breathing in a healthy
trachea
Trachea
The trachea is a tubular structure that forms part of the lower respiratory tract. The trachea is continuous superiorly with the larynx and inferiorly becomes the bronchial tree within the lungs. The trachea consists of a support frame of semicircular, or C-shaped, rings made out of hyaline cartilage and reinforced by collagenous connective tissue.
Trachea: Anatomy versus tracheomalacia:
Due to the structural laxity of the
cartilage
Cartilage
Cartilage is a type of connective tissue derived from embryonic mesenchyme that is responsible for structural support, resilience, and the smoothness of physical actions. Perichondrium (connective tissue membrane surrounding cartilage) compensates for the absence of vasculature in cartilage by providing nutrition and support.
Cartilage: Histology in tracheomalacia, the already significantly reduced
airway
Airway
ABCDE Assessment lumen further narrows during
expiration
Expiration
Ventilation: Mechanics of Breathing.
Laryngomalacia:
Tracheomalacia:
Plain X-ray X-ray Penetrating electromagnetic radiation emitted when the inner orbital electrons of an atom are excited and release radiant energy. X-ray wavelengths range from 1 pm to 10 nm. Hard x-rays are the higher energy, shorter wavelength x-rays. Soft x-rays or grenz rays are less energetic and longer in wavelength. The short wavelength end of the x-ray spectrum overlaps the gamma rays wavelength range. The distinction between gamma rays and x-rays is based on their radiation source. Pulmonary Function Tests of the neck Neck The part of a human or animal body connecting the head to the rest of the body. Peritonsillar Abscess and chest:
Airway Airway ABCDE Assessment fluoroscopy Fluoroscopy Production of an image when x-rays strike a fluorescent screen. X-rays:
Computed tomography (CT) scan:
A CT scan showing a double aortic arch Aortic arch Mediastinum and Great Vessels: Anatomy (arrow) compressing the trachea Trachea The trachea is a tubular structure that forms part of the lower respiratory tract. The trachea is continuous superiorly with the larynx and inferiorly becomes the bronchial tree within the lungs. The trachea consists of a support frame of semicircular, or C-shaped, rings made out of hyaline cartilage and reinforced by collagenous connective tissue. Trachea: Anatomy
Image: “Double aortic arch Aortic arch Mediastinum and Great Vessels: Anatomy” by the Shandong Medical Imaging Research Research Critical and exhaustive investigation or experimentation, having for its aim the discovery of new facts and their correct interpretation, the revision of accepted conclusions, theories, or laws in the light of newly discovered facts, or the practical application of such new or revised conclusions, theories, or laws. Conflict of Interest Institute, Shandong University, Ji’nan, Shandong, People’s Republic of China. License: CC BY 4.0, edited by Lecturio.Endoscopic appearance of laryngomalacia
Image: “Endoscopic features of laryngomalacia” by Wong Birgitta Yee-Hang et al AL Amyloidosis. License: CC BY 4.0.Bronchoscopy picture of tracheomalacia: Notice the narrowing of the lumen.
Image: “Bronchoscopy picture of tracheomalacia” by Quen Mok. License: CC BY 4.0.Mild:
Moderate/severe:
Children:
Adults: