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Junior Surgery Lecture
Stridor In Neonate/Infant: Evaluation And Management
RONALD W. DESKIN, M.D., FAAP
See SLIDES 1-32, and also SLIDE 53 (PediOto.pps)
I. Stridor - Airway sound secondary to turbulent airflow - may be inspiratory, expiratory or combined.
II. Pathophysiology
Venturi principle
Location
Supraglottic - inspiratory
Glottic/extra-thoracic trachea - inspiratory and expiratory
Intrathoracic trachea/bronchi - expiratory
III. History
Respiratory distress
Duration
Positional
Association with feeding
Voice
Other congenital anomalies
Trauma-?
Foreign body-?
IV. P/E
Observe - at rest and with agitation
Voice
Auscultation
X-ray
AP/Lat. Chest/Neck
Ba Swallow
Fluoroscopy
V. Endoscopy
Flexible
Rigid in OR
VI. Conditions
A. Supralaryngeal
Adenoid hypertrophy
Choanal atresia
Reserpine (maternal)
Cong. Lues
Hypothyroid
Nasal fracture
Macroglossia
Vallecula cyst
Internal thyroglossal duct cyst
Base of tongue tumor - thyroid, dermoid
Retropharyngeal abscess
Epulis
Hemangioma, lymphangioma
VII. Laryngeal/Subglottic
Laryngomalacia
Vocal cord paralysis - uni/bilateral
Stenosis
Web
Atresia
Hemangioma - 50% with cutaneous hemangioma
Cleft of larynx
Saccular cyst/laryngocele
Papilloma
VIII. Trachea
Tracheomalacia
Tracheal stenosis
T-E fistula
Extrinsic compression - vascular ring, esophageal foreign body