Tracheobronchomalacia presenting with transverse tracheal or bronchial malformation, scabbard or lateral airway deformity, or circumferential collapse represents a distinct anatomic subset with specific management requirements. Optimising the patient medically is the necessary first step before any surgical option is evaluated.
This protocol is specific to transverse tracheal and/or bronchial malformation, including scabbard or lateral deformity and circumferential collapse deformity of the airway. These variants are recognised to respond differently to standard tracheopexy procedures and require a tailored approach to achieve adequate airway support.
The protocol centres on maximum medical therapy directed at optimising mucociliary clearance — involving targeted inhaled agents and pulmonary hygiene measures — alongside management of contributing systemic factors. The full sequence of interventions and the criteria for escalation are detailed in the structured protocol.
Clinical goals: Controlled airway secretions and respiratory infections; optimum nutrition with adequate growth and positive nitrogen balance.
We found that anterior and posterior tracheobronchopexy have limited utility in cases of transverse tracheal and/or bronchial malformations and that application of an external splint provides better airway support in these conditions, often in combination with the other procedures.
We pursue direct tracheopexy options for all of our patients as the first-line surgical intervention but find these certain anatomic variants (scabbard or lateral deformities, circumferential collapse) to require additional support from the external splints.
In our opinion, all patients need to be optimized using medical therapy prior to considering surgical correction if that is an option, at a minimum to control secretions and infections, as well as optimum nutrition and at least two weeks of adequate growth and positive nitrogen balance in order to tolerate the stress of surgery.
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