TY - JOUR T1 - Pediatrik Üst Solunum Yolunun Rijit Teleskop Video Laringoskopi Yöntemi ile Değerlendirilmesi TT - Evaluation of Pediatric Upper Airway Diseases with Rigid Telescope - Video Laryngoscopy AU - Ketenci, İbrahim AU - Vural, Alperen AU - Kökoğlu, Kerem AU - Şahin, Mehmet İlhan PY - 2019 DA - August DO - 10.32941/pediatri.600331 JF - Güncel Pediatri PB - Galenos Yayınevi WT - DergiPark SN - 1304-9054 SP - 253 EP - 264 VL - 17 IS - 2 LA - tr AB - GİRİŞve AMAÇ: Pediatrik üst solunum yolu problemlerinin ayrıcı tanısı zordur. En iyimethod direkt görüntülemektir. Fleksibl nazofaingoskopi en sık uygulananyöntemdir. Rijit teleskop video laringoskopi (RTVL), fleksible nazofaringoskopiuygulanamayan hastalarda bir alternatif olabilir. Bu çalışmada RTLV ile üstsolunum yolu değerlendirilen hasta sonuçlarının değerlendirilmesi amaçlanmıştır.YÖNTEM ve GEREÇLER: Üst solunum yolu problemi nedeniyle RTVL uygulanan hastalarretrospektif olarak çalışmaya dahil edildi. Hastaların semptomları, ekhastalıkları ve bulguları kaydedildi. Uygulamalar 30 derece rijit teleskopvideo laringoskop ile aynı tecrübeli KBB uzmanınca gerçekleştirildi. Hastalarfleksibl nazofaringoskopi yapılamayan ya da cerrahi planlanan hastalarayapıldı. Bulgular ve cerrah işlemler kaydedildi.BULGULAR: 332 hastaya 427 işlem uygulandı. Stridor en sık endikasyondu. En sıkbulgu laringomalaziydi. 73 hastada endikasyon ekstübasyon başarısızlığıydı. Buhastaların 59'unda entübasyon granülomu en sık bulguydu. 67 hastaya trakeotomiişlemi yapıldı. Trakeotomi için en sık endikasyon uzamış entübasyondu. Tümişlemler içinde tek ciddi komplikasyon bir hastada gelişen bradikardiydi veuygun müdahale ile normale döndü.TARTIŞMA ve SONUÇ: Stridor ve uzamış entübasyon pediatrik üst havayolu için ensık semptomdu. Gastro-özefageal reflü ile birlikte olan ya da olmayanlaringomalazi en sık bulguydu. Rijit teleskop - video laringoskopi uygulaması,fleksibl nazofaingoskopi yapılamayan hastalarda yararlı bir metoddur. KW - stridor KW - laringomalazi KW - ses kısıklığı N2 - INTRODUCTION:It is hard to make a differential diagnosis of upper airway diseases inpediatrics. Best method is direct visualization. Flexible nasopharyngoscopy isthe most performed method. Rigid telescope - video laryngoscopy (RTVL) could bean alternative in patients who can not be performed flexible nasopharyngoscopy.It is aimed to review RTVL results of pediatric patients for the evaluation ofupper airway problems. METHODS: A retrospective analysis of patients who underwent RTVL because ofupper airway problems were conducted in the study. The patients’ symptoms,additional diseases and examination findings were recorded. The examinationswere performed with a 30 degree rigid telescope – video laryngoscopy by a same,experienced physician. The procedures were performed when flexible videonasopharyngolaryngoscopy was unsuccesfull or when any kind of surgicalintervention was planned. Examination findings as well as the surgicalprocedures performed were recorded. RESULTS: Total of 427 procedures were performed to 332 patients. Stridor wasthe most common indication for the procedure. The most common examinationfinding was laryngomalacia. There were 73 patients who had extubation failureand were applied rigid telescope – video laryngoscopy for this reason.Fifty-nine patients had intubation granuloma and this was the most commonfinding in patients with extubation failure. Tracheotomy was applied to 67patients. The most common indication for tracheotomy was prolonged intubation.One patient experienced bradycardia during all procedures who recovered withappropriate intervention. DISCUSSION AND CONCLUSION: Stridor and prolonged intubation were the mostcommon symptoms of pediatric upper airway diseases. Laryngomalacia with orwithout gastro-esophageal reflux were the most common causes. Rigid telescope –video laryngoscopy may be a useful method to evaluate pediatric upper airwaydiseases when flexible laryngoscopy can not be performed.  CR - 1. Haddad GG, Palazzo RM. Diagnostic Approach to Respiratory System. In: Kliegman RM, Stanton B, Geme JS, et al., editors. Nelson Textbook of Pediatrics. 19 ed: Elsevier; 2011.1378. CR - 2. Myer 3rd C, O'connor D, Cotton R. Proposed grading system for subglottic stenosis based on endotracheal tube sizes. Ann Otol Rhinol Laryngol 1994;103:319-23. CR - 3. Benjamin B. Technique of laryngoscopy. Int J Pediatr Otorhinolaryngol 1987 Oct;13:299-313. CR - 4. Nussbaum E. Flexible fiberoptic bronchoscopy and laryngoscopy in infants and children. Laryngoscope 1983;93:1073-5. CR - 5. Holinger LD. Diagnostic endoscopy of the pediatric airway. Laryngoscope 1989;99:346-8. CR - 6. Handler SD. Direct laryngoscopy in children: rigid and flexible fiberoptic. Ear Nose Throat J 1995;74:100-4, 6. CR - 7. Wood RE. Evaluation of the upper airway in children. Curr Opin Pediatr 2008;20:266-71. CR - 8. Hagberg C A, C GJ. Operative Pediatric Airway Endoscopy and Microlaryngeal Surgery. In: Hagberg C A, C GJ, editors. Benumof and Hagberg's Airway Management. Houston, Texas: Elsevier; 2013;807-8. CR - 9. Jaquet Y, Monnier P, Van Melle G, et al. Complications of different ventilation strategies in endoscopic laryngeal surgery: a 10-year review. Anesthesiol 2006;104:52-9. CR - 10. Martins RH, Dias NH, Castilho EC, Trindade SH. Endoscopic findings in children with stridor. Rev Brasileira Otorrinolaringol 2006;72:649-53. CR - 11. Contencin P, Narcy P. Size of endotracheal tube and neonatal acquired subglottic stenosis. Study Group for Neonatology and Pediatric Emergencies in the Parisian Area. Arch Otolaryngol Head Neck Surg 1993;119:815-9. CR - 12. Holzki J, Laschat M, Stratmann C. Stridor in the neonate and infant. Implications for the paediatric anaesthetist. Prospective description of 155 patients with congenital and acquired stridor in early infancy. Paediatr Anaesth 1998;8:221-7. CR - 13. Gupta P, Kuperstock JE, Hashmi S, et al. Efficacy and predictors of success of noninvasive ventilation for prevention of extubation failure in critically ill children with heart disease. Pediatr Cardiol 2013;34:964-77. CR - 14. Edmunds S, Weiss I, Harrison R. Extubation failure in a large pediatric ICU population. CHEST J 2001;119:897-900. CR - 15. Baisch SD, Wheeler WB, Kurachek SC, Cornfield DN. Extubation failure in pediatric intensive care incidence and outcomes. Pediatr Critic Care Med 2005;6:312-8. CR - 16. Jang M, Basa K, Levi J. Risk factors for laryngeal trauma and granuloma formation in pediatric intubations. Int J of Pediatr Otorhinolaryngol 2018;107:45-52. CR - 17. Weiss M, Dave M, Bailey M, et al. Endoscopic airway findings in children with or without prior endotracheal intubation. Paediatr Anaesth 2013;23:103-10. CR - 18. Choo K, Tan H, Balakrishnan A. Subglottic stenosis in infants and children. Singapore Med J. 2010;51:848-52. CR - 19. Landry AM, Thompson DM. Laryngomalacia: disease presentation, spectrum, and management. Int J Pediatr 2012;:753526. CR - 20. Thompson DM. Laryngomalacia: factors that influence disease severity and outcomes of management. Curr Opin Otolaryngol Head Neck Surg 2010;18:564-70. CR - 21. Daniel SJ. The upper airway: congenital malformations. Paediat Resp Rev 2006;7:260-S3. CR - 22. Friedman EM, Vastola AP, Mcgill TJ, Healy GB. Chronic pediatric stridor: etiology and outcome. The Laryngoscope 1990;100:277-80. CR - 23. Brigger MT, Hartnick CJ. Surgery for pediatric vocal cord paralysis: a meta-analysis. Otolaryngol Head Neck Surg 2002 126:349-55. CR - 24. Daya H, Hosni A, Bejar-Solar I, Evans JN, Bailey CM. Pediatric vocal fold paralysis: a long-term retrospective study. Arch Otolaryngol Head Neck Surg 2000;126:21-5. CR - 25. Truong MT, Messner AH, Kerschner JE, et al. Pediatric vocal fold paralysis after cardiac surgery: rate of recovery and sequelae Otolaryngol Head Neck Surg 2007;137:780-4. CR - 26. Bent J. Pediatric laryngotracheal obstruction: current perspectives on stridor. Laryngoscope 2006 ;116:1059-70. CR - 27. Garcia-Lopez I, Penorrocha-Teres J, Perez-Ortin M, et al. Paediatric vocal fold paralysis. Acta Otorrinolaringol Esp 201;64:283-8. CR - 28. Irace AL, Dombrowski ND, Kawai K, et al. Aspiration in children with unilateral vocal fold paralysis. The Laryngoscope 2019;129:569-73. CR - 29. Shah RK, Woodnorth GH, Glynn A, Nuss RC. Pediatric vocal nodules: correlation with perceptual voice analysis. Int J Pediatr Otorhinolaryngol. 2005;69:903-9. CR - 30. Zeitels SM, Healy GB. Laryngology and phonosurgery. N Engl J Med 200328;349:882-92. CR - 31. Bui T-H, Grunewald C, Frenckner B, et al. Successful EXIT (ex utero intrapartum treatment) procedure in a fetus diagnosed prenatally with congenital high-airway obstruction syndrome due to laryngeal atresia. Europ J Pediatr Surg: official journal of Austrian Association of Pediatric Surgery[et al]= Zeitschrift fur Kinderchirurgie 2000;10:328-33. CR - 32. Wiatrak BJ. Congenital anomalies of the larynx and trachea. Otolaryngol Clin North Am 2000;33:91-110. CR - 33. Abramson AL, Steinberg BM, Winkler B. Laryngeal papillomatosis: clinical, histopathologic and molecular studies. Laryngoscope 1987;97:678-85. UR - https://doi.org/10.32941/pediatri.600331 L1 - https://dergipark.org.tr/tr/download/article-file/776872 ER -