Pediatrik Üst Solunum Yolunun Rijit Teleskop Video Laringoskopi Yöntemi ile Değerlendirilmesi

Yıl 2019, Cilt: 17 Sayı: 2, 253 - 264, 02.08.2019

İbrahim Ketenci Alperen Vural Kerem Kökoğlu Mehmet İlhan Şahin

Öz

GİRİŞ
ve AMAÇ: Pediatrik üst solunum yolu problemlerinin ayrıcı tanısı zordur. En iyi
method direkt görüntülemektir. Fleksibl nazofaingoskopi en sık uygulanan
yöntemdir. Rijit teleskop video laringoskopi (RTVL), fleksible nazofaringoskopi
uygulanamayan hastalarda bir alternatif olabilir. Bu çalışmada RTLV ile üst
solunum yolu değerlendirilen hasta sonuçlarının değerlendirilmesi amaçlanmıştır.

YÖNTEM ve GEREÇLER: Üst solunum yolu problemi nedeniyle RTVL uygulanan hastalar
retrospektif olarak çalışmaya dahil edildi. Hastaların semptomları, ek
hastalıkları ve bulguları kaydedildi. Uygulamalar 30 derece rijit teleskop
video laringoskop ile aynı tecrübeli KBB uzmanınca gerçekleştirildi. Hastalar
fleksibl nazofaringoskopi yapılamayan ya da cerrahi planlanan hastalara
yapıldı. Bulgular ve cerrah işlemler kaydedildi.

BULGULAR: 332 hastaya 427 işlem uygulandı. Stridor en sık endikasyondu. En sık
bulgu laringomalaziydi. 73 hastada endikasyon ekstübasyon başarısızlığıydı. Bu
hastaların 59'unda entübasyon granülomu en sık bulguydu. 67 hastaya trakeotomi
işlemi yapıldı. Trakeotomi için en sık endikasyon uzamış entübasyondu. Tüm
işlemler içinde tek ciddi komplikasyon bir hastada gelişen bradikardiydi ve
uygun müdahale ile normale döndü.

TARTIŞMA ve SONUÇ: Stridor ve uzamış entübasyon pediatrik üst havayolu için en
sık semptomdu. Gastro-özefageal reflü ile birlikte olan ya da olmayan
laringomalazi en sık bulguydu. Rijit teleskop - video laringoskopi uygulaması,
fleksibl nazofaingoskopi yapılamayan hastalarda yararlı bir metoddur.

Anahtar Kelimeler

stridor, laringomalazi, ses kısıklığı

Evaluation of Pediatric Upper Airway Diseases with Rigid Telescope - Video Laryngoscopy

Öz

INTRODUCTION:
It is hard to make a differential diagnosis of upper airway diseases in
pediatrics. Best method is direct visualization. Flexible nasopharyngoscopy is
the most performed method. Rigid telescope - video laryngoscopy (RTVL) could be
an alternative in patients who can not be performed flexible nasopharyngoscopy.
It is aimed to review RTVL results of pediatric patients for the evaluation of
upper airway problems. 

METHODS: A retrospective analysis of patients who underwent RTVL because of
upper airway problems were conducted in the study. The patients’ symptoms,
additional diseases and examination findings were recorded. The examinations
were performed with a 30 degree rigid telescope – video laryngoscopy by a same,
experienced physician. The procedures were performed when flexible video
nasopharyngolaryngoscopy was unsuccesfull or when any kind of surgical
intervention was planned. Examination findings as well as the surgical
procedures performed were recorded. 

RESULTS: Total of 427 procedures were performed to 332 patients. Stridor was
the most common indication for the procedure. The most common examination
finding was laryngomalacia. There were 73 patients who had extubation failure
and were applied rigid telescope – video laryngoscopy for this reason.
Fifty-nine patients had intubation granuloma and this was the most common
finding in patients with extubation failure. Tracheotomy was applied to 67
patients. The most common indication for tracheotomy was prolonged intubation.
One patient experienced bradycardia during all procedures who recovered with
appropriate intervention. 

DISCUSSION AND CONCLUSION: Stridor and prolonged intubation were the most
common symptoms of pediatric upper airway diseases. Laryngomalacia with or
without gastro-esophageal reflux were the most common causes. Rigid telescope –
video laryngoscopy may be a useful method to evaluate pediatric upper airway
diseases when flexible laryngoscopy can not be performed. 

Anahtar Kelimeler

striodor, laryngomalacia, hoarseness

Kaynakça

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