Skip to main content
SpringerLink
Log in

Surgical Management of Tracheostomies and Tracheal Diversion in Children with Cerebral Palsy

  • Reference work entry
  • First Online:
Cerebral Palsy

  • 59 Accesses

Abstract

Children with cerebral palsy are most likely to have a tracheostomy placed for upper airway obstruction, although it may also aid in pulmonary toilet. The tracheostomy procedure is most safely performed in the operating room under general, endotracheal anesthesia. Initial postoperative care occurs in an intensive care unit until the first tracheostomy tube change, usually on postoperative day 5. However, a large percentage of children who receive a tracheostomy experience one or more complications. Complications are classified as immediate (occurring during surgery), early (occurring prior to the first tracheostomy tube change), or late (occurring after the first tracheostomy tube change) with late complications being by far the most common. While most complications are minor, accidental decannulation, tube obstruction, and bleeding from a tracheo-innominate fistula can be life-threatening. The surgical technique for tracheostomy should include the use of stay sutures and stomal maturation sutures as these help to minimize immediate and early postoperative complications. Children, particularly those who have already received a tracheostomy, with significant difficulties maintaining pulmonary hygiene or with recurrent aspiration pneumonia may benefit from a procedure to separate the airway from the digestive tract. Two such procedures are the laryngotracheal separation and tracheoesophageal diversion.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution

Institutional subscriptions

References

  • Byard RW, Gilbert JD (2011) Potentially lethal complications of tracheostomy: autopsy considerations. Am J Forensic Med Pathol 32(4):352–354

    Article  PubMed  Google Scholar 

  • Carr MM, Poje CP, Kingston L, Kielma D, Heard C (2001) Complications in pediatric tracheostomies. Laryngoscope 111(11 Pt 1):1925–1928

    Article  CAS  PubMed  Google Scholar 

  • Cohen SR, Holmes RE, Machado L, Magit A (2002) Surgical strategies in the treatment of complex obstructive sleep apnoea in children. Paediatr Respir Rev 3(1):25–35

    PubMed  Google Scholar 

  • Colman KL, Mandell DL, Simons JP (2010) Impact of stoma maturation on pediatric tracheostomy-related complications. Arch Otolaryngol Head Neck Surg 136(5):471–474

    Article  PubMed  Google Scholar 

  • Cook SP (2009) Laryngotracheal separation in neurologically impaired children: long-term results. Laryngoscope 119(2):390–395

    Article  PubMed  Google Scholar 

  • Corbett HJ et al (2007) Tracheostomy – a 10-year experience from a UK pediatric surgical center. J Pediatr Surg 42(7):1251–1254

    Article  PubMed  Google Scholar 

  • Dal’Astra AP, Quirino AV, Caixêta JA, Avelino MA (2017) Tracheostomy in childhood: review of the literature on complications and mortality over the last three decades. Braz J Otorhinolaryngol 83(2):207–214

    Article  PubMed  Google Scholar 

  • Das P et al (2012) Tracheotomy-related catastrophic events: results of a national survey. Laryngoscope 122(1):30–37

    Article  PubMed  PubMed Central  Google Scholar 

  • de Trey L, Niedermann E, Ghelfi D, Gerber A, Gysin C (2013) Pediatric tracheotomy: a 30-year experience. J Pediatr Surg 48(7):1470–1475

    Article  PubMed  Google Scholar 

  • Fry TL, Jones RO, Fischer ND, Pillsbury HC (1985) Comparisons of tracheostomy incisions in a pediatric model. Ann Otol Rhinol Laryngol 94(5 Pt 1):450–453

    Article  CAS  PubMed  Google Scholar 

  • Garcia J et al (2016) Obstructive sleep apnea in children with cerebral palsy and epilepsy. Dev Med Child Neurol 58(10):1057–1062

    Article  PubMed  Google Scholar 

  • Goldenberg D et al (2000) Tracheotomy complications: a retrospective study of 1130 cases. Otolaryngol Head Neck Surg 123(4):495–500

    Article  CAS  PubMed  Google Scholar 

  • Gurunluoglu R, Gurunluoglu A (2003) Paul of Aegina: landmark in surgical progress. World J Surg 27(1):18–25

    Article  PubMed  Google Scholar 

  • Hara H, Hori T, Sugahara K et al (2014) Effectiveness of laryngotracheal separation in neurologically impaired pediatric patients. Acta Otolaryngol 134(6):626–630

    Article  PubMed  Google Scholar 

  • Hawkins SM, Jensen EL, Simon SL, Friedman NR (2016) Correlates of pediatric CPAP adherence. J Clin Sleep Med 12(6):879–884

    Article  PubMed  PubMed Central  Google Scholar 

  • Joshi AS et al (2007) Nonsurgical treatment of tracheoinnominate fistula in the pediatric population. Arch Otolaryngol Head Neck Surg 133(3):294–296

    Article  PubMed  Google Scholar 

  • Karkos PD, Papouliakos S (2014) “Floppy airway” in older children with cerebral palsy: the laryngomalacia-reflux-dystonia syndrome. Int J Pediatr Otorhinolaryngol 78(3):574–575

    Article  PubMed  Google Scholar 

  • Kontorinis G, Thevasagayam MS, Bateman ND (2013) Airway obstruction in children with cerebral palsy: need for tracheostomy? Int J Pediatr Otorhinolaryngol 77(10):1647–1650

    Article  PubMed  Google Scholar 

  • Kremer B, Botos-Kremer AI, Eckel HE, Schlöndorff G (2002) Indications, complications, and surgical techniques for pediatric tracheostomies – an update. J Pediatr Surg 37(11):1556–1562

    Article  CAS  PubMed  Google Scholar 

  • Magardino TM, Tom LW (1999) Surgical management of obstructive sleep apnea in children with cerebral palsy. Laryngoscope 109(10):1611–1615

    Article  CAS  PubMed  Google Scholar 

  • Miyake N, Ueno H, Kitano H (2013) Pathological consideration of tracheo-innominate artery fistula with a case report. Int J Pediatr Otorhinolaryngol 77(8):1322–1324

    Article  PubMed  Google Scholar 

  • Park JY, Suskind DL, Prater D, Muntz HR, Lusk RP (1999) Maturation of the pediatric tracheostomy stoma: effect on complications. Ann Otol Rhinol Laryngol 108(12):1115–1119

    Article  CAS  PubMed  Google Scholar 

  • Parrilla C, Scarano E, Guidi ML, Galli J, Paludetti G (2007) Current trends in paediatric tracheostomies. Int J Pediatr Otorhinolaryngol 71(10):1563–1567

    Article  PubMed  Google Scholar 

  • Simma B et al (1994) Tracheostomy in children. Eur J Pediatr 153(4):291–296

    Article  CAS  PubMed  Google Scholar 

  • Takano K, Kurose M, Mitsuzawa H et al (2015) Clinical outcomes of tracheoesophageal diversion and laryngotracheal separation for aspiration in patients with severe motor and intellectual disability. Acta Otolaryngol 135(12):1304–1310

    Article  PubMed  Google Scholar 

  • Tantinikorn W, Alper CM, Bluestone CD, Casselbrant ML (2003) Outcome in pediatric tracheotomy. Am J Otolaryngol 24(3):131–137

    Article  PubMed  Google Scholar 

  • Wilcox LJ, Weber BC, Cunningham TD, Baldassari CM (2016) Tracheostomy complications in institutionalized children with long-term tracheostomy and ventilator dependence. Otolaryngol Head Neck Surg 154(4):725–730

    Article  PubMed  Google Scholar 

  • Wilkinson DJ, Baikie G, Berkowitz RG, Reddihough DS (2006) Awake upper airway obstruction in children with spastic quadriplegic cerebral palsy. J Paediatr Child Health 42(1–2):44–48

    Article  PubMed  Google Scholar 

  • Yapijakis C (2009) Hippocrates of Kos, the father of clinical medicine, and Asclepiades of Bithynia, the father of molecular medicine. In Vivo 23(4):507–514

    PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Division of Pediatric Otolaryngology, Nemours duPont Hospital for Children, Wilmington, DE, USA

    Richard Schmidt & Patrick Barth

  2. Department of Otolaryngology, Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, PA, USA

    Richard Schmidt & Patrick Barth

  3. Division of Pediatric Otolaryngology, Department of Surgery, Nemours Alfred I. DuPont Hospital for Children, Wilmington, DE, USA

    Christopher Tsang

Authors
  1. Richard Schmidt
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Christopher Tsang
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Patrick Barth
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Richard Schmidt .

Editor information

Editors and Affiliations

  1. Department of Orthopaedics, Nemours/Alfred I. duPont Hospital for Children, Wilmington, DE, USA

    Freeman Miller

  2. Department of Pediatrics, Nemours/Alfred I. duPont Hospital for Children, Wilmington, USA

    Steven Bachrach

  3. Nemours/Alfred I. duPont Hospital for Children, Wilmington, DE, USA

    Nancy Lennon

  4. Columbia University, Irving Medical Center, Programs in Physical Therapy, New York, NY, USA

    Margaret E. O'Neil

Section Editor information

  1. AI DuPont Hospital for Children, Wilmington, DE, USA

    Freeman Miller

  2. Al duPont Hospital for Children, Wilmington, DE, USA

    Steven Bachrach

Rights and permissions

Reprints and permissions

Copyright information

© 2020 Springer Nature Switzerland AG

About this entry

Check for updates. Verify currency and authenticity via CrossMark

Cite this entry

Schmidt, R., Tsang, C., Barth, P. (2020). Surgical Management of Tracheostomies and Tracheal Diversion in Children with Cerebral Palsy. In: Miller, F., Bachrach, S., Lennon, N., O'Neil, M.E. (eds) Cerebral Palsy. Springer, Cham. https://doi.org/10.1007/978-3-319-74558-9_225

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-74558-9_225

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-74557-2

  • Online ISBN: 978-3-319-74558-9

  • eBook Packages: MedicineReference Module Medicine

Publish with us

Policies and ethics

Search

Navigation