Tracheobronchial obstruction is very uncommon in children and small infants.
Stenosis and malacia, either congenital or acquired, are probably the most frequent diagnosis in this setting. Clinical symptoms are common to both airway anomalies and bronchoscopy plays a crucial role in the diagnostic work-up. Management is complex and surgeons involved in it should be familiar with multiple surgical and endoscopical techniques. Symptomatic short
tracheal stenosis are best treated by means of resection and reconstruction, although endoscopic dilation or
laser resection can be tried first in selected cases. In long
tracheal stenosis, slide tracheoplasty is the
surgical procedure of choice. Tracheobronchial malacia is usually self-limiting by the age of 3 years and most cases show mild symptoms that can be treated conservatively. In a small group of patients airway compromise is severe enough to require surgical or endoscopical treatment. Aortopexy or
tracheostomy are the classic treatments for
congenital tracheomalacia, but increasing experience with endoscopic airway
stent placement in children is making this technique more attractive and popular. Acquired
tracheomalacia is usually caused by a long-standing
tracheostomy and if decannulation is impaired surgical treatment is mandatory.