Congenital Lesions Associated With Airway Narrowing, Respiratory Distress, and Unexpected Infant and Early Childhood Death

Abstract

A review was undertaken of the range of possible congenital lesions of the major airways and adjacent tissues that may cause critical compromise of luminal diameter with resultant respiratory arrest from airway occlusion. Lesions included micrognathic syndromes, macroglossia, choanal atresia and stenosis, tumors and choristomas, posterior lingual masses, laryngeal atresia and stenosis, laryngeal webs, laryngeal cysts and laryngoceles, laryngomalacia, tracheomalacia, and bronchomalacia. An autopsy approach to possible congenital obstructive lesions of the upper airway requires: (1) review of the clinical and family histories looking specifically at the nature of the terminal episode; (2) external examination looking for dysmorphic syndromes with mandibular or mid-facial hypoplasia; and (3) internal examination with layer dissection of the soft tissues of the neck and en bloc removal of the upper aerodigestive tract, with photographic recording and histological sampling.

Forensic issues in Down syndrome fatalities

“…In addition subglottic stenosis, laryngomalacia, tracheomalacia and congenital malformations of the larynx, trachea and bronchi may also further reduce the diameter of the airways. 35 Exacerbating factors including obesity and gastro-oesophageal reflux may contribute to the occurrence of sleep apnoea. 10,36 Asphyxial deaths have been reported in mentally handicapped individuals from a combination of factors including respiratory depression from major tranquillizers, autonomic instability and impaired swallowing reflexes.…”

Respiratory Tract Malacia: Possible cause of sudden death in infancy and early childhood

“…These conditions should, however be considered, since there are multiple cases reported of affected children who experienced severe cyanosis and respiratory arrest 23913. Careful examination of the respiratory tract should be done in all cases of unexpected infant death, particularly where there is a history of respiratory distress 11.…”

“… review of the clinical and family histories looking specifically at the nature of the terminal episode; external examination looking for dysmorphic syndromes; and internal examination with layer dissection of the soft tissues of the neck and en block removal of the upper aerodigestive tract, with photographic recording and histological sampling with multiple sections of various parts of the respiratory tree, because of the possibility of a segmental location of the changes 11. …”

“…internal examination with layer dissection of the soft tissues of the neck and en block removal of the upper aerodigestive tract, with photographic recording and histological sampling with multiple sections of various parts of the respiratory tree, because of the possibility of a segmental location of the changes 11.…”

The Butterfly Procedure: A New Technique and Review of the Literature for Treating Anterior Laryngeal Webs

“…1,2 Webs of the glottis are categorized as anterior, posterior, or complete, 3 which most commonly affect the anterior portion of the glottis. 4,5 Anterior glottic webs can be either congenital or acquired.…”