Topics Discussed: acute epiglottitis; airway obstruction; allergic disorders; angioedema; bacterial epiglottitis, acute; bacterial infection; congenital anomaly of upper respiratory system; congenital laryngeal abductor palsy; congenital laryngeal web; congenital laryngocele; congenital obstruction of airway; congenital stridor; croup; ear, nose, and throat; epiglottis; gastroesophageal reflux disease; glossoepiglottic fold; glottis; hemangioma; laryngeal cyst; laryngeal diseases; laryngeal neoplasm; laryngitis; laryngomalacia; laryngotracheal papillomatosis; larynx; larynx, injury of; oropharynx; parainfluenza virus 2, human; pharyngeal diphtheria; pharynx; phonation disorder; respiratory papillomatosis; spasmodic croup; stridor; subglottic stenosis; subglottic stenosis, congenital; subglottis; supraglottis; tracheal injury; tracheobronchomalacia; tracheoesophageal cleft; tracheostomy; upper respiratory tract; viral pharyngitis; virus diseases; vocal cord; vocal cord nodule; vocal cord paralysis.
Excerpt:"The larynx is a complex evolutionary structure that joins the
trachea and the bronchi to the pharynx as a common aerodigestive
pathway. The larynx serves the essential functions of (1) ventilation
of the lungs, (2) protection of the lungs during deglutition by
its sphincteric mechanisms, (3) clearance of secretions by a vigorous
cough, and (4) vocalization. An infant's survival is predicated
on the structural and neurological integrity of the larynx, and
prompt diagnostic and surgical intervention for airway management
is mandatory.Careful inspection of the patient is the first priority in any
infant with difficulty breathing. The child should remain in the
parent's arms, and the physician can judge the respiratory
rate and degree of distress. The physician should look for tachypnea
or the onset of fatigue, which may portend respiratory collapse.
Flaring of the nasal alae and using accessory neck or chest muscles
indicate that an increased degree of respiratory effort is needed
to maintain an oxygenated state. Cyanosis and air hunger, particularly
from supraglottic infection or from a foreign body, will cause the
patient to sit with the neck hyperextended in an attempt to improve
airflow. The patient should be permitted to maintain such a posture.
In a gravely ill child, additional examination should not be undertaken
lest it precipitate respiratory arrest. The child requires prompt
transport to an appropriate hospital.The pathogenesis of laryngomalacia, which is the most common..."
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