Pediatric Laryngeal Dimensions: An Age-Based Analysis

@article{Dalal2009PediatricLD,
 title={Pediatric Laryngeal Dimensions: An Age-Based Analysis},
 author={Priti G. Dalal and David J. Murray and Anna H. Messner and Angela Feng and John D. McAllister and David W. Molter},
 journal={Anesthesia \& Analgesia},
 year={2009},
 volume={108},
 pages={1475-1479},
 url={https://api.semanticscholar.org/CorpusID:45405055}
}
In this study of infants and children, the glottis rather than cricoid was the narrowest portion of the pediatric airway.

137 Citations

Analysis of the functionally-narrowest portion of the pediatric upper airway in sedated children
Since the most susceptible portion for airway damage is unyielding portion, the findings suggest that, functionally, the narrowest portion of the pediatric larynx is located in the subcricoid region.

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US-guided cricoid diameter can act as a reliable method to ascertain the proper size of ET tube, closely followed by US-guided subcricoid diameter over the traditional age-based formula.

The shape of the pediatric larynx: cylindrical or funnel shaped?
In this issue of Anesthesia & Analgesia, Dalal et al. published a study on the laryngeal dimensions with magnetic resonance imaging scans in 99 infants and children, neonates to 14-yr-old, spontaneously breathing under deep sedation with propofol and found that the shape of the pediatric larynx was "conical in the transverse dimension with the apex of the cone at the level of the vocal cord and cylindrical in the AP dimension

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Pediatric airway anatomy may not be what we thought: implications for clinical practice and the use of cuffed endotracheal tubes
The following article reviews the historical data leading to the assumption that the pediatric airway is conical as well as the more recent imaging and direct bronchoscopic observational studies which refute this tenet.
...

27 References

Developmental Changes of Laryngeal Dimensions in Unparalyzed, Sedated Children
In sedated, unparalyzed children, the narrowest portions of the larynx are the glottic opening and the immediate sub–vocal cord level, and there is no change in the relationships of laryngeal dimensions relative to cricoid dimensions throughout childhood.

The shape of the pediatric larynx: cylindrical or funnel shaped?
In this issue of Anesthesia & Analgesia, Dalal et al. published a study on the laryngeal dimensions with magnetic resonance imaging scans in 99 infants and children, neonates to 14-yr-old, spontaneously breathing under deep sedation with propofol and found that the shape of the pediatric larynx was "conical in the transverse dimension with the apex of the cone at the level of the vocal cord and cylindrical in the AP dimension

Airway sizes and proportions in children quantified by a video-bronchoscopic technique
The large airways progressively increase in cross sectional area size, maintain constant proportional relationships to the cricoid and are gender independent across childhood.

Appropriate placement of intubation depth marks in a new cuffed paediatric tracheal tube.
The insertion depth marks of the new Microcuff paediatric tracheal tube allow adequate placing of the trachea tube with a cuff-free subglottic zone and without the risk for endobronchial intubation in children from birth to adolescence.

Determination of Endotracheal Tube Size in a Perinatal Population: An Anatomical and Experimental Study
The elasticity of laryngeal structures in premature babies is identified, allowing intubation with tube sizes greater than predicted by anatomical measurements with an increasing injury risk located in the posterior part of the glottic plane.

Cuffed tracheal tubes in children – things have changed
It is affirm that cuffed TTs with highvolume and low-pressure can be used safely in Pediatric Anesthesia, however, it is possible that they may produce damage to the laryngeal mucosa in the presence of long duration anesthesia, overinflated cuff, high position of the cuff at the cricoid level and incorrect position ofthe head and the neck.

THE INFANT LARYNX: DIRECT LARYNGOSCOPIC OBSERVATIONS: CHAIRMAN'S ADDRESS
The infant larynx is of general medical interest because, owing to the peculiarities of its structure, the larynx becomes an important etiologic factor in respiratory and throat diseases much more...

The rate of growth of the cricoid cartilage
Recent interest in the condition of subglottic stenosis and post intubational stenosis of the lower respiratory tract led to a search through the literature to determine the rate at which the larynx and trachea enlarged but no work in this field was found.

Laryngeal damage from tracheal intubation
Convincing arguments indicate that intubational trauma in children under the year of rules during the intubation procedure may cause preventable injuries to the airway, particularly in eight is frequently caused by a too large a tube.