Tracheomalacia
| Classification according to ICD-10 | |
|---|---|
| J39.8 | Other specified diseases of the upper respiratory tract |
| Q32.0 | Congenital tracheomalacia |
| ICD-10 online (WHO version 2019) | |
Tracheomalacia is a disease that is characterized by slack in the windpipe . The reason for this lies in the inadequate stability of the cartilage braces located in the trachea , which typically leads to a collapse of the trachea at the time of the inhalation phase (but often also the exhalation phase ). Tracheomalacia can affect a segment or the entire trachea.
Tracheomalacia often occurs together with bronchomalacia and is then also referred to as tracheobronchomalacia .
Pathogenesis
Since a negative pressure must be present in the inhalation phase in order to allow air to flow into the lungs, the trachea with abnormally soft cartilage tissue collapses more easily than in the exhalation phase. This leads to an inspiratory, but also an expiratory stridor (both as a sign of increased airway resistance). Ultimately, the airway resistance can become so high and breathing so severely impaired that the patient develops increasing dyspnea and ultimately suffocates without suitable therapy.
Classification
There are three different forms:
- Type 1: congenital, reinforcement in the supine position
- Type 2: indentation of the trachea caused by external compression (e.g. tumors or goiter )
- Type 3: instability acquired due to chronic infection or excessively long intubation
Therapy and prognosis
In the case of congenital tracheomalacia, it is often sufficient to lie the baby on their stomach and not on their back. Usually there is a spontaneous healing tendency over the course of months and years. In the case of tracheomalacia due to external compression, the cause should be removed if possible (e.g. in the case of a goiter by a strumectomy or radioiodine therapy ). In the case of infection-related tracheomalacia, antibiosis appropriate to the test is indicated. The prognosis is less favorable, especially in the infection-related form, and tracheal stenosis is possible. As a last resort , surgical dilation of the trachea is possible.
If the tracheomalacia is so pronounced that it restricts the patient's breathing in a life-threatening manner , symptom-related measures must be taken to enable adequate ventilation of the lungs again. Depending on the extent and location of the affected tracheal sections, a tracheotomy with subsequent insertion of a tracheostomy tube may be sufficient. In special cases, however, it may also be necessary to advance a tube to the bifurcation (the point at which the trachea divides into the left and right main bronchus).
Individual evidence
- ↑ Deutsches_Ärzteblatt
- ↑ a b c A. Franzen: Ear, nose and throat medicine. Urban & Fischer-Verlag, 2001, ISBN 3-437-42960-4 , (online at: books.google.de ) .
- ↑ a b c d K.-H. Niessen ao: Pediatrics. Thieme Verlag, 2001, ISBN 3-13-113246-9 , p. 426. (online at: books.google.de ) .
- ↑ a b c d H. P. Zenner: Practical therapy of ear, nose and throat diseases. Schattauer Verlag, 2008, ISBN 978-3-7945-2264-4 , p. 402, (online at: books.google.de ) .
