A pilot study of balloon dilation in an animal model resulting in cricoid cartilage fracture: Implications for the stenotic pediatric airway

Authors

  • Annette H. Ang MD,

    1. Department of Otorhinolaryngology, Weill Medical College of Cornell University, New York Presbyterian Hospital, New York, New York
    2. Department of Otolaryngology, KK Women's and Children's Hospital, Singapore
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  • Vikash K. Modi MD,

    Corresponding author
    1. Department of Otorhinolaryngology, Weill Medical College of Cornell University, New York Presbyterian Hospital, New York, New York
    • Division of Pediatric Otorhinolaryngology, Department of Otorhinolaryngology, Weill Medical College of Cornell University, 428 East 72nd Street, Suite 100, New York, NY 10021
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  • Roheen Raithatha MD,

    1. Department of Otorhinolaryngology, Weill Medical College of Cornell University, New York Presbyterian Hospital, New York, New York
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  • Max M. April MD,

    1. Department of Otorhinolaryngology, Weill Medical College of Cornell University, New York Presbyterian Hospital, New York, New York
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  • Robert F. Ward MD

    1. Department of Otorhinolaryngology, Weill Medical College of Cornell University, New York Presbyterian Hospital, New York, New York
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  • The findings of this article were presented at the Annual Society for Ear, Nose and Throat Advances in Children (SENTAC) Meeting 2009, Salt Lake City, Utah, on December 3, 2009. The presentation was awarded second prize in the Poster Category.

  • The authors report no financial disclosure and no conflicts of interest.

Abstract

Objective:

Endoscopic balloon dilation is increasingly popular as primary therapy for infants with subglottic stenosis. We aim to determine the maximum balloon diameter and pressure where no fracture of the cricoid would occur, minimum balloon size and pressures where a gross fracture of the cricoid occurs, and location of these fractures. We tested these objectives by performing balloon dilation in laryngotracheal complexes of eight euthanized adult male New Zealand white rabbits, with airway characteristics similar to a 3- to 9-month-old infant.

Methods:

Subglottic airway diameter of each specimen was determined using endotracheal tubes (Cotton-Myer grading system). Preexistent subglottic disease was excluded by rigid endoscopy. Serial dilation with balloon catheters was performed, employing incremental balloon sizes and pressures, to determine balloon size and pressure, which resulted in a cricoid fracture. Locations of gross fractures were validated by two independent observers.

Results:

Airway diameter of all specimens was 5.4 mm (size 4.0 endotracheal tube). Four of the seven cricoid cartilages exhibited gross fractures. Dilation with balloon diameters less than 6.0 mm failed to induce a fracture despite maximal inflation to 16.0 atmospheres. The minimum balloon size required to create a fracture was 7.0 mm, at a pressure of 6.0 atmospheres. All fractures occurred at the anterior lamina of cricoid ring.

Conclusions:

No fractures occurred when balloon dilation was performed with a balloon 0.6 mm or smaller than the measured subglottic diameter. Fractures of the cricoid occurred when balloon dilation was performed with a balloon 1.6 mm or larger than the subglottic diameter. Laryngoscope, 2010

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