QUAD #15: Managing A-Frame Deformities with Dr. Matt Smith

Stay Current in Pediatric Surgery

In this video, we dive into the complexities of tracheal A-frame deformities, a common issue following airway surgeries like tracheostomies or reconstructions.

• What Are A-Frame Deformities? A tracheal deformity that typically occurs at the site of a previous tracheostomy, affecting about a third of patients with prior airway surgery.
• Challenges in Airway Sizing: Traditional endotracheal tube sizing is unreliable for A-frame deformities due to the oblong shape of the airway, making it crucial to assess both static and dynamic aspects of the deformity.
• Symptoms and Progression: Symptoms may take 1-2 years to manifest post-decannulation, often presenting as exercise intolerance, dyspnea, or obstructive sleep apnea.
• Surgical Interventions: Dr. Smith demonstrates two approaches for treating A-frame deformities—open repair with tracheoplasty or anterior graft placement, and endoscopic resection using a CO2 laser.
• Case Studies: Real-life examples of successful interventions, including a 6-year-old with campomelic dysplasia and a 12-year-old with subglottic and tracheal stenosis, highlighting the effectiveness of both open and endoscopic procedures.