Tracheotomy is a procedure that aims to ensure airway patency in patients with respiratory failure, when there is a high risk of upper airway obstruction or a need for prolonged mechanical ventilation. It has, as expected, profound implications for patients' quality of life and family dynamics. The aim of this study is to present the case series of pediatric tracheotomies over the last 25 years in a tertiary pediatric hospital. A retrospective observational study was conducted on pediatric patients who underwent tracheotomy at the Otolaryngology Department of Coimbra's Local Health Unit, between April 2000 and April 2025. A total of 44 patients were included, with a median age of 4 months and the majority (59%) being male. A median of 2 tracheotomy procedures were performed per year, with a maximum of 6 procedures performed in 2014. The most common indication for tracheotomy was airway obstruction (32%), followed by laryngeal immobility due to neurological impairment (29%), craniofacial anomalies (23%), cardiopulmonary disease (14%), and, lastly, traumatic injury (2%). Complications were recorded in 32% of patients, the majority being tracheal obstructions (5 cases) and accidental decannulations (5 cases). There was no tracheotomy related mortality. Overall mortality rate was 41% and it was higher in cases of neurological dysfunction, mostly due to progression of the underlying disease. Our results show that pediatric tracheotomy is a safe and effective procedure. Outcomes highlight the need for close monitoring and individualized perioperative care, especially in children with severe comorbidities.

Mandibular distraction osteogenesis (MDO) is a common procedure used to correct upper airway obstruction in patients with Robin sequence. However, analysis of predictors of adverse outcomes after MDO has relied on small single-institution cohorts. This retrospective cohort study leveraged the Epic Cosmos multicenter database to evaluate predictors of morbidity and mortality in patients with Robin sequence undergoing MDO from January 2015 to December 2024. A multivariable logistic regression was used to evaluate associations between perinatal factors, airway anomalies, genetic syndromes, and congenital anomalies affecting the cardiopulmonary, gastrointestinal and central nervous system (CNS), and postoperative outcomes including 1-year mortality, tracheostomy, intensive care unit (ICU) admission within 30 days, 30-day hospital readmission, 30-day emergency department visit, ICU length of stay (LOS), and overall hospital LOS. Across a total of 685 patients, CNS anomalies were statistically significantly associated with 1-year mortality; cardiopulmonary anomalies and bronchomalacia were predictive of tracheostomy; tracheal stenosis was associated with ICU admission; CNS anomalies were associated with 30-day emergency department visit; and no variables were significantly associated with 30-day readmission. Age at surgery was inversely associated with longer ICU LOS and overall LOS, whereas prematurity, prenatal drug exposure, gastroesophageal reflux, and CNS anomalies were associated with longer overall LOS. These results highlight the burden of comorbidities of the airway, cardiopulmonary system, and central nervous system for patients with Robin sequence undergoing MDO and can inform surgeons on the likelihood of adverse events based on the diagnostic characteristics of the patient.

Mandibular distraction osteogenesis (MDO) is the established standard of care in the United States for severe upper airway obstruction in infants with Pierre Robin Sequence (PRS). While airway plates have been utilized effectively in Europe for decades, this approach was not adopted in the United States until 2020, when an institution-specific protocol was developed to coexist with surgical paradigms. The current study details the design and clinical implementation of the institution's Orthodontic Airway Plate (OAP). By applying orthodontic Visual Treatment Objective principles to maxillofacial computed tomography, infant-specific airway dimensions were preprogrammed into the device design. This methodology ensures immediate airway patency upon device delivery and minimizes bedside modifications associated with traditional methods. An innovative outpatient adjustment regimen was developed to accelerate mandibular growth without hindering maxillary development. In a cohort of 64 consecutively treated infants, 62 (96.9%) were successfully discharged home. Thirty-five infants were transferred from other hospitals specifically for OAP at distances exceeding 350 miles, including 30 from outside the state of California. None required subsequent MDO or tracheostomy. The mean age (± standard deviation) was 1.7 months (±0.9) at the start of treatment. The mean hospital stay from OAP delivery to discharge was 16.2 days (±8.1). The mean treatment duration was 3.6 months (±1.3). The mean Obstructive Apnea Hypopnea Index decreased from 33.9 events/hour (±26.0) to 8.5 events/hour (±5.0) immediately following OAP delivery. This OAP protocol has demonstrated efficacy as a robust and predictable nonsurgical complement to MDO, marking a significant milestone in contemporary management of infants with PRS.

Palatine tonsillar hypertrophy is a common cause of upper airway obstruction and is often assessed through oropharyngeal examination using the Brodsky classification. However, this bidimensional method may underestimate the actual tonsillar volume, particularly in cases of atypical anatomy. We report the case of a patient with long-standing rhinophonia associated with dysphonia and vocal fatigue. Oroscopic examination suggested tonsillar hypertrophy. Due to the discrepancy between symptoms and physical examination findings, videolaryngoscopy was performed, revealing more significant airway compromise than initially appreciated. This case highlights the importance of clinical-endoscopic correlation and suggests that discordance between symptoms and oroscopic findings should prompt endoscopic evaluation to avoid the underdiagnosis of clinically relevant airway obstruction.

Achondroplasia is the most common skeletal dysplasia, characterized by disproportionate short stature and associated craniofacial, musculoskeletal, and neurological abnormalities. Respiratory complications are frequent and represent a major contributor to morbidity and mortality. Sleep-disordered breathing (SDB), encompassing obstructive (OSA) and central sleep apnea (CSA), is the most prevalent respiratory complication with pediatric prevalence reported between 22% and 93%. OSA results primarily from multilevel upper-airway obstruction related to craniofacial abnormalities and adenotonsillar hypertrophy, whereas CSA is often linked to cervicomedullary compression secondary to foramen magnum stenosis (FMS). Early sleep evaluation, particularly during infancy, is essential. Management strategies include adenotonsillectomy, maxillofacial interventions, cervicomedullary decompression, and non-invasive ventilation (NIV), according to underlying pathophysiology. Restrictive lung disease, pulmonary hypertension (PH), airway malacia and conductive hearing loss (CHL) further contribute to respiratory burden. Over the last fifteen years, major advances in this field have included improved recognition of the heterogeneity of SDB, the role of dynamic airway abnormalities and residual postoperative obstruction, and the emergence of FGFR3-targeted therapies. However, major gaps remain regarding optimal surveillance strategies and the impact of novel therapies on respiratory outcomes. Early identification, multidisciplinary management and follow-up are critical to optimize long-term outcomes.

Obstructive sleep apnea (OSA) is a sleep-disordered breathing condition characterized by recurrent upper-airway obstruction, leading to intermittent hypoxemia, sleep fragmentation, and sympathetic activation. OSA is highly prevalent in patients with cardiovascular diseases and is strongly associated with hypertension, atrial fibrillation, coronary artery disease, heart failure, and adverse prognosis. This review summarizes current evidence on the pathophysiology of OSA, its cardiovascular consequences, and available diagnostic and therapeutic strategies, with particular attention to clinical implications in cardiology practice. We discuss established treatments such as lifestyle interventions, continuous positive airway pressure, mandibular advancement devices, and selected surgical options, as well as emerging therapies, including pharmacological approaches targeting weight loss and ventilatory control. While OSA treatment improves symptoms and quality of life, evidence for cardiovascular event reduction remains heterogeneous and appears strongly influenced by patient selection and treatment adherence. Identifying patients most likely to benefit from targeted OSA management remains a key challenge.

The purpose of this study was to investigate the upper airway (UA) dimensional growth in normal subjects from preadolescence to young adulthood in correlation with skeletal maturation stages. The samples consisted of 518 subjects (255 males, 263 females; age: 6-18 y) who underwent 3-dimensional computed tomography (3D-CT) scans of the head and neck. They were divided into 26 groups based on sex and age. After reorientation of 3D-images, cervical vertebrae maturation index (CVMI) stages were assessed using a 6-stage scoring method. The UA dimensions, including volume, cross-sectional area (CSA), and length, were measured, and statistical analyses were performed. On the basis of chronological age, females exhibited larger volume and mean CSA values during early adolescence, with earlier appearance of plateaus; whereas males showed later but greater enlargement during late adolescence, especially after age 17. According to CVMI stage, females reached plateaus around CVMI stages 4 and 5. However, males demonstrated continuous increases across CVMI stages. Combination of longer length and smaller volume in preadolescent males might be related to higher susceptibility to UA collapsibility. Despite a late onset of UA enlargement in males, steady UA development persisted into late adolescence. As age and CVMI stage were significantly correlated with UA variables (all P<0.001), CVMI stages 3 and 4 (male: 11.7-12.8 y; females: 10.1-11.3 y) may represent the period of UA dimensional growth peak. Sex-related differences in the magnitude and timing of UA dimensional growth may serve as basic reference for assessing the risk of UA obstruction from preadolescents to young adulthood.