1. Anne Connell Mater Children’s Hospital 2012 New Zealand IMAGING THE PAEDIATRIC AIRWAY

2. Anne Connell Mater Children’s Hospital

3. Anne Connell Mater Children’s Hospital ADULT CHILD

4. Anne Connell Mater Children’s Hospital ADULT CHILD

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6. Anne Connell Mater Children’s Hospital

7. Anne Connell Mater Children’s Hospital BUTTON BATTERIES and COINS

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10. 21 Month old swallowed watch battery (10.30am) Oesophageal mucosa burn 12 noon

11. Anne Connell Mater Children’s Hospital SORE THROAT ? TONSILITIS

12. Anne Connell Mater Children’s Hospital

13. Anne Connell Mater Children’s Hospital SORE THROAT ? TONSILITIS DROOLING, CHOKING ? FOREIGN BODY

14. Anne Connell Mater Children’s Hospital

15. Anne Connell Mater Children’s Hospital Stylohyoid ligament calcification

16. Anne Connell Mater Children’s Hospital SORE THROAT ? TONSILITIS DROOLING, CHOKING ? FOREIGN BODY NECK SWELLING ? RETROPHARYNGEAL ABCESS

17. Anne Connell Mater Children’s Hospital

18. Anne Connell Mater Children’s Hospital SORE THROAT ? TONSILITIS DROOLING, CHOKING ? FOREIGN BODY NECK SWELLING ? RETROPHARYNGEAL ABCESS BARKING COUGH, “HOOP” ? CROUP

19. Anne Connell Mater Children’s Hospital

20. Anne Connell Mater Children’s Hospital SORE THROAT ? TONSILITIS DROOLING, CHOKING ? FOREIGN BODY NECK SWELLING ? RETROPHARYNGEAL ABCESS BARKING COUGH, “HOOP” ? CROUP STRIDOR ? EPIGLOTITIS

21. Anne Connell Mater Children’s Hospital EPIGLOTITIS

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25. Anne Connell Mater Children’s Hospital ? RETROPHARYNGEAL ABCESS SUPINE NECK EXTENDED

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28. Anne Connell Mater Children’s Hospital PSEUDO SUBLUXATION PSEUDO Dictionary definition 1. False not genuine 2. Resembling or Imitating Appearance of subluxation Created artificially Pseudosubluxation

29. Anne Connell Mater Children’s Hospital SWISCHUCK LINE Posterior cervical line drawn Posterior arch of C1 to Posterior arch of C3 Should pass through or be less than 1mm anterior to posterior arch of C2 Spino-Laminar line

30. Anne Connell Mater Children’s Hospital PseudosubluxationTrue subluxation

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33. Article from Neurosurgery March 2002 MANAGEMENT OF THE PAEDIATRIC CERVICAL SPINE AND SPINE CORD INJURY Conclusion Thoracic elevation or occipital recess to prevent flexion of the head and neck when restrained supine on flat board allows better neutral alignment in children younger than 8 years.

34. Anne Connell CORRECT NECK FLEXION SHOULD PRODUCE NEUTRAL POSITION

35. Anne Connell MATER RADIOLOGY QUEST Produce the most effective “TED” Thoracic elevation Device Study by Nypaver & Treloar 1994 Evaluated 40 children younger than 8 years Assessed their neutral position on backboard All 40 required elevation of torso to eliminate neck flexion Mean amount of elevation required was 25mm

36. Anne Connell Mater TED Dimensions 30mm high 20cms wide Placed under shoulders at level of acromioclavicular ligament

37. Anne Connell Mater Children’s Hospital ELEVATION EXTEND THE NECK CONCLUSION

38. Anne Connell Mater Children’s Hospital GRATEFUL THANKS Dr Tony Lamont Dr Gill Long Adam Lack for photography Gerard Duckworth for photography Ivan Simic & my son Crawford for computer skills Olivia & Madonna, Jordan & Sally for modeling Kate Bilby for speech pathology assistance Vic Summers for his image suggestion Yourselves for listening

39. Anne Connell Mater Children’s Hospital REFERENCES AND TEXTS Pediatric Videofluoroscopy Studies Joan C. Arvendson Maureen A. Lefton-Greif Atlas of Human Body Professor Peter Abrahams Eyewitness visual dictionary of human body Covent Garden Books Internet article Bobby R. Alford Dept. of Otorhinolaryngology Atlas of Human Anatomy Frank H. Netter