1. Upper Respiratory tract Obstruction
presented by : Dr. Mona Ahmed A/Raheem ENT Surgeon Khartoum National Center for Ear, Nose and Throat Diseases and Head and Neck Surgery Assistant Professor Faculty of Medicine & Health Sciences Alneelain University

2. Definition
It is obstruction of the respiratory tract above the larynx.
The upper airway extends from the nares to the inferior end of the larynx.
The lower airway extends from the inferior end of the larynx to the terminal bronchioles.

3. Respiratory System Diagram

4. Stridor Is a physical sign common to all causes of URT obstruction
It is a harsh, raspy noise produced by the flow of air through partially obstructed airway

6. Inspiratory stridor:
Obstruction at the level of the larynx or above
Biphasic stridor:
Obstruction in the trachea
Expiratory stridor:
0bstruction below the carena

7. causes Larynx Supraglottic: web cystic hygroma laryngocele
laryngomalacia
web
cystic hygroma
laryngocele

8. Glottic:
web
vocal cord paralysis
Subglottic:
stenosis
haemangioma

9. Laryngeal Web (glottic)

10. Laryngeal Web (endoscopic view)

11. 3- Trauma 2- Trachea & Bronchi web stenosis tracheomalacia
thermal &chemical
external
surgical
intubation

12. 4- Foreign Body 5- Inflammtory 6- Allergy 7- Neoplasm laryngeal
tracheal
broncheal
5- Inflammtory
acute laryngitis
laryngeotracheobronchitis (croup)
acute epiglottitis
diphtheria
6- Allergy
7- Neoplasm

13. 2- secure the upper airway
Managment
1- History
2- secure the upper airway

14. Foreign Bodies History:
Usually there is definitive history of choking followed by paroxysmal coughing then subsides.
After the initial paroxysm of coughing the tracheobronchial mucosa becomes tolerant to the F.B & cough ceases.

15. The triad of symptoms of F.B inhalation are
chocking
Choughing
Wheezing
Present in 91% OF pts.
Sudden onset of wheeze in a child not known to be asthmatic especially if it is unilateral possibility of F.B inhalation

16. Persistent fever with respiratory tract infection not respond to treatment is possible to be F.B inhalation.
Persistent or recurrent penumonia needs Brochoscopy to execlude the presnce of F.B

17. Clinical features:
Patient present with variety of symptoms depending on the location of the F.B & degree of obstruction
In the first few hours
Audible click may be heared by stethoscope due to movement of F.B
Unilateral respiratory wheeze & reduced air entery indecate F.B bronchus.
If F.B not removed within the first 24 hours

18. Pneumotic signes may be found
Atelectasis of the distal lung
Lung absces ( takes several months )

19. Investigation
Radiological, X RAY with extended neck both antroposterior & lateral views
Sometimes may need CT SCAN in long standing F.Bs

20. Treatment
laryngoscopy or bronchoscopy

21. F.B Right Main Bronchus

22. F.B

23. Tracheostomy
is a surgical procedure to create an opening through the neck into the trachea.A tube is usually placed through this opening.

24. Indications 1- foreign body inhalation
2- major head and neck surgeries
3- severe maxillofacial injuries and laryngeal trauma
4- cervical spine injuries with vocal cord that are difficult to visualize
5- angioneuretic oedema

25. Procedure
1- make skin incision (vertical or transverse) between sternal notch & cricoid cartilage
2- mid line vertical incision deviding strap muscles
3- division of thyroid isthmus or elevate it
4- vertical tracheal incision
5- insert tracheostomy tube fixed either by tape around the neck or stay suture

26. Complications 1- Early infection haemorrhage subcutaneous emphysema
pneumothorax
tracheoesophageal fistula
recurrent laryngeal nerve injury
tube displacement

27. 2- Delayed tracheal stenosis tracheocutaneous fistula
delay tracheoesophageal fistula

28. Tracheostomy

29. Tracheostomy Procedure

30. Plastic Tracheostomy Tube(Portics)

31. Metalic Tracheostomy Tube

32. THANK YOU