![]() The mucous membrane covering the supraglottic and subglottic parts of the airway are lax in infants and are more prone to edema when injured or inflamed. As a result, they are more susceptible to obstruction with negative pressure ventilation, especially when there is preexisting partial airway obstruction. The cartilaginous part of the pediatric airway is soft and compliant as compared to adults. The airway is narrowest at the level of the cricoid cartilage for children, while for adults, it is at the level of the vocal cords. The epiglottis in pediatric patients is more U shaped and may lie across the laryngeal inlet. The vocal cords do not lie at right angles to the trachea instead, they are inclined at anterior-inferior to the posterior-superior direction. The location of cricoid cartilage varies with age such that it is located at the C4 vertebral level at the time of birth and C6 in adults. The larynx lies at a higher level in children. Cross-sectional studies of the airway reveal that adult airway is more elliptical than that of the child. The tongue in infants and children is larger, while the mandible is smaller in size. The larger occiput, along with short neck, makes positioning during tracheostomy relatively difficult in pediatric patients. The first anatomical difference is that the head of the pediatric patient, which is relatively larger than the body size with prominent occipital protuberance. It is very crucial to understand the difference between pediatric and adult airway anatomy and physiology before planning for the tracheostomy. Many clinicians still consider pediatric tracheostomy to be a high-risk procedure, but recent evidence suggests that the inherent risk associated with it is not as high as previously perceived. Previously, the most common indication for tracheostomy was upper airway obstruction due to infectious diseases, but now, most of the pediatric tracheostomies are being done for prolonged ventilation, laryngotracheal stenosis, trauma, neurological disorders and airway obstruction due to craniofacial abnormalities. The last few decades have seen a dramatic change in indications for tracheostomy in pediatric patients due to better survival of premature infants and those suffering from severe congenital anomalies. ![]() Tracheostomy is considered a life-saving procedure, but older evidence demonstrates a higher risk in children as compared to adults. The procedure, as we know today, was standardized by Chevalier Jackson in the early 20th century. Surgical access to the trachea has been in practice since ancient times, but the modern era of tracheostomy started with Armand Trousseau, who used it to treat children suffering from diphtheria associated dyspnea in the mid-1800s.
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