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Practical Implications

J. Mark Reed, MD; David M. O'Connor; Charles M. Myer, III, MD

Arch Otolaryngol Head Neck Surg. 1996;122(6):605-608.

Abstract
Objective
To determine normative anatomical data on the pediatric upper airway.

Design
Anatomical study of the trachea and surrounding structures in vivo using magnetic resonance imaging. Three-dimensional positions of the hyoid bone, sternum, skin, and trachea were determined. Tracheal angulation was measured from the vertical plane.

Subjects
One hundred children (53 males and 47 females) undergoing magnetic resonance imaging of the brain or chest.

Intervention
None.

Results
Ages ranged from 2 days to 20.4 years, with a median of 6.05 years. Gender differences were not significant. The mean distance from the hyoid bone to the sternal notch was 63.0 mm (SD, 22.04 mm). The skin to anterior tracheal wall distance averaged 9.34 mm (SD, 3.29 mm), and tracheal diameter averaged 8.48 mm (SD, 2.88 mm). The trachea was not found to be a linear structure. An anterior angulation change of 9.9° (SD, 7.89°) was detected. The point of inflection was found to lie below the sternal notch in children younger than 2 years and above the notch in older children.

Conclusions
Normal anatomical data of the pediatric airway have been acquired using magnetic resonance imaging. Because the trachea exhibits a previously unknown anterior angulation, current design of tracheotomy tubes may not be ideal. Rigid tracheotomy tubes that do not conform to the anatomical structure of the trachea may be responsible for suprastomal collapse or innominate artery erosion.

(Arch Otolaryngol Head Neck Surg. 1996;122:605-608)

Author Affiliations
From the Children's Hospital Medical Center, Department of Pediatric Otolaryngology and Maxillofacial Surgery, Cincinnati, Ohio.

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