Tracheal anomalies associated with Down syndrome: Review
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Airway anomalies are accountable for a substantial part of morbidity and mortality in children with Down syndrome (DS). Although tracheal anomalies occur more often in DS children, a structured overview on the topic is lacking. We systematically reviewed the characteristics of tracheal anomalies in DS children.

A search of MEDLINE and EMBASE for DS and tracheal abnormalities was conducted. Tracheal stenosis, full tracheal ring deformity (CTRD), tracheal bronchus, tracheomalacia, tracheal network, tracheal agenesis or atresia, laryngotracheoesophageal cleft type 3 or 4, trachea sleeve, and missing tracheal rings were all examples of tracheal anomalies.

--59 articles were included.

--The trachea of DS children is significantly smaller than non?DS children. Tracheomalacia and tracheal bronchus are seen significantly more often in DS children.

--Furthermore, tracheal stenosis, CTRD, and tracheal compression by vascular structures are seen regularly in children with DS.

--These findings are reflected by the significantly higher frequency of tracheostomy and tracheoplasty performed in DS children.

In conclusion, tracheal abnormalities are more common in children with DS, and tracheal surgery is done more often than in children without DS. When symptoms of tracheal airway obstruction are present in children with DS, such as biphasic stridor, dyspnea, or wheezing, diagnostic rigid laryngotracheobronchoscopy with particular attention to the trachea is recommended. In addition, imaging tests are crucial in the diagnosis of DS children with airway symptoms. The type, number, and degree of tracheal abnormalities determine how they are handled. In extreme cases, surgical treatment appears to be the only option.