Surgical treatment of primary tracheal dyskinesia in a 14-month-old child—Case report Rajko M. Jovic ´ a,1 , Zoran Komazec a , Slobodan Mitrovic ´ a , Danijela Dragic ˇevic ´ a, * , Dus ˇica Janjevic ´ b a University ENT Clinic, Clinical Center of Vojvodina Novi Sad, Hajduk Veljkova 1, Novi Sad 21000, Serbia b Department of Anaesthesiology, University ENT Clinic, Clinical Centerof Vojvodina Novi Sad, Hajduk Veljkova 1, Novi Sad 21000, Serbia Received 16 February 2009; accepted 17 June 2009 Available online 26 August 2009 Abstract The primary form of tracheal dyskinesia in early childhood is a rare congenital malformation of unknown origin. The degree of the posterior membranous tracheal wall involvement determines the intensity of obstruction and the severity of the clinical picture. The aim of this paper is to present a case of a 14-month-old child with severe tracheal dyskinesia that required surgical treatment. Fascia lata graft fixated with fibrin glue was used in strengthening the posterior tracheal wall. Three years following the surgery, the child is without breathing difficulties. In severe cases of primary dyskinesia, surgical treatment using fascia lata graft, fixated with fibrin glue is recommended in strengthening the posterior tracheal wall. # 2009 Elsevier Ireland Ltd. All rights reserved. Keywords: Tracheal dyskinesia; Dyspnea; Child; Fascia lata 1. Introduction In 1949, Lemoine and Gareix described the tracheal dyskinesia [1], but its etiopathogenic mechanism still remains uncertain to this day [2–4]. It is thought to be a congenital disease characterized by the prolapse of the posterior membranous part of the trachea into the lumen during expiration [4]. This prolapse, as noticed by Keller and Herzog [2] occurs due to the increased intraluminal pressure. Clinical symptoms are determined by the degree of prolapse of the posterior membranous tracheal wall, appearing when the tracheal lumen is narrowed more than 50%. Difficulties of breathing during rest indicate that the lumen of trachea and main bronchia is narrowed more than 70%. There are two forms of tracheal dyskinesia: primary and secondary. The primary form develops in the newborns, while the secondary form occurs usually in adults, due to the chronic obstruction of the airway with a consequent atrophy and collapse of the tracheobronchial tree [2]. Primary dyskinesia can either be isolated or more frequently associated with other more complex syndromes or congenital malformations of the midline such as: esophageal atresia, tracheoesophageal fistula, laryngotracheal cleft, etc. [3,4]. Clinical symptoms with hypoxemia and hypercapnia along with the requirement for an endoscopic examination are the basis in diagnosing this condition [4]. This condition must be considered in differential diagnosis in cases of apnea crisis of various durations which appear and usually resolve spontaneously. In determining if and when the surgical treatment is indicated, an evaluation of clinical sign’s intensity, vital parameters, the response to conservative treatment, and an endoscopic examination is required. The aim of this paper is to describe a rare upper airway disorder, its evaluation and rational treatment options by the presentation of a case. 2. Case report The patient, a 14-month-old boy who had been admitted to the ENT Clinic in Novi Sad, Serbia due to apnea crisis of www.elsevier.com/locate/anl Auris Nasus Larynx 37 (2010) 263–267 * Corresponding author. Tel.: +381 638982051. E-mail addresses: rajkojov@EUnet.yu (R.M. Jovic ´), bebac@nscable.net (D. Dragic ˇevic ´). 1 Tel.: +381 216612022; fax: +381 216613140. 0385-8146/$ – see front matter # 2009 Elsevier Ireland Ltd. All rights reserved. doi:10.1016/j.anl.2009.06.012