Management of <scp>A‐Frame</scp> Tracheal Deformity in Children With Endoscopic Resection Tracheoplasty
Bibliographic record
Abstract
Objectives Tracheal A‐frame deformity is a known consequence of tracheostomy that may lead to obstruction after decannulation. The goal of this study is to demonstrate the feasibility and success of endoscopic carbon dioxide (CO 2 ) laser‐assisted tracheoplasty of tracheal A‐frame deformity in children. Methods Retrospective case series of symptomatic children with tracheal A‐frame deformity with no other site of airway obstruction (2016–2018). All patients underwent CO 2 ‐laser assisted endoscopic resection tracheoplasty. Results Eight patients (six male) were included with a median age of 15.4 (IQR 12.3–17.9) years. Patients had a median of two previous open airway surgeries (IQR 1–2.5) and all patients had a history of tracheostomy with successful decannulation. Tracheal A‐frame deformity presented as dyspnea on exertion for all patients (n = 8, 100%). Obstructive sleep apnea was confirmed for all patients who underwent polysomnography (4/4, 100%). Median interval from decannulation to development of symptoms was 8.7 years (IQR 5.8–9.3). All patients sized with an age‐appropriate endotracheal tube despite the deformity. Endoscopic A‐frame tracheoplasty was successful for 7/8 (87.5%) patients and was performed with overnight observation for these patients (8/8, 100%). Unilateral A‐frame tracheoplasty was performed successfully for five patients (62.5%), bilateral A‐frame tracheoplasty was performed successfully for two patients (25.0%), and one patient (12.5%) did not have complete resolution of symptoms after bilateral A‐frame tracheoplasty due to multi‐level airway obstruction. Conclusions CO 2 laser‐assisted tracheoplasty is an innovative endoscopic technique to relieve symptoms of airway obstruction for selected patients with tracheal A‐frame deformity although avoiding the morbidity and hospital stay duration associated with tracheal resection. Level of Evidence 4 Laryngoscope , 131:E719–E723, 2021
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".