Approach to congenital airway anomalies

Liew Zheyi
Sultanah Aminah Hospital, Johor Bahru, Malaysia

Congenital airway anomalies, though relatively uncommon, pose significant diagnostic and therapeutic challenges in paediatric practice. These conditions encompass a broad spectrum, ranging from laryngomalacia and tracheomalacia to more complex anomalies, such as tracheoesophageal fistula, congenital tracheal stenosis, and vascular rings that cause extrinsic compression. Early recognition is crucial, as delayed diagnosis may result in recurrent respiratory symptoms, feeding difficulties, and, in severe cases, life‑threatening airway compromise.

This presentation outlines a practical and systematic approach to congenital airway anomalies, beginning with clinical suspicion based on history and physical examination, followed by the judicious use of diagnostic tools, including flexible bronchoscopy, rigid endoscopy, cross-sectional imaging, and dynamic airway studies. Emphasis will be placed on multidisciplinary evaluation involving paediatric pulmonologists, otolaryngologists, cardiothoracic surgeons, and radiologists to ensure accurate diagnosis and tailored management.

Treatment strategies vary widely, from conservative monitoring in self‑limiting conditions such as mild laryngomalacia to complex surgical reconstruction in cases of severe tracheal stenosis or complete tracheal rings. Supportive care—including optimisation of nutrition, respiratory physiotherapy, and treatment of comorbidities such as gastroesophageal reflux—forms an integral part of management.

Through an illustrative and structured framework, this talk aims to equip clinicians with key principles to recognise, investigate, and manage congenital airway anomalies effectively. Ultimately, a timely and coordinated approach is crucial for enhancing outcomes and improving the quality of life for affected children and their families.