Management of severe tracheobronchomalacia with 3D printed resorbable airway splints: An Australian first

Introduction

Tracheobronchomalacia (TBM) is the loss of the cartilaginous support of the trachea and/or major bronchi, leading to the dynamic collapse of the airway during respiration. It usually resolves by the age of two. Severe cases often present with recurrent pneumonias requiring hospitalisations, inability to extubate following illness or procedures, or life-threatening events.

Methods

We present the first Australian case of a successful implantation of tracheal splints using 3D printing technology to treat a 21-month-old with severe TBM who failed non-invasive treatments. His disease could not be improved with other established airway procedures. After multidisciplinary discussions at the Sydney Children's Hospital Network's tracheal reconstruction group, the case was further discussed with the multidisciplinary team at CS Mott's Children's Hospital to assist with surgical planning and the custom design of stents. The Australian Therapeutic Goods Administration's approval for the devices was sought. Consent was obtained from the hospital executives, as well as the New South Wales Department of Communities and Justice.

Results

The surgery was facilitated by placing the patient on extracorporeal membrane oxygenation for the sternotomy. Intraoperative flexible bronchoscopy was performed to confirm the site of TBM. Two airway splints were utilised for the long segment tracheomalacia involving the distal trachea and proximal left main bronchus. They were placed on the anterior and lateral surface of the trachea and bronchus. The patency was confirmed with intraoperative flexible bronchoscopy. The patient was extubated after 5 days. He remains clinically well.

Conclusions

3D printed tracheal splint is another viable alternative for children with severe TBM. The computer aided design and biomaterial 3d printing creates anatomically specific implantable devices for patients with TBM.