Pharyngolaryngeal venous malformations in children are rare congenital lesions that can cause severe supraglottic narrowing and pose significant challenges for airway management during anesthesia. When conventional intubation is unsafe or infeasible, alternative strategies are required to establish a secure airway and facilitate repeated interventions. We report a 6-year-old girl with an extensive pharyngolaryngeal venous malformation causing marked upper-airway obstruction and requiring multiple sessions of sclerotherapy. Preoperative evaluation revealed severe supraglottic narrowing that limited visualization of the glottic structures. To ensure a safe and stable airway, a combined approach using ultrasound localization and bronchoscopic-guided percutaneous dilatational tracheostomy (PDT) was selected. Under general anesthesia with preserved spontaneous ventilation through a laryngeal mask airway, ultrasound was used to identify the tracheal anatomy and determine an optimal puncture site. Bronchoscopic guidance enabled continuous airway visualization during puncture, dilation, and tube placement. After successful PDT, the patient safely underwent four sessions of image-guided sclerotherapy over four months. No airway-related complications, tracheostomy tube intolerance, or perioperative adverse events were observed. The patient was successfully decannulated and demonstrated complete airway recovery at follow-up. This case illustrates that combining ultrasound localization with bronchoscopic guidance may offer a feasible, minimally invasive approach to establishing a stable airway in children with complex supraglottic obstruction. In this patient, the technique enabled repeated sclerotherapy sessions while maintaining ventilation stability and minimizing airway trauma. It may be considered as a potential option in carefully selected older children with immediate surgical backup when conventional airway techniques are limited by severe supraglottic distortion.
Zan et al. (Wed,) studied this question.