Josef Holzki

University Children´s Hospital, Belgium



Biography

Dr Josef Holzki is a teaching professor at the University Children´s Hospital Liège, Belgium, after retiring from being Director/Chairman of the department of Pediatric
Anesthesia and Surgical Intensive Care Unit (SICU) in Children´s Hospital Cologne, Germany for 23 years. He also served as a President of the FEAPA (Federation of
European associations of Pediatric Anesthesia), Lecturer in international meetings of Pediatric Anesthesia and –intensive care and airway endoscopy, honorary member
of the Association of Pediatric anesthesia of Great Britain and Ireland (APA).

Abstract

The literature about the anatomy of the pediatric larynx goes back to 1897. Since then a considerable number of investigations
has been published dealing with the different aspects of the pediatric larynx. One classic article by J E Eckenhoff from
1951 described the cartilaginous, non-distensible cricoid ring as the narrowest part of the pediatric larynx according to older
scientific publications. Eckenhoff´s paper served for many years as basis for selecting adequate sizes of tracheal tubes to seal
the pediatric airway at the outlet of the cricoid ring in order to prevent airway injury and aspiration. Between 2003 and 2016
several in vivo studies (MRI, CT-scan, Planimetry) were published questioning Eckenhoff´s arguments, asserting that the
glottis would be the narrowest part of the pediatric larynx. However, the authors of these studies ignored the in vivo pliability
of glottis and subglottis which flawed their arguments considerably. An additional critical aspect of the in vivo studies arises
from misrepresentating the literature in these studies and from omitting very relevant publications from the field of pediatric
airway surgery which were not yet part of the discussion. The author of this presentation, being well connected worldwide with
many colleagues having published in the field of the anatomy and injury of the pediatric airway, would like to correct what
might be inadequate in recent literature. Unsuitable references were corrected and the content of relevant publications which
were missing in the criticized articles, were added. Experience and knowledge of surgical tracheo-laryngology was integrated
in this review, also recent, yet unpublished data from an ongoing investigation in infant specimen of the Institution of Legal
Medicine of the University of Cologne (Head: M. Rothschild), could be quoted. This demonstrates the real size and form of
the pediatric larynx, difficult to be described only by words. This article might equip pediatric anesthesiologists with reliable
knowledge about anatomy and function of the pediatric larynx which might have been confounded in recent years.