Optical Coherence Tomography in Pediatric Airway Surgery: A Case Series and Focused Review

ABSTRACT Objective To describe the role of optical coherence tomography (OCT) in the evaluation and surgical planning of pediatric patients with complex airway pathology. Methods We conducted a retrospective case series of four pediatric patients who underwent OCT imaging of the trachea and mainstem bronchi between 2020 and 2024 at a tertiary children's hospital. Imaging was performed intraoperatively using a microcatheter‐based OCT catheter under general anesthesia. OCT findings were reviewed in conjunction with bronchoscopy, preoperative imaging, and operative reports. Results In each case, OCT provided high‐resolution structural detail that refined diagnosis and informed surgical planning. OCT was instrumental in delineating the extent of stenosis, evaluating mainstem bronchial involvement, and assessing stent patency and epithelialization. OCT imaging demonstrated value both in preoperative assessment and postoperative follow‐up. Conclusion OCT offers a high‐resolution, radiation‐free imaging modality for pediatric airway evaluation. In this small, uncontrolled series, OCT served as a feasible adjunct that provided additional structural detail concordant with operative findings and, in selected cases, informed surgical approach. Prospective studies are needed to define workflow, performance, and impact on outcomes. Level of Evidence 4.