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Wilcox LJ, Schweiger C, Hart CK, de Alarcon A, Peddireddy NS, Rutter MJ. Growth and Management of Repaired Complete Tracheal Rings after Slide Tracheoplasty. Otolaryngol Head Neck Surg 2019; 161:164-170. [DOI: 10.1177/0194599819841893] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
ObjectiveThis study documents the growth and course of repaired complete tracheal rings over time after slide tracheoplasty.Study DesignCase series with review.SettingTertiary pediatric academic medical center.Subjects/MethodsMedical records of pediatric patients with confirmed tracheal rings on bronchoscopy who underwent slide tracheoplasty between January 2001 and December 2015 were reviewed. Patients who had operative notes documenting tracheal sizing over time were included. Exclusion criteria included tracheal stenosis not caused by complete tracheal rings, surgical repair prior to presentation at our institution, or lack of adequate sizing information. The postoperative follow-up was examined and airway growth over time documented.ResultsOf 197 slide tracheoplasties performed during the study time period, 139 were for complete tracheal rings, and 40 of those children met inclusion criteria. The median age at time of surgery was 7 months, and the median initial airway size was 3.9 mm (n = 34). The median growth postoperatively was 1.9 mm over a median follow-up period of 57 months (0.42 mm/year), which is similar to growth rates of unrepaired complete tracheal rings ( P = .53). Children underwent a median of 10 postoperative endoscopies, with time between endoscopies increasing further out from surgery. The most commonly performed adjunctive procedure was balloon dilation.ConclusionsThis is the first study documenting continued growth of repaired complete tracheal rings after slide tracheoplasty. Postoperative endoscopic surveillance ensures adequate growth. Intervals between airway endoscopies can be increased as the child gets older, as the airway increases in size, and as long as symptoms are minimal.
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Affiliation(s)
- Lyndy J. Wilcox
- Division of Pediatric Otolaryngology–Head and Neck Surgery, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, USA
- Division of Pediatric Otolaryngology–Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Claudia Schweiger
- Division of Pediatric Otolaryngology–Head and Neck Surgery, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, USA
| | - Catherine K. Hart
- Division of Pediatric Otolaryngology–Head and Neck Surgery, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, USA
- Aerodigestive and Esophageal Center, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, USA
- Department of Otolaryngology–Head & Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Alessandro de Alarcon
- Division of Pediatric Otolaryngology–Head and Neck Surgery, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, USA
- Aerodigestive and Esophageal Center, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, USA
- Department of Otolaryngology–Head & Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | | | - Michael J. Rutter
- Division of Pediatric Otolaryngology–Head and Neck Surgery, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, USA
- Aerodigestive and Esophageal Center, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, USA
- Department of Otolaryngology–Head & Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
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Donato L, Mai Hong Tran T, Ghori UK, Musani AI. Pediatric Interventional Pulmonology. Clin Chest Med 2018; 39:229-238. [DOI: 10.1016/j.ccm.2017.11.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Torre M. Left pulmonary artery sling and congenital tracheal stenosis: to slide or not to slide? J Thorac Dis 2018; 9:4881-4883. [PMID: 29312682 DOI: 10.21037/jtd.2017.11.76] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Michele Torre
- Units of Pediatric Surgery and Airway Team, Istituto Giannina Gaslini, Genova, Italy
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Eber E, Antón-Pacheco JL, de Blic J, Doull I, Faro A, Nenna R, Nicolai T, Pohunek P, Priftis KN, Serio P, Coleman C, Masefield S, Tonia T, Midulla F. ERS statement: interventional bronchoscopy in children. Eur Respir J 2017; 50:50/6/1700901. [DOI: 10.1183/13993003.00901-2017] [Citation(s) in RCA: 58] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Accepted: 08/08/2017] [Indexed: 12/25/2022]
Abstract
Paediatric airway endoscopy is accepted as a diagnostic and therapeutic procedure, with an expanding number of indications and applications in children. The aim of this European Respiratory Society task force was to produce a statement on interventional bronchoscopy in children, describing the evidence available at present and current clinical practice, and identifying areas deserving further investigation. The multidisciplinary task force panel performed a systematic review of the literature, focusing on whole lung lavage, transbronchial and endobronchial biopsy, transbronchial needle aspiration with endobronchial ultrasound, foreign body extraction, balloon dilation and occlusion, laser-assisted procedures, usage of airway stents, microdebriders, cryotherapy, endoscopic intubation, application of drugs and other liquids, and caregiver perspectives. There is a scarcity of published evidence in this field, and in many cases the task force had to resort to the collective clinical experience of the committee to develop this statement. The highlighted gaps in knowledge underline the need for further research and serve as a call to paediatric bronchoscopists to work together in multicentre collaborations, for the benefit of children with airway disorders.
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Clinical and biological acceptance of a fibrocollagen-coated mersylene patch for tracheal repair in growing dogs. The Journal of Laryngology & Otology 2014; 128:630-40. [PMID: 25075948 DOI: 10.1017/s0022215114001339] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Collagen-covered prostheses can be used as a non-circumferential segmental tracheal replacement. However, the applicability of these implants in young subjects has not yet been reported. METHODS In this experimental, longitudinal study, dogs aged 29-32 days underwent limited segmental tracheal replacement with a polyester prosthesis or were allocated to a control, untreated group. The dogs were evaluated clinically, endoscopically and tomographically for up to one year. RESULTS Although there was evidence of tracheal growth in the experimental group, tomographic measurements were significantly smaller in this group than in the control group throughout the observation period. At the end of the study, there was no evidence of implant rejection, stenosis or collapse. Normal respiratory epithelium had grown across the implanted membrane in the experimental group. CONCLUSION The homologous collagen mersylene membrane allowed for limited structural tracheal growth and was functionally integrated into the segmented tracheal wall in growing dogs.
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Anton-Pacheco JL, Comas JV, Luna C, Benavent MI, Lopez M, Ramos V, Mendez MD. Treatment strategies in the management of severe complications following slide tracheoplasty in children. Eur J Cardiothorac Surg 2014; 46:280-5; discussion 285. [DOI: 10.1093/ejcts/ezt617] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Chueng K, Chadha NK. Primary dilatation as a treatment for pediatric laryngotracheal stenosis: a systematic review. Int J Pediatr Otorhinolaryngol 2013; 77:623-8. [PMID: 23453794 DOI: 10.1016/j.ijporl.2013.02.003] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2012] [Revised: 01/27/2013] [Accepted: 02/01/2013] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To identify and review original studies on balloon and rigid dilatation as primary therapy for laryngotracheal stenosis (LTS) in pediatric patients. DESIGN Systematic review. METHODS A comprehensive search strategy in MEDLINE, EMBASE and the Cochrane Central Register of Controlled Trials was conducted and limited to human studies published in English after 1980. Two independent reviewers identified original studies on primary dilatation therapy for LTS in patients younger than 18 years. Studies on tracheobronchial stenosis or stents for tracheomalacia were excluded. 22 of 369 identified studies (6%) met the inclusion criteria. Two reviewers independently appraised the level of evidence of each study, using the Oxford clinical evidence-based medicine guidelines, and extracted raw data using a standardized form developed a priori. RESULTS The patient population consisted of grades I-III LTS. Most studies used adjuvant therapy including laser or topical agents. The primary outcome of success was achieving a functional airway without open laryngo-tracheal surgery or ongoing need for a tracheostomy. In studies using balloon dilatation alone (6 studies, n=10) or rigid dilatation alone (5 studies, n=68), success rates were 50% and 53%, respectively. Success rates ranged from 50% to 78% for balloon dilatation with adjuvant therapy (6 studies, n=24) and 53%-100% for rigid dilatation with adjuvant therapy (5 studies, n=61). CONCLUSIONS Dilatation was successful as primary therapy in the majority of low-grade pediatric LTS. Given the lack of comparative studies among other study limitations, it could not be determined whether one method of dilatation was superior to another.
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Affiliation(s)
- Kristelle Chueng
- Division of Otolaryngology, University of British Columbia, Vancouver, British Columbia, Canada
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Antón-Pacheco JL, López M, Moreno C, Bustos G. Congenital tracheal stenosis caused by a new tracheal ring malformation. J Thorac Cardiovasc Surg 2011; 141:e39-40. [PMID: 21457996 DOI: 10.1016/j.jtcvs.2011.02.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2011] [Revised: 01/31/2011] [Accepted: 02/18/2011] [Indexed: 10/18/2022]
Affiliation(s)
- Juan L Antón-Pacheco
- Division of Pediatric Surgery and Pediatric Airway Unit, Hospital Universitario 12 de Octubre, Madrid, Spain.
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Blackmore K, Kubba H, Clement WA. Laser division of congenital complete tracheal rings. Int J Pediatr Otorhinolaryngol 2010; 74:1327-30. [PMID: 20800297 DOI: 10.1016/j.ijporl.2010.07.019] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2010] [Revised: 07/20/2010] [Accepted: 07/22/2010] [Indexed: 11/30/2022]
Abstract
Congenital complete tracheal rings are a rare and life threatening problem in young children and they are often challenging to manage. Whilst historically associated with high mortality rates increasing experience with this tracheal pathology has led to much improved survival rates and slide tracheoplasty has become the treatment of choice. We present 3 cases in which an open procedure was not deemed possible and they underwent laser division (CO2, KTP) of their complete rings. Two patients subsequently required stent insertion. All patients are alive and well at a mean follow up of 3 years and 5 months. Whilst laser division of complete tracheal rings has only been described in a small number of cases it may provide an alternative approach in patients who are not able to undergo an open procedure or in an emergency situation.
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Affiliation(s)
- Kate Blackmore
- Department of ENT, Royal Hospital for Sick Children, Dalnair Street, Glasgow G3 8SJ, United Kingdom.
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Bryant R, Morales DLS. Corkscrew trachea: a novel type of congenital tracheal stenosis. Ann Thorac Surg 2009; 87:1923-5. [PMID: 19463623 DOI: 10.1016/j.athoracsur.2008.10.083] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2008] [Revised: 09/26/2008] [Accepted: 10/28/2008] [Indexed: 10/20/2022]
Abstract
The classic definition of congenital tracheal stenosis includes the presence of complete tracheal rings with absence of the membranous portion of the trachea. The morphologic type, based on Cantrell's classification, dictates the surgical management. In this report, we describe the presentation and surgical management of a novel type of distal congenital tracheal stenosis referred to as "corkscrew" trachea.
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Affiliation(s)
- Roosevelt Bryant
- Department of Congenital Heart Surgery, Texas Children's Hospital, Houston, Texas 77309, USA.
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Abstract
Long-segment near-complete tracheal ring deformity is a rare condition with few documented cases. We present the case of a 7-week-old male with total anomalous pulmonary venous return and long-segment near-complete tracheal rings. We discuss the presentation, evaluation, and management of near-complete and complete tracheal rings.
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Clement WA, Geddes NK, Best C. Endoscopic Carbon Dioxide Laser Division of Congenital Complete Tracheal Rings: A New Operative Technique. Ann Thorac Surg 2005; 79:687-9. [PMID: 15680863 DOI: 10.1016/j.athoracsur.2003.09.105] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/05/2003] [Indexed: 11/24/2022]
Abstract
A carbon dioxide laser was used through a bronchoscope to split the posterior aspect of complete tracheal rings in the distal trachea of a 16-month-old boy previously palliated for cyanotic congenital heart disease. After laser division of the complete tracheal rings, the patient was successfully extubated. Subsequently, the boy had granulation tissue develop, which required bronchoscopic resection, and then severe posterior tracheal impingement developed from the esophageal herniation, which required placement of a distal tracheal stent. Although unsuccessful in this case, carbon dioxide laser division of complete tracheal rings may be a safe and effective method of treating congenital tracheal stenosis in selected cases.
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Affiliation(s)
- W Andrew Clement
- Department of Otolaryngology, Royal Hospital for Sick Children, Glasgow, United Kingdom.
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McLaren CA, Elliott MJ, Roebuck DJ. Tracheobronchial intervention in children. Eur J Radiol 2005; 53:22-34. [PMID: 15607850 DOI: 10.1016/j.ejrad.2004.07.022] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2004] [Revised: 07/20/2004] [Accepted: 07/26/2004] [Indexed: 11/19/2022]
Abstract
Disorders of the major airways in children are often difficult to treat. Recent advances in interventional radiology are proving useful, for both assessment of the severity of the problem and treatment. Flexible bronchoscopy and bronchography are essential tools for diagnosis, intervention and follow-up. Echocardiography, computed tomography and magnetic resonance imaging may also be important for the evaluation of cardiovascular anomalies, which are often associated with airway obstruction. Surgery remains the first line of treatment for most congenital abnormalities of the airway and for cardiac anomalies that cause airway compression. Balloon dilatation and stenting are helpful in certain other conditions, as well as in children whose airway problem is not fully corrected by surgery. A multidisciplinary approach is required, with input from pediatric cardiothoracic surgeons, radiologists, radiographers, otolaryngologists, pulmonologists, anesthesiologists, intensivists, physiotherapists and liaison nurses.
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Affiliation(s)
- Clare A McLaren
- Tracheal Service, Great Ormond Street Hospital, London WC1N 3JH, UK.
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Smith WK, Morrison G. Balloon dilatation following tracheal reconstruction for congenital microtrachea. Int J Pediatr Otorhinolaryngol 2004; 68:1563-6. [PMID: 15533572 DOI: 10.1016/j.ijporl.2004.07.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2004] [Revised: 07/02/2004] [Accepted: 07/04/2004] [Indexed: 11/20/2022]
Abstract
A male infant presented with failed extubation was diagnosed with congenital microtrachea. After primary combined surgery with excision of a left pulmonary artery sling and microtracheal resection with anastomosis incorporating the excised microtrachea as an autologous anterior tracheal graft he was treated with balloon dilatation of the re-stenosed segment on three occasions during the following year. During the 4 years follow-up, stridor has been minimal and intermittent. His feeding and growth have been normal. We have found balloon dilatation to be a useful adjunct to tracheal reconstructive surgery in this difficult condition.
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Affiliation(s)
- Wendy Kim Smith
- Department of Otolaryngology, Ipswich Hospital, Ipswich, Suffolk, UK.
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Elliott M, Roebuck D, Noctor C, McLaren C, Hartley B, Mok Q, Dunne C, Pigott N, Patel C, Patel A, Wallis C. The management of congenital tracheal stenosis. Int J Pediatr Otorhinolaryngol 2003; 67 Suppl 1:S183-92. [PMID: 14662192 DOI: 10.1016/j.ijporl.2003.08.023] [Citation(s) in RCA: 84] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
This paper reviews current concepts and results in the management of congenital tracheal stenosis (CTS). Diagnostic options are considered and the requirements for successful management defined. Chief amongst these is a multi-disciplinary approach with individualised patient management. Severe long-segment CTS represents the biggest challenge to clinicians and the worst problems for affected families. Near-death episodes are frequent in affected infants and some cannot be ventilated and require ECMO. Associated cardiovascular anomalies are frequent. Patients require immediate resuscitation and transfer to a specialist unit. After careful assessment, accurate diagnosis and discussion, primary resection and end-to-end repair with a slide technique should always be the first option, with concomitant repair of associated cardiac anomalies. If this is impossible because of the severity of the lesion, some form of patch tracheoplasty will be indicated. Cardiopulmonary bypass is often required. Patches include pericardium, autograft trachea, carotid artery, cartilage, and allograft trachea. Mortality ranges from 0 to 30% in the literature, which largely comprises single-centre long-term experience. Recurrence is common and can be managed by stenting and tracheal homograft implantation. Long-term quality of life of survivors is little reported but seems good. Physiological data are lacking. To improve results, we suggest a treatment algorithm to rationalise care.
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Affiliation(s)
- Martin Elliott
- The Great Ormond Street Hospital for Children NHS Trust, Great Ormond Street, London WC1N 3JH, UK.
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Abstract
Pediatric tracheal surgery is uncommon, and few centers have enough experience to make meaningful conclusions about treatment. Short-segment congenital tracheal stenosis is treated by tracheal resection, whereas long-segment stenosis is treated by either augmentation tracheoplasty or slide tracheoplasty (the author's preferred approach). Tracheomalacia is treated most commonly by aortopexy. Postintubation tracheal stenosis is usually treated by tracheal (or laryngotracheal) resection.
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Affiliation(s)
- Cameron D Wright
- General Thoracic Surgical Unit, Department of Surgery, Blake 1570, Massachusetts General Hospital, 32 Fruit Street Boston, MA 02114, USA.
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