Laryngo-Tracheal Anastomosis: Post-Operative Evaluation by Helical CT and Computerized Reformations

Successful tracheoscopy-assisted reconstruction of traumatic tracheal avulsion in a cat

OBJECTIVE

To outline the clinical findings, surgical management, complications, and outcomes in a case of intrathoracic, traumatic, tracheal avulsion.

CASE SUMMARY

A 2-year-old domestic shorthair cat presented with respiratory distress 18 days after a motor vehicle accident. A tracheal avulsion was diagnosed and treated by surgical anastomosis. The initial anastomosis failed. The subsequent tracheoscopic-assisted tracheal anastomosis was successful. The cat had no further episodes of respiratory distress following the second surgery in a 9-month follow-up period.

UNIQUE INFORMATION PROVIDED

This communication describes a complication of intrathoracic, traumatic, tracheal avulsion repair that has not previously been described and the use of tracheoscopy during the subsequent surgical procedure to ensure accurate suture placement.

Evaluation of plethysmography for diagnosis of postintubation tracheal stenosis

OBJECTIVES

Post-intubation tracheal stenosis is a serious disease caused by cuff pressure during tracheal intubation. The reported prevalence of post-intubation tracheal stenosis is 10%-22% in intubated patients. Invasive diagnostic methods based on fiberoptic or rigid bronchoscopy are suggested for initial assessment and treatment. This study aimed to evaluate plethysmography as an alternative diagnostic tool for post-intubation tracheal stenosis. We also assessed the relationship between plethysmography and bronchoscopy findings in patients with post-intubation tracheal stenosis.

METHODS

The sample included 30 patients who were admitted to our intensive care unit or surgical ward during the course of a year, and diagnosed with post-intubation tracheal stenosis. All patients underwent plethysmography and rigid bronchoscopy. The relationship between the plethysmography and bronchoscopy findings was examined.

RESULTS

Stricture intensity had the strongest correlation with upper airway resistance (p = 0.001). The relationship of length of stricture to forced expiratory volume in 1 s and maximum expiratory flow 50 and 75 was significant in univariate analysis, and to reserve volume and total lung capacity in multivariate analysis.

CONCLUSION

Significant relationships were found between plethysmography variables and rigid bronchoscopy findings in patients with post-intubation tracheal stenosis, and some formulas were developed to give an alternative estimate of stricture severity, without bronchoscopy.

Adult laryngotracheal stenosis: etiology and surgical management

PURPOSE OF REVIEW

The most common causes of laryngotracheal stenosis have changed over the last 100 years, with external trauma and infection being supplanted by iatrogenic trauma from intubation and tracheotomy. Modern-day surgeons continue to struggle with the prevention and the treatment of this difficult problem, and the purpose of this review is to examine new causes, diagnostic methods, and treatments in laryngotracheal stenosis.

RECENT FINDINGS

Recent publications have focused on the topics of idiopathic subglottic stenosis; percutaneous dilational tracheotomy, with the possibility of this technique increasing the incidence of stenosis; the role of laryngopharyngeal reflux; and the use of primary resection with anastomosis as a curative treatment.

SUMMARY

Although promising work has been reported in the treatment of laryngotracheal stenosis, notably with primary resection and anastomosis, many questions remain to be answered, especially in the causes of this potentially life-threatening disease.