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Iokura D, Okanoue Y, Otsuki S, Oe K, Takata K, Tarui A, Kojima T. Safety and efficacy of high tracheostomy with inferior retraction of the thyroid isthmus. Auris Nasus Larynx 2024; 51:231-235. [PMID: 37926659 DOI: 10.1016/j.anl.2023.10.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Revised: 09/05/2023] [Accepted: 10/26/2023] [Indexed: 11/07/2023]
Abstract
OBJECTIVE In typical surgical tracheostomy, the thyroid isthmus is divided or retracted superiorly and preserved. However, at our institution, the thyroid isthmus is retracted inferiorly and preserved. Thereafter, a tracheal incision is made above the thyroid isthmus. This method, hereinafter defined as high tracheostomy, has the advantage of facilitating immediate access to the trachea in a superficial position; moreover, it can be quickly replaced with cricothyrotomy in emergency situations. However, tracheotomies placed too high can potentially damage the cricoid cartilage, thereby causing subglottic granulation and tracheal stenosis. We aimed to validate the safety and efficacy of high tracheostomy with inferior retraction of the thyroid isthmus. METHODS This was a retrospective cohort analysis. We analyzed the operative method and other relevant characteristics of 90 patients who underwent surgical tracheostomy between April 2016 and June 2022. For those who underwent high tracheostomies, we analyzed the duration of surgery, amount of intraoperative bleeding, occurrence of complications, problems with stoma closure, and perioperative mortality. RESULTS High tracheostomy was performed in 73 patients. Subglottic granulation occurred in one patient, and the granulation tissue spontaneously shrank. Subcutaneous emphysema occurred in two patients. No patient developed wound infection or tracheoinnominate artery fistula. Moreover, no patient experienced false route tracheotomy tube insertion because the thyroid glands were located under the stoma. CONCLUSION The frequency of complications was comparable to that reported in other studies on tracheostomy. Additionally, no patient developed tracheal stenosis secondary to tracheostomy above the thyroid isthmus. Therefore, high tracheostomy with inferior retraction and preservation of the thyroid isthmus is safe and advantageous.
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Affiliation(s)
- Daisuke Iokura
- Department of Otolaryngology, Tenri Hospital, Tenri, Nara, Japan
| | - Yusuke Okanoue
- Department of Otolaryngology, Tenri Hospital, Tenri, Nara, Japan
| | - Shuya Otsuki
- Department of Otolaryngology, Tenri Hospital, Tenri, Nara, Japan
| | - Kengo Oe
- Department of Otolaryngology, Tenri Hospital, Tenri, Nara, Japan
| | - Kuniaki Takata
- Department of Otolaryngology, Tenri Hospital, Tenri, Nara, Japan
| | - Akihito Tarui
- Department of Otolaryngology, Tenri Hospital, Tenri, Nara, Japan
| | - Tsuyoshi Kojima
- Department of Otolaryngology, Tenri Hospital, Tenri, Nara, Japan; Department of Otolaryngology-Head and Neck Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
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Ding M, Ning J, Liu X, Mi R, Cai Y. Stenotic geometry effects on airflow dynamics and respiration for central airway obstruction. Comput Methods Programs Biomed 2023; 241:107760. [PMID: 37573642 DOI: 10.1016/j.cmpb.2023.107760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Revised: 08/08/2023] [Accepted: 08/09/2023] [Indexed: 08/15/2023]
Abstract
BACKGROUND AND OBJECTIVE The quantitative relationship between tracheal anatomy and ventilation function can be analyzed by using engineering-derived methods, including mathematical modeling and numerical simulations. In order to provide quantitative functional evaluation for patients with tracheobronchial stenosis, we here propose an aerodynamics-based assessment method by applying computational fluid dynamics analysis on synthetic and patient-specific airway models. METHODS By using 3D reconstruction of tracheobronchial tree and computational fluid dynamics simulations, the aerodynamic environment from the stenotic central airway down to the 4th-6th bifurcation of the tracheobronchial tree is examined in both synthetic and patient-derived models. The effects of stenotic anatomy (the degree of stenosis, stenotic length and location) on the aerodynamic parameters, including pressure drop, area-average velocity, volume flow rate, wall shear stress and airflow resistance, are investigated on three-dimensional models of tracheobronchial tree. RESULTS The results from 36 synthetic models demonstrate that 70% constriction marks the onset of a precipitous decrease in airflow relative to a normal airway. The analyses of simulation results of 8 patient-specific models indicate that the Myer-Cotton stenosis grading system can be interpreted in terms of aerodynamics-derived description, such as flow resistance. The tracheal stenosis significantly influences the resistance of peripheral bronchi, especially for patients with severe stenosis. CONCLUSIONS The present study forms a systematic framework for future development of more robust, bioengineering-informed evaluation methods for quantitative assessment of respiratory function of patients with central airway obstruction.
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Affiliation(s)
- Ming Ding
- Department of Respiratory Medicine, Southeast University Zhongda Hospital, Nanjing, Jiangsu, China
| | - Jing Ning
- School of Biological Sciences and Medical Engineering, Southeast University, Nanjing, Jiangsu, China
| | - Xiuyan Liu
- Department of Respiratory Medicine, Southeast University Zhongda Hospital, Nanjing, Jiangsu, China
| | - Runze Mi
- School of Biological Sciences and Medical Engineering, Southeast University, Nanjing, Jiangsu, China
| | - Yan Cai
- School of Biological Sciences and Medical Engineering, Southeast University, Nanjing, Jiangsu, China.
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Plocienniczak M, Sambhu KM, Noordzij JP, Tracy L. Impact of Socioeconomic Demographics and Race on Laryngotracheal Stenosis Etiology and Outcomes. Laryngoscope 2023; 133:908-913. [PMID: 35906885 DOI: 10.1002/lary.30321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Revised: 07/11/2022] [Accepted: 07/12/2022] [Indexed: 11/05/2022]
Abstract
OBJECTIVE Certain sociodemographic variables are known to result in health care disparities. This study investigates potential differences in outcomes for patients with laryngotracheal stenosis (LTS) based on racial backgrounds and socioeconomic variables including insurance status and English language-Proficiency. METHODS Patients with LTS from 2016 to 2021were identified by relevant ICD codes. Variables including race, age, gender, language preference and insurance status were collected from medical records. Risk factors for LTS including COPD, smoking history, diabetes, GERD, and BMI were obtained. Etiology of LTS was categorized as autoimmune, traumatic, iatrogenic, or idiopathic. Need for temporary tracheostomy and tracheostomy dependence were determined at last follow-up visit. RESULTS 129 patients were included for review. 70% of Black patients had iatrogenic LTS, whereas 65% of the White patient cohort had autoimmune or idiopathic LTS. Black patients were more strongly associated with temporary tracheostomy and tracheostomy dependence compared to White patients. Public health insurance and co-morbid GERD were associated with tracheostomy dependence for White patients only. CONCLUSION This study identified a disproportionate representation of Black patients in the iatrogenic etiology of LTS. Although controlling for risk factors of LTS, this cohort had an increased need for temporary tracheostomy and tracheostomy dependence compared to White and Latinx cohorts. This finding merits further study. LEVEL OF EVIDENCE 3 Laryngoscope, 133:908-913, 2023.
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Affiliation(s)
- Michal Plocienniczak
- Boston University School of Medicine, Boston, Massachusetts, USA.,Department of Otolaryngology - Head and Neck Surgery, Boston Medical Center, Boston, Massachusetts, USA
| | | | - J Pieter Noordzij
- Boston University School of Medicine, Boston, Massachusetts, USA.,Department of Otolaryngology - Head and Neck Surgery, Boston Medical Center, Boston, Massachusetts, USA
| | - Lauren Tracy
- Boston University School of Medicine, Boston, Massachusetts, USA.,Department of Otolaryngology - Head and Neck Surgery, Boston Medical Center, Boston, Massachusetts, USA
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Ayten O, Iscanli IGE, Canoglu K, Ozdemir C, Saylan B, Caliskan T, Akin H, Tezel C. Tracheal Stenosis After Prolonged Intubation Due to COVID-19. J Cardiothorac Vasc Anesth 2022; 36:2948-2953. [PMID: 35283040 PMCID: PMC8832874 DOI: 10.1053/j.jvca.2022.02.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 02/04/2022] [Accepted: 02/06/2022] [Indexed: 01/01/2023]
Abstract
Objectives The authors aimed to evaluate the characteristics and management outcomes of patients who developed tracheal stenosis after invasive mechanical ventilation (IMV) due to COVID-19. Design, Setting, and Participants The data of 7 patients with tracheal stenosis and 201 patients without tracheal stenosis after IMV due to COVID-19 between March 2020 and October 2021 were retrospectively analyzed. Interventions Flexible bronchoscopy was performed for the diagnosis of tracheal stenosis and the evaluation of the treatment's effectiveness, and rigid bronchoscopy was applied for the dilatation of tracheal stenosis. Measurements and Main Results In the follow-up period, tracheal stenosis was observed in 7 of 208 patients (2 women, 5 men; 3.3%). The patients were divided into 2 groups as patients with tracheal stenosis (n = 7) and patients without tracheal stenosis (n = 201). There were no statistically significant differences between the 2 groups in terms of age, sex, body mass index, and comorbidities (p > 0.05). The mean duration of IMV of the patients with tracheal stenosis was longer than patients without tracheal stenosis (27.9 ± 13 v 11.2 ± 9 days, p < 0.0001, respectively). Three (43%) of the stenoses were web-like and 4 (57%) of them were complex-type stenosis. The mean length of the stenoses was 1.81 ± 0.82 cm. Three of the patients were treated successfully with bronchoscopic dilatation, and 4 of them were treated with tracheal resection. Conclusions Tracheal stenosis developed in 7 of 208 (3.3%) patients with COVID-19 who were treated with IMV. The most important characteristic of patients with tracheal stenosis was prolonged IMV support.
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Affiliation(s)
- Omer Ayten
- Department of Pulmonary Medicine, Sultan Abdulhamid Han Teaching Hospital, Istanbul, Turkey.
| | - Insa Gul Ekiz Iscanli
- Department of Intensive Care Unit, Sultan Abdulhamid Han Teaching Hospital, Istanbul, Turkey
| | - Kadir Canoglu
- Department of Pulmonary Medicine, Sultan Abdulhamid Han Teaching Hospital, Istanbul, Turkey
| | - Cengiz Ozdemir
- Department of Pulmonary Medicine, Yedikule Teaching Hospital for Pulmonology and Thoracic Surgery, Istanbul, Turkey
| | - Bengü Saylan
- Department of Pulmonary Medicine, Sultan Abdulhamid Han Teaching Hospital, Istanbul, Turkey
| | - Tayfun Caliskan
- Department of Pulmonary Medicine, Sultan Abdulhamid Han Teaching Hospital, Istanbul, Turkey
| | - Hasan Akin
- Department of Thoracic Surgery, Yedikule Teaching Hospital for Pulmonology and Thoracic Surgery, Istanbul, Turkey
| | - Cağatay Tezel
- Department of Thoracic Surgery, Sultan Abdulhamid Han Teaching Hospital, Istanbul, Turkey
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Agrawal A, Baird BJ, Madariaga MLL, Blair EA, Murgu S. Multi-disciplinary management of patients with benign airway strictures: A review. Respir Med 2021; 187:106582. [PMID: 34481304 DOI: 10.1016/j.rmed.2021.106582] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2021] [Accepted: 08/18/2021] [Indexed: 11/29/2022]
Abstract
Histologically benign airway strictures are frequently misdiagnosed as asthma or COPD and may present with severe symptoms including respiratory failure. A clear understanding of pathophysiology and existing classification systems is needed to determine the appropriate treatment options and predict clinical course. Clinically significant airway strictures can involve the upper and central airways extending from the subglottis to the lobar airways. Optimal evaluation includes a proper history and physical examination, neck and chest computed tomography, pulmonary function testing, endoscopy and serology. Available treatments include medical therapy, endoscopic procedures and open surgery which are based on the stricture's extent, location, etiology, morphology, severity of airway narrowing and patient's functional status. The acuity of the process, patient's co-morbidities and operability at the time of evaluation determine the need for open surgical or endoscopic interventions. The optimal management of patients with benign airway strictures requires the availability, expertise and collaboration of otolaryngologists, thoracic surgeons and interventional pulmonologists. Multidisciplinary airway teams can facilitate accurate diagnosis, guide management and avoid unnecessary procedures that could potentially worsen the extent of the disease or clinical course. Implementation of a complex airway program including multidisciplinary clinics and conferences ensures that such collaboration leads to timely, patient-centered and evidence-based interventions. In this article we outline algorithms of care and illustrate therapeutic techniques based on published evidence.
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Affiliation(s)
- Abhinav Agrawal
- Interventional Pulmonology & Bronchoscopy, Division of Pulmonary, Critical Care & Sleep Medicine, Zucker School of Medicine at Hofstra/Northwell, New Hyde Park, NY, USA.
| | - Brandon J Baird
- Section of Otolaryngology - Head and Neck Surgery, Department of Surgery, University of Chicago, Chicago, IL, USA.
| | - Maria Lucia L Madariaga
- Section of Thoracic Surgery, Department of Surgery, University of Chicago, Chicago, IL, USA.
| | - Elizabeth A Blair
- Section of Otolaryngology - Head and Neck Surgery, Department of Surgery, University of Chicago, Chicago, IL, USA.
| | - Septimiu Murgu
- Interventional Pulmonology, Section of Pulmonary and Critical Care, Department of Medicine, University of Chicago, Chicago, IL, USA.
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Naunheim MR, Zhou AS, Puka E, Franco RA, Carroll TL, Teng SE, Mallur PS, Song PC. Laryngeal complications of COVID-19. Laryngoscope Investig Otolaryngol 2020; 5:1117-1124. [PMID: 33364402 PMCID: PMC7752067 DOI: 10.1002/lio2.484] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Revised: 10/06/2020] [Accepted: 10/10/2020] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVE To describe and visually depict laryngeal complications in patients recovering from coronavirus disease 2019 (COVID-19) infection along with associated patient characteristics. STUDY DESIGN Prospective patient series. SETTING Tertiary laryngology care centers. SUBJECTS AND METHODS Twenty consecutive patients aged 18 years or older presenting with laryngological complaints following recent COVID-19 infection were included. Patient demographics, comorbid medical conditions, COVID-19 diagnosis dates, symptoms, intubation, and tracheostomy status, along with subsequent laryngological symptoms related to voice, airway, and swallowing were collected. Findings on laryngoscopy and stroboscopy were included, if performed. RESULTS Of the 20 patients enrolled, 65% had been intubated for an average duration of 21.8 days and 69.2% requiring prone-position mechanical ventilation. Voice-related complaints were the most common presenting symptom, followed by those related to swallowing and breathing. All patients who underwent flexible laryngoscopy demonstrated laryngeal abnormalities, most frequently in the glottis (93.8%), and those who underwent stroboscopy had abnormalities in mucosal wave (87.5%), periodicity (75%), closure (50%), and symmetry (50%). Unilateral vocal fold immobility was the most common diagnosis (40%), along with posterior glottic (15%) and subglottic (10%) stenoses. 45% of patients underwent further procedural intervention in the operating room or office. Many findings were suggestive of intubation-related injury. CONCLUSION Prolonged intubation with prone-positioning commonly employed in COVID-19 respiratory failure can lead to significant laryngeal complications with associated difficulties in voice, airway, and swallowing. The high percentage of glottic injuries underscores the importance of stroboscopic examination. Otolaryngologists must be prepared to manage these complications in patients recovering from COVID-19. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Matthew R. Naunheim
- Department of Otolaryngology—Head and Neck SurgeryMassachusetts Eye and Ear InfirmaryBostonMassachusettsUSA
- Department of Otolaryngology—Head and Neck SurgeryHarvard Medical SchoolBostonMassachusettsUSA
| | - Allen S. Zhou
- Department of Otolaryngology—Head and Neck SurgeryMassachusetts Eye and Ear InfirmaryBostonMassachusettsUSA
- Department of Otolaryngology—Head and Neck SurgeryHarvard Medical SchoolBostonMassachusettsUSA
| | - Elefteria Puka
- Department of Otolaryngology—Head and Neck SurgeryMassachusetts Eye and Ear InfirmaryBostonMassachusettsUSA
- Department of Otolaryngology—Head and Neck SurgeryHarvard Medical SchoolBostonMassachusettsUSA
| | - Ramon A. Franco
- Department of Otolaryngology—Head and Neck SurgeryMassachusetts Eye and Ear InfirmaryBostonMassachusettsUSA
- Department of Otolaryngology—Head and Neck SurgeryHarvard Medical SchoolBostonMassachusettsUSA
| | - Thomas L. Carroll
- Department of Otolaryngology—Head and Neck SurgeryHarvard Medical SchoolBostonMassachusettsUSA
- Division of OtolaryngologyBrigham and Womens HospitalBostonMAUSA
| | - Stephanie E. Teng
- Department of Otolaryngology—Head and Neck SurgeryHarvard Medical SchoolBostonMassachusettsUSA
- Division of OtolaryngologyBeth Israel Deaconess Medical CenterBostonMAUSA
| | - Pavan S. Mallur
- Department of Otolaryngology—Head and Neck SurgeryHarvard Medical SchoolBostonMassachusettsUSA
- Division of OtolaryngologyBeth Israel Deaconess Medical CenterBostonMAUSA
| | - Phillip C. Song
- Department of Otolaryngology—Head and Neck SurgeryMassachusetts Eye and Ear InfirmaryBostonMassachusettsUSA
- Department of Otolaryngology—Head and Neck SurgeryHarvard Medical SchoolBostonMassachusettsUSA
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Kuzucuoğlu M, Topuz RD, Altun E. Effect of mitomycin-C applied through different approaches following tracheal surgery on development of granulation tissue and level of nephrotoxicity in rats. Turk Gogus Kalp Damar Cerrahisi Derg 2019; 27:73-9. [PMID: 32082830 DOI: 10.5606/tgkdc.dergisi.2019.16337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Accepted: 07/25/2018] [Indexed: 11/21/2022]
Abstract
Background This study aims to evaluate the effect of mitomycin-C applied through different drug administration approaches on the development of granulation tissue in the field of surgery and renal functions in rats which underwent tracheal surgery. Methods Fifty male adult Sprague Dawley rats (weighing mean 200 g to 300 g) were divided into five groups. An incision was performed between the fifth and sixth cartilage ring of the trachea in all groups under anesthesia and the incision was primarily repaired with a 6/0 monofilament absorbable suture. A single dose of mitomycin-C 0.5 mg was applied in the experimental animals appropriate with their assigned groups as topical, intraperitoneal injection, injection to the wound edges, and through inhalation. No mitomycin-C was administered in one group which was accepted as the control group. Rats were sacrificed four weeks after surgery and their tracheas were excised subsequently. Tracheal tissue samples were histopathologically evaluated in terms of epithelization, fibrosis, amount of fibroblasts, angiogenesis, and inflammatory response. Diameter and wall thickness of the tracheas were measured. Blood urea and creatinine levels were evaluated for nephrotoxicity, and the rats were immunohistochemically examined for glomerular pathology. Results Epithelization was statistically significantly decelerated (p<0.01), diameter of the trachea was statistically significantly larger (p<0.05), and wall thickness of the trachea was significantly thicker in the group with topical mitomycin-C application compared to the control group (p<0.01). Conclusion Topically applied mitomycin-C following tracheal surgery slows down epithelization and, thus, decreases the development of granulation tissue and maintains a wider diameter of the trachea.
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Janik S, Kliman J, Hacker P, Erovic BM. Preserving the thyroidal isthmus during low tracheostomy with creation of a Björk flap. Laryngoscope 2018; 128:2783-2789. [PMID: 30284245 PMCID: PMC6585656 DOI: 10.1002/lary.27310] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Revised: 04/29/2018] [Accepted: 05/03/2018] [Indexed: 11/05/2022]
Abstract
OBJECTIVES/HYPOTHESIS Surgical tracheostomy (ST) with creation of an inferiorly based U-shaped tracheal flap, known as the Björk flap, is the most commonly performed. The purpose of this study was to evaluate whether outcome was different in patients who underwent low ST with retraction and preservation of the thyroid isthmus compared to those who underwent high ST with ligation of the thyroid isthmus. STUDY DESIGN Retrospective cohort study. METHODS We included 1,143 patients who underwent ST with creation of a Björk flap between 2008 and 2015. Different outcome parameters, including complications, decannulation, inpatient mortality, and surgical characteristics, such as length of surgery and height of tracheal incision, were assessed comparing low and high ST. RESULTS Complications occurred in 7.7% of patients, of which persistent stoma (4.1%) and hemorrhages (2.7%) were the most common. Low tracheostomy with retraction and preservation of thyroid isthmus was done in 31.4% of cases. Complications did not significantly differ between low and high tracheostomies (8.0% vs. 7.0%, P = .468). Moreover, decannulation rate and inpatient mortality were also not significantly different in low compared to high tracheostomies (P = .816 and P = .152, respectively). However, low tracheostomies were associated with significantly shorter operation times (33.0 ± 0.8 min vs. 38.7 ± 0.5 min, P < .001) and lower tracheal incisions for creation of a Björk flap (P < .001) compared to high tracheostomies. CONCLUSIONS Low tracheostomies are as safe as high tracheostomies regarding complications. Due to the fact that low tracheostomies are associated with shorter operation times and lower tracheal incisions, we recommend performong low tracheostomies whenever feasible. LEVEL OF EVIDENCE 4 Laryngoscope, 128:2783-2789, 2018.
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Affiliation(s)
- Stefan Janik
- Department of Otorhinolaryngology-Head and Neck Surgery , Medical University of Vienna, Vienna, Austria
| | - Jonathan Kliman
- Department of Otorhinolaryngology-Head and Neck Surgery , Medical University of Vienna, Vienna, Austria
| | - Philipp Hacker
- Department of Otorhinolaryngology-Head and Neck Surgery , Medical University of Vienna, Vienna, Austria
| | - Boban M Erovic
- Department of Otorhinolaryngology-Head and Neck Surgery , Medical University of Vienna, Vienna, Austria.,Institute for Head and Neck Diseases , Evangelical Hospital Vienna, Vienna, Austria
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Joshua J, Scholten E, Schaerer D, Mafee MF, Alexander TH, Crotty Alexander LE. Otolaryngology in Critical Care. Ann Am Thorac Soc 2018; 15:643-654. [PMID: 29565639 PMCID: PMC6207134 DOI: 10.1513/annalsats.201708-695fr] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2017] [Accepted: 03/22/2018] [Indexed: 01/02/2023] Open
Abstract
Diseases affecting the ear, nose, and throat are prevalent in intensive care settings and often require combined medical and surgical management. Upper airway occlusion can occur as a result of malignant tumor growth, allergic reactions, and bleeding events and may require close monitoring and interventions by intensivists, sometimes necessitating surgical management. With the increased prevalence of immunocompromised patients, aggressive infections of the head and neck likewise require prompt recognition and treatment. In addition, procedure-specific complications of major otolaryngologic procedures can be highly morbid, necessitating vigilant postoperative monitoring. For optimal outcomes, intensivists need a broad understanding of the pathophysiology and management of life-threatening otolaryngologic disease.
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Affiliation(s)
- Jisha Joshua
- Pulmonary and Critical Care Section, Department of Medicine, Veterans Affairs San Diego Healthcare System, San Diego, California; and
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine
| | - Eric Scholten
- Pulmonary and Critical Care Section, Department of Medicine, Veterans Affairs San Diego Healthcare System, San Diego, California; and
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine
| | | | - Mahmood F. Mafee
- Division of Neuroradiology, Department of Radiology, University of California–San Diego, San Diego, California
| | | | - Laura E. Crotty Alexander
- Pulmonary and Critical Care Section, Department of Medicine, Veterans Affairs San Diego Healthcare System, San Diego, California; and
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine
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Ansari A, Thomas A. Multimodality Surgical Approach in Management of Laryngotracheal Stenosis. Case Rep Otolaryngol 2018; 2018:4583726. [PMID: 29808149 DOI: 10.1155/2018/4583726] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2018] [Revised: 02/28/2018] [Accepted: 03/17/2018] [Indexed: 01/12/2023] Open
Abstract
Introduction Postintubation laryngotracheal stenosis requires a precise diagnosis and an experienced operator in both endoscopic and surgical treatment. This report presents surgically treated cases of laryngotracheal stenosis secondary to long-term intubation/tracheostomy with review of the literature. Materials and Methods In this retrospective study, we present 5 cases (a 23-year-old male, 13-year-old male, 22-year-old male, 19-year-old male, and 33-year-old female) of postintubation/tracheostomy laryngotracheal (glottic/subglottic) stenosis in the years 2016 and 2017. Each patient was managed differently. Intubation characteristics, localization of stenosis, surgical technique and material, postoperative complications, and survival of patients were recorded. Results The site of stenosis was in the subglottis in 4 patients and glottis in 1 patient. The mean length of the stenosis was greater in the postintubation group. Postintubation stenosis had a mean duration of intubation of 6.8 days, compared to 206.25 days of cannulation following tracheostomies. Each patient underwent an average of 2 procedures during their treatment course. One patient underwent open surgical anastomosis because of recurrent subglottic stenosis after multiple treatments. Phonation improved immediately in almost all except in the patient who underwent only endoscopic dilatation. Discussion The reasons for laryngeal stenosis and its delayed diagnosis have been reviewed from the literature. Suture tension should be appropriate, and placement of the suture knot outside the trachea minimizes formation of granulation tissue. The published reports suggest that resection by endoscopy with laser and open technique resection and primary anastomosis are the best treatment modality so far as the long-term results are concerned. Conclusion Resection of stenotic segment by open surgical anastomosis and laser-assisted resection is a safe option for the treatment of subglottic stenosis following intubation without the need for repeated dilation. Endoscopic dilation can be reserved for unfit patients.
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Bourinet V, Raguin T, Fortin M, Chetrit E, Guinde J, Laroumagne S, Fakhry N, Astoul P, Debry C, Dutau H. Experience with Transcordal Silicone Stents in Adult Laryngotracheal Stenosis: A Bicentric Retrospective Study. Respiration 2018; 95:441-448. [PMID: 29621756 DOI: 10.1159/000487242] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Accepted: 01/25/2018] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Benign stenosis involving laryngeal and upper tracheal structures represents a therapeutic challenge. Open surgery and endoscopic management have to be discussed by a multidisciplinary board in order to evaluate the risk and benefit for each patient. OBJECTIVE The objective of this retrospective study was to report the experience of two French centers with transcordal silicone stents (TSS) in the endoscopic management of benign laryngotracheal stenosis (BLTS) in adults, with focus on efficacy, safety, and tolerability. METHODS We performed a retrospective chart review of all cases of BLTS treated with TSS between January 2001 and June 2017 at two tertiary centers in France: the Centre Hospitalier Régional Universitaire de Strasbourg and the Hôpital Nord de Marseille. RESULTS A total of 17 patients were included. Eleven had a tracheostomy at initial management which consisted of 8 T-tubes and 9 strictly endoluminal stents placements. The main complications were minor aspirations in 5 patients (29%), granulation in 3 patients (18%), migration in 2 patients (12%), and severe dysphonia in 3 patients (18%). After a mean duration of 18.3 months, 11 patients (65%) had had their TSS definitely removed, 13 patients were tracheostomy free (76%), and a TSS remained in place in 4 patients (24%). CONCLUSIONS Adult BLTS treatment with TSS placement is associated with low morbidity and excellent clinical outcomes, with a large proportion of patients free of airway instrumentation on long-term follow-up.
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Affiliation(s)
- Valerian Bourinet
- Department of Thoracic Oncology, Pleural Diseases, and Interventional Pulmonology, North Hospital of Marseille, Aix-Marseille University, Marseille, France
| | - Thibaut Raguin
- Department of Otorhinolaryngology and Head and Neck Surgery, University Hospital of Strasbourg, Strasbourg, France
| | - Marc Fortin
- Department of Thoracic Oncology, Pleural Diseases, and Interventional Pulmonology, North Hospital of Marseille, Aix-Marseille University, Marseille, France
| | - Elsa Chetrit
- Department of Radiology, North Hospital of Marseille, Aix-Marseille University, Marseille, France
| | - Julien Guinde
- Department of Thoracic Oncology, Pleural Diseases, and Interventional Pulmonology, North Hospital of Marseille, Aix-Marseille University, Marseille, France
| | - Sophie Laroumagne
- Department of Thoracic Oncology, Pleural Diseases, and Interventional Pulmonology, North Hospital of Marseille, Aix-Marseille University, Marseille, France
| | - Nicolas Fakhry
- Department of Otorhinolaryngology and Head and Neck Surgery, University Hospital of Marseille, Marseille, France.,Aix-Marseille University, Marseille, France
| | - Philippe Astoul
- Department of Thoracic Oncology, Pleural Diseases, and Interventional Pulmonology, North Hospital of Marseille, Aix-Marseille University, Marseille, France.,Aix-Marseille University, Marseille, France
| | - Christian Debry
- Department of Otorhinolaryngology and Head and Neck Surgery, University Hospital of Strasbourg, Strasbourg, France
| | - Hervé Dutau
- Department of Thoracic Oncology, Pleural Diseases, and Interventional Pulmonology, North Hospital of Marseille, Aix-Marseille University, Marseille, France
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Bitar MA, Al Barazi R, Barakeh R. Airway reconstruction: review of an approach to the advanced-stage laryngotracheal stenosis. Braz J Otorhinolaryngol 2017; 83:299-312. [PMID: 27184508 PMCID: PMC9444725 DOI: 10.1016/j.bjorl.2016.03.012] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2015] [Revised: 03/06/2016] [Accepted: 03/31/2016] [Indexed: 11/30/2022] Open
Abstract
Introduction The management of laryngotracheal stenosis is complex and is influenced by multiple factors that can affect the ultimate outcome. Advanced lesions represent a special challenge to the treating surgeon to find the best remedying technique. Objective To review the efficacy of our surgical reconstructive approach in managing advanced-stage laryngotracheal stenosis treated at a tertiary medical center. Methods A retrospective review of all patients that underwent open laryngotracheal repair/reconstruction by the senior author between 2002 and 2014. Patients with mild/moderate stenosis (e.g. stage 1 or 2), or those who had an open reconstructive procedure prior to referral, were excluded. Patients who had only endoscopic treatment (e.g. laser, balloon dilatation) and were not subjected to an open reconstructive procedure at our institution, were not included in this study. Variables studied included patient demographics, clinical presentation, etiology of the laryngotracheal pathology, the location of stenosis, the stage of stenosis, the type of corrective or reconstructive procedure performed with the type of graft used (where applicable), the type and duration of stent used, the post-reconstruction complications, and the duration of follow-up. Outcome measures included decannulation rate, total number of reconstructive surgeries needed to achieve decannulation, and the number of post-operative endoscopies needed to reach a safe patent airway. Results Twenty five patients were included, aged 0.5 months to 45 years (mean 13.5 years, median 15 years) with 16 males and 9 females. Seventeen patients (68%) were younger than 18 years. Most patients presented with stridor, failure of decannulation, or respiratory distress. Majority had acquired etiology for their stenosis with only 24% having a congenital pathology. Thirty-two reconstructive procedures were performed resulting in decannulating 24 patients (96%), with 15/17 (88%) pediatric patients and 5/8 (62.5%) adult patients requiring only a single reconstructive procedure. Cartilage grafts were mostly used in children (84% vs. 38%) and stents were mostly silicone made, followed by endotracheal tubes. The number of endoscopies required ranged from 1 to 7 (mean 3). More co-morbidities existed in young children, resulting in failure to decannulate one patient. Adult patients had more complex pathologies requiring multiple procedures to achieve decannulation, with grafting less efficacious than in younger patients. The pediatric patients had double the incidence of granulation tissue compared to adults. The decannulated patients remained asymptomatic at a mean follow-up of 50.5 months. Conclusion The review of our approach to open airway repair/reconstruction showed its efficacy in advanced-stage laryngotracheal stenosis. Good knowledge of a variety of reconstructive techniques is important to achieve good results in a variety of age groups.
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Affiliation(s)
- Mohamad Ahmad Bitar
- American University of Beirut, Faculty of Medicine and Medical Center, Department of Otolaryngology and Head & Neck Surgery, Beirut, Lebanon; American University of Beirut, Faculty of Medicine and Medical Center, Department of Pediatrics and Adolescent Medicine, Beirut, Lebanon; University of Sydney, Sydney Medical School, The Children's Hospital at Westmead, Department of ENT Surgery, Sydney, Australia; Al Jalila Children's Specialty Hospital, Department of Otolaryngology Head & Neck Surgery, Dubai, UAE.
| | - Randa Al Barazi
- American University of Beirut, Faculty of Medicine and Medical Center, Department of Otolaryngology and Head & Neck Surgery, Beirut, Lebanon
| | - Rana Barakeh
- American University of Beirut, Faculty of Medicine and Medical Center, Department of Otolaryngology and Head & Neck Surgery, Beirut, Lebanon
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Yadav N, Ahmad SR, Kumar N, Mishra B. Airway Management of a Post Tracheostomy Stenosis Patient With Respiratory Difficulty: Make Sure You Have Fibre Optic Guidance Before Administering a Muscle Relaxant! Trauma Mon 2017; 21:e20927. [PMID: 28180115 PMCID: PMC5282931 DOI: 10.5812/traumamon.20927] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2014] [Revised: 10/07/2014] [Accepted: 12/08/2014] [Indexed: 12/03/2022] Open
Affiliation(s)
- Naveen Yadav
- Department of Anaesthesiology, JPN Apex Trauma Centre, AIIMS, New Delhi, India
- Corresponding author: Naveen Yadav, Department of Anaesthesiology, JPN apex Trauma Centre, AIIMS, New Delhi, Raj Nagar New Delhi, India. Tel: +91-1126731230, E-mail:
| | - Suma Rabab Ahmad
- Department of Anaesthesiology, JPN Apex Trauma Centre, AIIMS, New Delhi, India
| | - Niraj Kumar
- Department of Anaesthesiology, JPN Apex Trauma Centre, AIIMS, New Delhi, India
| | - Biplab Mishra
- Department of Anaesthesiology, JPN Apex Trauma Centre, AIIMS, New Delhi, India
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Al-Qadi MO, Maldonado F. Focal tracheal stenosis due to intramural hematoma following endobronchial ultrasound-guided transbronchial needle aspiration. J Bronchology Interv Pulmonol 2014; 21:274-6. [PMID: 24992139 DOI: 10.1097/LBR.0000000000000078] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Tracheal obstruction can present insidiously or be acute and life threatening. This condition can occur acutely, as in cases of infection or foreign body aspiration, whereas posttraumatic tracheal stenosis or obstruction due to intraluminal tumor growth typically evolves more gradually. Tracheal stenosis secondary to intramural hematoma is exceedingly rare. We report a case of intramural tracheal hematoma causing obstruction following endobronchial ultrasound-guided transbronchial needle aspiration in a 69-year-old woman.
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Plojoux J, Laroumagne S, Vandemoortele T, Astoul PJ, Thomas PA, Dutau H. Management of Benign Dynamic “A-Shape” Tracheal Stenosis: A Retrospective Study of 60 Patients. Ann Thorac Surg 2015; 99:447-53. [DOI: 10.1016/j.athoracsur.2014.08.037] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2014] [Revised: 08/19/2014] [Accepted: 08/25/2014] [Indexed: 10/24/2022]
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Gelbard A, Francis DO, Sandulache VC, Simmons JC, Donovan DT, Ongkasuwan J. Causes and consequences of adult laryngotracheal stenosis. Laryngoscope 2014; 125:1137-43. [PMID: 25290987 DOI: 10.1002/lary.24956] [Citation(s) in RCA: 190] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2014] [Revised: 08/06/2014] [Accepted: 09/08/2014] [Indexed: 12/26/2022]
Abstract
OBJECTIVES/HYPOTHESIS Laryngotracheal stenosis (LTS) is largely considered a structural entity, defined on anatomic terms (i.e., percent stenosis, distance from vocal folds, overall length). This has significant implications for identifying at-risk populations, devising systems-based preventive strategies, and promoting patient-centered treatment. The present study was undertaken to test the hypothesis that LTS is heterogeneous with regard to etiology, natural history, and clinical outcome. STUDY DESIGN Retrospective cohort study of consecutive adult tracheal stenosis patients from 1998 to 2013. METHODS Subjects diagnosed with laryngotracheal stenosis (ICD-9: 478.74, 519.19) between January 1, 1998, and January 1, 2013, were identified. Patient characteristics (age, gender, race, follow-up duration) and comorbidities were extracted. Records were reviewed for etiology of stenosis, treatment approach, and surgical dates. Stenosis morphology was derived from intraoperative measurements. The presence of tracheostomy at last follow-up was recorded. RESULTS One hundred and fifty patients met inclusion criteria. A total of 54.7% had an iatrogenic etiology, followed by idiopathic (18.5%), autoimmune (18.5%), and traumatic (8%). Tracheostomy dependence differed based on etiology (P < 0.001). Significantly more patients with iatrogenic (66%) and autoimmune (54%) etiologies remained tracheostomy-dependent compared to traumatic (33%) or idiopathic (0%) groups. On multivariate regression analysis, each additional point on Charlson Comorbidity Index was associated with a 67% increased odds of tracheostomy dependence (odds ratio 1.67; 95% confidence interval 1.04-2.69; P = 0.04). CONCLUSIONS Laryngotracheal stenosis is not a homogeneous clinical entity. It has multiple distinct etiologies that demonstrate disparate rates of long-term tracheostomy dependence. Understanding the mechanism of injury and contribution of comorbid illnesses is critical to systems-based preventive strategies and patient-centered treatment. LEVEL OF EVIDENCE 4.
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Affiliation(s)
- Alexander Gelbard
- Department of Otolaryngology, Vanderbilt School of Medicine, Nashville, Tennessee
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Bacon JL, Patterson CM, Madden BP. Indications and interventional options for non-resectable tracheal stenosis. J Thorac Dis 2014; 6:258-70. [PMID: 24624290 DOI: 10.3978/j.issn.2072-1439.2013.11.08] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2013] [Accepted: 11/20/2013] [Indexed: 12/12/2022]
Abstract
Non-specific presentation and normal examination findings in early disease often result in tracheal obstruction being overlooked as a diagnosis until patients present acutely. Once diagnosed, surgical options should be considered, but often patient co-morbidity necessitates other interventional options. Non-resectable tracheal stenosis can be successfully managed by interventional bronchoscopy, with therapeutic options including airway dilatation, local tissue destruction and airway stenting. There are common aspects to the management of tracheal obstruction, tracheomalacia and tracheal fistulae. This paper reviews the pathogenesis, presentation, investigation and management of tracheal disease, with a focus on tracheal obstruction and the role of endotracheal intervention in management.
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Al-Qadi MO, Artenstein AW, Braman SS. The "forgotten zone": acquired disorders of the trachea in adults. Respir Med 2013; 107:1301-13. [PMID: 23669413 DOI: 10.1016/j.rmed.2013.03.017] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2012] [Revised: 03/14/2013] [Accepted: 03/26/2013] [Indexed: 12/22/2022]
Abstract
The upper airway is generally defined as the air passage segment that extends between the naso- or oropharynx and the carina. The longest segment of the upper airway—the trachea—begins at the inferior portion of the larynx and extends to the branch point of the main carina. The trachea has the potential to be a “forgotten zone” in differential diagnoses, as pathological processes involving this portion may not receive prominent clinical consideration in disorders presenting with respiratory symptoms and signs. Unlike the oropharynx, this anatomical area is beyond visualization on routine inspection; unlike the mediastinum and lung fields, it is a potential “blind spot” on initial, plain radiographic examination of the chest. Nonetheless, the adult trachea is affected by a number of primary disorders and is also a target organ of a variety of systemic diseases. This review will focus on both primary and systemic diseases involving the adult trachea with specific attention to their clinical manifestations and diagnostic hallmarks.
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Svider PF, Pashkova AA, Husain Q, Mauro AC, Eloy JD, Baredes S, Eloy JA. Determination of Legal Responsibility in Iatrogenic Tracheal and Laryngeal Stenosis. Laryngoscope 2013; 123:1754-8. [DOI: 10.1002/lary.23997] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2012] [Revised: 10/16/2012] [Accepted: 12/24/2012] [Indexed: 11/05/2022]
Affiliation(s)
| | - Anna A. Pashkova
- University of Medicine and Dentistry of New Jersey; Robert Wood Johnson Medical School; New Brunswick; New Jersey; U.S.A
| | - Qasim Husain
- Department of Otolaryngology-Head and Neck Surgery; University of Medicine and Dentistry of New Jersey; New Jersey Medical School; Newark; New Jersey; U.S.A
| | - Andrew C. Mauro
- University of Michigan Law School; Ann Arbor; Michigan; U.S.A
| | - Jean Daniel Eloy
- Department of Anesthesiology; University of Medicine and Dentistry of New Jersey; New Jersey Medical School; Newark; New Jersey; U.S.A
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Kim JE, Jung SH, Ma DS. Experiences of tracheal procedure assisted by extracorporeal membrane oxygenator. Korean J Thorac Cardiovasc Surg 2013; 46:80-3. [PMID: 23423782 PMCID: PMC3573172 DOI: 10.5090/kjtcs.2013.46.1.80] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/22/2012] [Revised: 09/26/2012] [Accepted: 10/08/2012] [Indexed: 11/21/2022]
Abstract
We report on the application of a venovenous type extracorporeal membrane oxygenator (ECMO) in high-risk tracheal procedures in six cases consisting of five patients with tracheal stenosis. An ECMO should be helpful for preventing respiratory emergency during a tracheal procedure.
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Affiliation(s)
- Ji Eon Kim
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Korea
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Mota LAA, de Cavalho GB, Brito VA. Laryngeal complications by orotracheal intubation: Literature review. Int Arch Otorhinolaryngol 2012; 16:236-45. [PMID: 25991942 PMCID: PMC4399631 DOI: 10.7162/s1809-97772012000200014] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2010] [Accepted: 09/01/2010] [Indexed: 01/16/2023] Open
Abstract
INTRODUCTION The injuries caused for the orotracheal intubation are common in our way and widely told by literature. Generally the pipe rank of or consequence of its permanence in the aerial ways of the patient is caused by accidents in. It has diverse types of larynx injuries, caused for multiple mechanisms. OBJECTIVE To verify, in literature, the main causes of laryngeal complications after- orotracheal intubation and its mechanisms of injury. Revision of Literature: The searched databases had been LILACS, BIREME and SCIELO. Were updated, books and theses had been used, delimiting itself the period enters 1953 the 2009. The keywords used for the search of articles had been: complications, injuries, larynx, intubation, endotracheal, orotracheal, granulomas, stenosis. 59 references had been selected. The used criteria of inclusion for the choice of articles had been the ones that had shown to the diverse types of injuries caused for the orotracheal intubation and its pathophysiology. FINAL CONSIDERATIONS This revision of literature was motivated by the comment in the practical clinic of a great number of laryngeal sequels in patients submitted to the orotracheal intubation. Of that is ahead important the knowledge, for the professionals of the area of health, the types of complications and its causes, with intention to prevent them, adopting measured of prevention of these injuries.
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Affiliation(s)
- Luiz Alberto Alves Mota
- Master in Surgery for the Federal University of Pernambuco. Professor Assistant of Otolaryngology of the College of Medical Sciences of the University of Pernambuco.
| | - Glauber Barbosa de Cavalho
- Graduating of Medicine of the College of Medical Sciences of the University of Pernambuco. Graduating of Medicine of the College of Medical Sciences of the University of Pernambuco.
| | - Valeska Almeida Brito
- Graduating of Medicine of the College of Medical Sciences of the University of Pernambuco. Graduating of Medicine of the College of Medical Sciences of the University of Pernambuco.
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Bush CM, Prosser JD, Morrison MP, Sandhu G, Wenger KH, Pashley DH, Birchall MA, Postma GN, Weinberger PM. New technology applications: Knotless barbed suture for tracheal resection anastomosis. Laryngoscope 2012; 122:1062-6. [PMID: 22473356 DOI: 10.1002/lary.23229] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2011] [Revised: 12/31/2011] [Accepted: 01/09/2012] [Indexed: 12/19/2022]
Abstract
OBJECTIVES/HYPOTHESIS Tracheal resection anastomoses are often under tension and can be technically challenging. New suture materials such as V-loc (barbed, knotless wound closure device) may offer advantages over conventional methods. The objective of this study is to determine if a running V-loc suture is of comparable tensile strength to conventional closure. STUDY DESIGN Laboratory based study of human cadaveric tissue. METHODS Fresh human cadaveric tracheas were dissected and incised into segments. Anastomosis of adjacent segments was then performed with either submucosal interrupted 3-0 Vicryl, or a running submucosal 3-0 V-loc suture. Anastomosed specimens were stretched to failure on an Instron force tension machine. Surgeon satisfaction was recorded by visual analog scale (VAS). RESULTS The tensile strength of 12 tracheal anastomoses was tested. Video documentation of V-loc suture technique and anastomosis failure was recorded. In both Vicryl (80%) and V-loc (100%) anastomoses, failure occurred at the membranous intercartilaginous region. In 20% of the Vicryl anastomoses, the suture was noted to break prior to tissue failure. Anastomoses with V-loc suture had equivalent failure force (mean, 59 N) compared to interrupted Vicryl (51 N), with P = .57. On VAS, surgeons were more satisfied with V-loc suture closure compared to interrupted Vicryl closure (paired t test, P = .003). CONCLUSIONS Tracheal anastomosis with running v-loc suture is a feasible alternative to conventional closure with interrupted Vicryl suture. V-loc suture provided a surgical advantage by improved ease of use.
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Affiliation(s)
- Carrie M Bush
- Department of Otolaryngology and Center for Voice, Airway, and Swallowing Disorders, Georgia Health Sciences University, Augusta, Georgia, USA
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Lee JE, Chang MY, Kim KH, Jung YH. Post-intubation tracheoesophageal fistula with posterior glottic web. Clin Exp Otorhinolaryngol 2011; 4:105-8. [PMID: 21716949 DOI: 10.3342/ceo.2011.4.2.105] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2009] [Accepted: 07/31/2009] [Indexed: 11/13/2022] Open
Abstract
Tracheoesophageal fistula (TEF) after prolonged intubation could present as chronic aspiration and could be mistaken as unilateral or bilateral vocal fold palsy, especially when there was combined posterior glottic synechia. We present a case of post-intubation TEF which was successfully treated with tracheal resection and anastomosis with primary esophageal closure. The accompanying posterior glottic web was treated by endoscopic technique of web lysis, with topical application of mitomycin C solution.
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Nandakumar R, Jagdish C, Prathibha CB, Shilpa C, Sreenivas V, Balasubramanya AM, Nayar RC. Tracheal resection with end-to-end anastomosis for post-intubation cervical tracheal stenosis: study of 14 cases. J Laryngol Otol 2011; 125:958-61. [PMID: 21729445 DOI: 10.1017/S002221511100137X] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND AND OBJECTIVES The incidence of acquired laryngeal stenosis is increasing. This retrospective study aimed to assess the long term results of circumferential resection with end-to-end tracheal anastomosis for isolated post-intubation stenosis of the cervical trachea, and to review the relevant literature. METHODS Twelve male and two female patients (aged 16-30 years, mean age 24 years) treated between February 2003 and December 2008 were included. Hospital and office records were reviewed and relevant surgical details recorded. RESULTS Indications for tracheal resection anastomosis were post-intubation stenosis (78.57 per cent) and trauma (21.42 per cent). One to five tracheal rings were resected (i.e. 1-2.5 cm of cervical trachea). Tracheal anastomosis was considered successful if the patient remained asymptomatic for 24 months of close follow up (involving regular flexible bronchoscopy and neck X-ray). The anastomotic success rate was 92.85 per cent. CONCLUSION Tracheal resection and end-to-end anastomosis is relatively safe and reliable for definitive treatment of benign tracheal stenosis in appropriate patients. Local application of mitomycin C prevents granulation and aids long term airway patency.
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Murgu SD, Colt HG. Interventional bronchoscopy from bench to bedside: new techniques for central and peripheral airway obstruction. Clin Chest Med 2010; 31:101-15, Table of Contents. [PMID: 20172436 DOI: 10.1016/j.ccm.2009.09.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
This article discusses how basic scientific concepts, based on a greater understanding of airway physiology, support the development and dissemination of multidimensional classification systems for tracheal stenosis, expiratory central airway collapse, and innovative interventional bronchoscopic procedures for patients with asthma and chronic obstructive pulmonary disease.
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Ferreira S, Nogueira C, Oliveira A, Neves S, Almeida J, Moura e Sá J. [Bronchoscopic dilation techniques and topical application of mitomycin-C in the treatment of tracheal stenosis post intubation - two case reports]. Rev Port Pneumol 2010; 16:149-56. [PMID: 20054514 DOI: 10.1016/s0873-2159(15)30012-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Tracheal stenosis follows any injury to the airway mucosa, such as ischaemic, traumatic and other injuries. The treatment of tracheal stenosis remains a challenging problem despite all the advances in endoscopic and surgical techniques. Scar formation and reestenosis are the main causes of treatment failure. The authors present two cases of successful treatment of a tracheal stenosis after tracheal injury from prolonged oro -tracheal intubation / tracheostomy following dilatation with rigid broncoscope and laser therapy, associated with topical application of mitomycin C as an adjuvant treatment.
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Wong JL, Tie ST, Samril B, Lum CL, Rahman MRA, Rahman JAA. Successful treatment of tracheal stenosis by rigid bronchoscopy and topical mitomycin C: a case report. Cases J 2010; 3:2. [PMID: 20150982 PMCID: PMC2820441 DOI: 10.1186/1757-1626-3-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/19/2009] [Accepted: 01/04/2010] [Indexed: 11/10/2022]
Abstract
Tracheal stenosis is a known complication of prolonged intubation. It is difficult to treat and traditional surgical approach is associated with significant risk and complications. Recurrent stenosis due to granulation tissue necessitates repeated procedures. We describe a case of short web-like tracheal stenosis (concentric membranous stenosis less than 1 cm in length without associated cartilage damage) managed by a minimally invasive thoracic endoscopic approach. Topical application of Mitomycin C, a potent fibroblast inhibitor reduces granulation tissue formation and prevents recurrence.
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Affiliation(s)
- Jyi Lin Wong
- Department of Respiratory Medicine, Queen Elizabeth Hospital, Kota Kinabalu, Sabah, Malaysia
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Zias N, Chroneou A, Tabba MK, Gonzalez AV, Gray AW, Lamb CR, Riker DR, Beamis JF. Post tracheostomy and post intubation tracheal stenosis: report of 31 cases and review of the literature. BMC Pulm Med 2008; 8:18. [PMID: 18803874 PMCID: PMC2556644 DOI: 10.1186/1471-2466-8-18] [Citation(s) in RCA: 128] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2008] [Accepted: 09/21/2008] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Severe post tracheostomy (PT) and post intubation (PI) tracheal stenosis is an uncommon clinical entity that often requires interventional bronchoscopy before surgery is considered. We present our experience with severe PI and PT stenosis in regards to patient characteristics, possible risk factors, and therapy. METHODS We conducted a retrospective chart review of 31 patients with PI and PT stenosis treated at Lahey Clinic over the past 8 years. Demographic characteristics, body mass index, co-morbidities, stenosis type and site, procedures performed and local treatments applied were recorded. RESULTS The most common profile of a patient with tracheal stenosis in our series was a female (75%), obese (66%) patient with a history of diabetes mellitus (35.4%), hypertension (51.6%), and cardiovascular disease (45.1%), who was a current smoker (38.7%). Eleven patients (PI group) had only oro-tracheal intubation (5.2 days of intubation) and developed web-like stenosis at the cuff site. Twenty patients (PT group) had undergone tracheostomy (54.5 days of intubation) and in 17 (85%) of them the stenosis appeared around the tracheal stoma. There was an average of 2.4 procedures performed per patient. Rigid bronchoscopy with Nd:YAG laser and dilatation (mechanical or balloon) were the preferred methods used. Only 1(3.2%) patient was sent to surgery for re-stenosis after multiple interventional bronchoscopy treatments. CONCLUSION We have identified putative risk factors for the development of PI and PT stenosis. Differences in lesions characteristics and stenosis site were noted in our two patient groups. All patients underwent interventional bronchoscopy procedures as the first-line, and frequently the only treatment approach.
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Affiliation(s)
- Nikolaos Zias
- Department of Pulmonary and Critical Care Medicine, Lahey Clinic Medical Center, Tufts University School of Medicine, Burlington, Massachusetts, USA.
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Abstract
BACKGROUND Segmental tracheal resection is considered to be the standard treatment of tracheal stenoses. MATERIALS/METHODS During the time period 1985-2002, segmental tracheal resection with a primary end-to-end anastomosis was performed in 117 patients with a cervical or upper thoracal stenosis of the trachea. The age distribution of the patients was between 7 and 77 years. Of the patients with a benign tracheal stenosis, sufficient data for a retrospective analysis were available in 101 patients. The length of the resected tracheal segments varied between 2 and 6 cm which required mobilisation of the trachea and the larynx and, if necessary, incision of the pulmonary ligament. RESULTS In 5 patients a permanent damage of the recurrent laryngeal nerve was seen, of which 4 had undergone revision surgery and 10 months after surgery 93% presented with a large and stable tracheal lumen without any relevant restenosis. Due to a restenosis of 70-80% causing dyspnea at rest, 3% of the 101 patients had to undergo revision surgery. In 4% a mild and asymptomatic restenosis of 30-40% was seen which did not require any further treatment. CONCLUSION These results demonstrate that segmental tracheal resection can safely and effectively remove stenotic tracheal segments of up to 6 cm and is therefore the treatment of choice.
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Affiliation(s)
- M Weidenbecher
- Klinik mit Poliklinik für Hals-Nasen-Ohrenheilkunde, Kopf- und Halschirurgie, Universität, 91054, Erlangen
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Abstract
To review our experience with tracheal resection with end-to-end anastomosis for tracheal stenosis, we performed a retrospective review at a tertiary-care academic medical center. Twenty-eight patients underwent circumferential tracheal resection with end-to-end anastomosis by 2 attending otolaryngologists from 1989 to 2002. Patients were excluded if they were under 12 years of age or if the surgical indication was tracheal or thyroid neoplasm. The indications for tracheal resection were postintubation stenosis (n = 9; 32%), posttracheotomy stenosis (n = 7; 25%), both postintubation and posttracheotomy stenosis (n = 9; 32%), external tracheal trauma (n = 2; 7%), and presence of a foreign body (n = 1; 4%). Two to 8 rings were resected. The follow-up periods ranged from 18 months to 13.5 years. The anastomotic success rate was 89% (n = 25). No patients died as a result of the procedure. We conclude that tracheal resection with end-to-end anastomosis is a relatively safe and reliable procedure for the treatment of tracheal stenosis in appropriately selected patients.
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Affiliation(s)
- Rhoda Wynn
- Department of Otolaryngology, State University of New York Downstate Medical Center at Brooklyn, Brooklyn, New York, USA
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Cuisnier O, Righini C, Pison C, Ferretti G, Reyt E. Prise en charge chirurgicale et/ou endoscopique des sténoses trachéales acquises non tumorales de l’adulte. ACTA ACUST UNITED AC 2004; 121:3-13. [PMID: 15041829 DOI: 10.1016/s0003-438x(04)95485-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVES Retrospective survey (over 13 Years) of the surgical treatment of 46 acquired tracheal stenosis, in adult patients. Our goals were to study their epidemiology, changes in the surgical technique with the cervical or endoscopic approach, and the recent contribution of endoprotheses. MATERIALS AND METHODS Sixty-six therapeutic procedures were performed for 46 tracheal stenoses. Most of stenoses were post-intubation and/or post-tracheotomy and were fixed in 50% of the cases. We used 21 sleeve resections with end-to-end anastomoses, 9 tracheal stents, 27 dilations, 6 calibrations, and 3 electro-coagulations. RESULTS The sleeve resection gave 91% success (1 failure and 1 death). The endoscopic treatments were less efficient: 79% for tracheal stents (2 mobilizations), 50% success for iterative dilations. The respiratory tests were meaningfully improved with a mean follow-up of 18 Months. CONCLUSION Sleeve resection remains the gold standard treatment. For all temporary or definitive contraindications to open surgery, tracheal stents would be an excellent alternative to avoid often inefficient iterative dilations.
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Affiliation(s)
- O Cuisnier
- Clinique ORL, Service ORL du Pr Reyt, CHU Michallon, 38043 Grenoble Cedex 09.
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Abstract
OBJECTIVE The aim of the present study was to evaluate the results of surgical treatment in patients with simultaneous occurrence of postintubation tracheal stenosis (TS) and tracheoesophageal fistula (TEF). METHODS In the group of 51 patients with postcannulation tracheal stenosis who underwent segmental resection, TEF was identified simultaneously in five (10%) of them. The mean age of the TS-TEF patients was 43 years (range 35-60 years). The patients underwent a single-stage operation during which TEF was sealed and resection of the stenotic tracheal segment was performed. RESULTS The cause of TEF and of TS was artificial pulmonary ventilation by tracheostomy tube (n=4) or by endotracheal tube (n=1) with a simultaneous insertion of nasogastric tube. In one of the patients with tracheostomy the fistula resulted from an injury to the pars membranacea tracheae and the esophageal wall during tracheostomy. All the patients were respiring spontaneously before the surgical treatment. The mean length of the fistula was 24.0 mm (range 15-30 mm), the fistulae were located at the junction of the upper and middle third of the trachea. The mean length of the resected tracheal segment was 29.6 mm (range 26-32 mm). Postoperative complications were not observed in the group of the TS-TEF patients, none of them died. CONCLUSIONS The method of choice of the surgical treatment of TEF associated with TS is a single-stage procedure in the patient who respires spontaneously.
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Affiliation(s)
- P Fiala
- Clinic of Pneumology and Thoracic Surgery, 3rd Medical Faculty of the Charles University, University Hospital Bulovka, Budínova 2, 180 81 Prague 8, Czech Republic.
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Abstract
Introdução: Várias complicações, muitas vezes graves, têm sido relacionadas com a intubação traqueal (IT), com incidência chegando a 18%. Objetivos: Analisar as alterações da laringe provocadas pela IT: o desenvolvimento de estenose e de granuloma na laringe e a evolução da voz. Pacientes e métodos: Foram estudados prospectivamente 73 pacientes internados na Unidade de Terapia Intensiva do Hospital Cajuru, da Pontifícia Universidade Católica do Paraná, na região Sul do Brasil, submetidos a IT por cinco dias consecutivos e com previsão de necessidade de IT por mais sete dias, que foram traqueostomizados no sexto dia de IT. Foi realizada fibrolaringotraqueobroncoscopia (FLTB) nos 6º, 14º, 21º, 28º, 60º, 90º e no 180º dias após a IT. Resultados: No 180º dia do estudo havia 30 pacientes sobreviventes: 18 apresentavam voz normal, nove não puderam ser avaliados e três apresentavam disfonia. Em oito pacientes foram observados granulomas na laringe, sendo que cinco foram curados espontaneamente, dois foram ressecados e um permaneceu no 180º dia do estudo. Apenas um paciente apresentou estenose de laringe. Conclusões: Devido ao menor tempo de exposição da laringe ao trauma da cânula orotraqueal, a realização da traqueostomia no 6º dia da IT parece causar poucas complicações.
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Abstract
Management of laryngotracheal stenosis (LTS) remains one of the most challenging problems facing the otolaryngologist. The key to success is to obtain adequate rigid circular support with normal mucosal lining. Sixty patients with LTS were surgically treated in our institution over a 20-year period. Most patients were adults; the mean age was 29 years. There were 39 males and 21 females. The most frequent cause of stenosis was intubation, in 25 patients, and tracheostomy was the cause in 21. Forty-two patients (70%) were successfully decannulated following 117 procedures in this series. An average of 1.95 procedures per patient was performed. The median time between treatment and decannulation was 561 days. These results confirm the complexity of the management of LTS. Decannulation is not always possible, and to achieve this goal, more than one treatment is frequently required. It is better to prevent LTS rather than to treat it once it has occurred.
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Affiliation(s)
- J Gavilán
- Department of Otorhinolaryngology, La Paz Hospital, Autonomous University, Madrid, Spain
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Affiliation(s)
- O Laccourreye
- Department of Otorhinolaryngology-Head and Neck Surgery, Laënnec Hospital, University Paris V, France
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Laccourreye O, Naudo P, Brasnu D, Jouffre V, Cauchois R, Laccourreye H. Tracheal resection with end-to-end anastomosis for isolated postintubation cervical trachea stenosis: long-term results. Ann Otol Rhinol Laryngol 1996; 105:944-8. [PMID: 8973280 DOI: 10.1177/000348949610501203] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
A 20-year experience with end-to-end tracheal resection and anastomosis for isolated postintubation stenosis of the cervical trachea, in a consecutive series of 32 adult patients, has been reviewed. Surgical death was never encountered. The overall incidences for superficial wound infection, pneumonia, and inferior left laryngeal nerve paralysis were 6.2%, 3.1%, and 3.1%, respectively. One-, 3- and 5-year actuarial anastomosis success rates were 96.7%, 93.3%, and 93.3%, respectively. Successful revision tracheal end-to-end anastomosis was performed once, resulting in an overall 96.9% success rate in our series. None of the following variables-sex, age, cause for intubation, intubation type (laryngotracheal and/or tracheotomy) and duration, delay from initial injury, presence of an open stoma, number of tracheal rings resected, and type of sutures used-were statistically related to the anastomosis success rate or the incidence of complications.
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Affiliation(s)
- O Laccourreye
- Department of Otorhinolaryngology-head and Neck Surgery, Laënnec Hospital, University Paris V, France
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Martinez-Ballarin JI, Diaz-Jimenez JP, Castro MJ, Moya JA. Silicone stents in the management of benign tracheobronchial stenoses. Tolerance and early results in 63 patients. Chest 1996; 109:626-9. [PMID: 8617068 DOI: 10.1378/chest.109.3.626] [Citation(s) in RCA: 175] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
STUDY OBJECTIVE To assess tolerance and early results of Dumon silicone stents inserted in patients with nonneoplastic airway obstruction. DESIGN Tracheobronchial stenting for palliative or curative restoration of airway narrowing has been evaluated in a retrospective study. SETTING Tertiary-referral teaching hospital. PATIENTS Between May 1991 and September 1994, 64 patients with a mean age of 52 years had endobronchial silicone stent insertion for benign tracheal stenosis (82% secondary to intubation or tracheostomy injury). Lesions were pure fibrous stenosis in 25 patients and fibroinflammatory stenosis in 38. Prostheses were used for temporary stenting of the airway during 18 months in 48 patients in whom cure was expected and as a procedure for palliation in the remaining 15 patients. INTERVENTIONS In all cases, the Dumon tracheobronchial stent was implanted with the rigid bronchoscope under general anesthesia. RESULTS Five patients died (four from unrelated causes); one was due to hypersecretion and airway obstruction at the time of an emergency tracheostomy 20 days after stent insertion. Complications included migration of prostheses in 11 (17.5%) patients, granuloma formation in 4 (6.3%) patients, and airway obstruction due to heavy secretion in 4 (6.3%). In 48 patients who received silicone stents with curative expectations, removal of the device was accomplished in 21 patients. Therapy proved successful in 17 patients with a mean follow-up of 259+/- 173 days and stenosis recurred in 4. In 16 patients, stents still remain for a mean period of 364+/-119 days. In the series of 15 patients in whom silicon stents were implanted for palliation, prostheses were placed permanently in 11 with a mean follow-up of 486+/-260 days. In the remaining four patients with tracheostomy, silicone stents were used after inability to expand the upper limb of the T-tube (two patients) or placed above the tracheostomy stoma to maintain laryngotracheal patency and preserve phonation when a T-tube was poorly tolerated (two patients). CONCLUSIONS Silicone tracheobronchial stents are effective in the maintenance of airway patency and are associated with good tolerance and infrequent complications that are rarely life-threatening.
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Affiliation(s)
- J I Martinez-Ballarin
- Unidad de Laser, Servicio de Neumologia, Ciutat Sanitaria i Universitaria de Bellvitge, Barcelona, Spain
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39
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Abstract
One case of isolated type IV posterior glottic stenosis successfully treated with CO2 laser posterior transverse cordotomy is presented. This report emphasized the value of the CO2 laser posterior transverse cordotomy in this situation. A review of the various therapeutic options advocated in the medical literature to treat isolated posterior glottic stenosis is also presented.
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Affiliation(s)
- H Gaboriau
- Department of Otolaryngology, Head and Neck Surgery, Hospital Laënnec, University Paris V, France
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Abstract
We present our experience with circumferential tracheal resection with end-to-end anastomosis. Between 1985 and 1992 we performed this procedure on 19 patients with tracheal stenosis. The cause of the stenosis was related to intubation and/or tracheotomy in 78.9% of the patients. Two to 8 tracheal rings were resected and a tension-free anastomosis was achieved with mobilization techniques that were limited to suprahyoid release, peritracheal dissection, and chin-to-chest suture. Infrahyoid release and intrathoracic perihilar mobilization techniques were not used. The anastomosis success rate was 94.7%.
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Affiliation(s)
- G Har-El
- Department of Otolaryngology, State University of New York Health Science Center at Brooklyn
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