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Ahmadian D, Wehbi N, Tseng P, Bixby B, Yip HT. Assessing the interrater and intrarater reliability of subglottic stenosis grading systems. Am J Otolaryngol 2024; 45:104323. [PMID: 38677144 DOI: 10.1016/j.amjoto.2024.104323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2024] [Revised: 04/17/2024] [Accepted: 04/17/2024] [Indexed: 04/29/2024]
Abstract
BACKGROUND Subglottic stenosis (SGS) is a condition leading to narrowing of the upper airway which can lead to dyspnea and life-threatening airway obstruction. Although other proposed grading systems exist, the Cotton Myer (CM) and percent stenosis systems are the most widespread in clinical practice. Despite this, the CM system has not yet been validated for visual assessment of SGS. OBJECTIVE To determine the interrater and intrarater reliability of the CM grading system among a cohort of physicians who manage patients with SGS. METHODS An online survey created with videos of tracheoscopies from 20 adult patients with subglotticstenosis (SGS) was sent individually to 9 expert physicians from various medical specialties, all of whom managed patients with SGS. Physicians were asked to view the 20 tracheoscopy videos and assess both the percent stenosis and Cotton Myer (CM) grade of each patient. After a period of 4 weeks, the physicians were sent the same survey of the 20 tracheoscopy videos. The interrater and intrarater reliability was calculated using the intraclass correlation coefficient (ICC), a measurement used to evaluate the reliability (the extent to which a measurement can be replicated) of two or more raters measuring the same subject. RESULTS Overall, CM and percent stenosis systems were found to have an ICC of 0.94 and 0.90 within the domain of interrater reliability, respectively, and ICC of 0.71 and 0.81 within the domain of intrarater reliability, respectively. CONCLUSION Our findings suggest that the CM and percent stenosis grading systems remain a valid clinical tool to measure and communicate the severity of airway obstruction in SGS.
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Affiliation(s)
- David Ahmadian
- University of Arizona, College of Medicine - Tucson, 1501 N Campbell Ave, Tucson, AZ 85724, United States of America.
| | - Nader Wehbi
- University of Arizona, College of Medicine - Phoenix, 475 N 5th St, Phoenix, AZ 85004, United States of America
| | - Phil Tseng
- University of Arizona, College of Medicine - Tucson, 1501 N Campbell Ave, Tucson, AZ 85724, United States of America
| | - Billie Bixby
- University of Arizona, College of Medicine - Tucson, Department of Medicine, 1501 N Campbell Ave, Tucson, AZ 85724, United States of America
| | - Helena T Yip
- University of Arizona, College of Medicine - Tucson, Department of Otolaryngology, 1501 N Campbell Ave, Tucson, AZ 85724, United States of America
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Bae SY, Lee JH, Kwon HW, Cho S, Kwon C, Kim WH, Kwak JG. Outcomes of not using tracheoplasty in asymptomatic tracheal stenosis found during open-heart surgery. INTERDISCIPLINARY CARDIOVASCULAR AND THORACIC SURGERY 2024; 38:ivae030. [PMID: 38441273 PMCID: PMC10948281 DOI: 10.1093/icvts/ivae030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Accepted: 03/02/2024] [Indexed: 03/20/2024]
Abstract
OBJECTIVES We aimed to review the outcomes of treating incidentally encountered asymptomatic airway stenosis during open-heart surgery conservatively without the use of tracheoplasty. METHODS Between January 2002 and October 2022, 25 patients were incidentally diagnosed with tracheal stenosis during open-heart surgery. Intraoperative bronchoscopy and/or laryngoscopy revealed tracheal stenosis; however, this was not consistent with the findings of the preoperative computed tomography. Patients who were diagnosed with a pulmonary artery or vascular sling or had moderate-to-severe respiratory symptoms before open-heart surgery were excluded. RESULTS The median age and weight of the patients at operation were 3.0 months and 5.1 kg, respectively. They were categorized as those having tracheal stenosis on preoperative computed tomography (n = 12) or not having tracheal stenosis (n = 13). The narrowest diameter was significantly smaller in the former group (3.0 vs 5.8 mm, P < 0.05). The rates of reintubation and the tracheostomy, and intubation days tended to be higher in former group without statistical significance. Stenotic degree improved 2 months and 1 year or more after the operation (39.3% at operation, 28.4% at 2 months, 12.5% after 1 year). All patients were Ross class 1 or 2 at follow-up (mean, 7.1 years). CONCLUSIONS Patients with tracheal stenosis showed tolerable long-term outcomes without using tracheoplasty. Accordingly, if tracheal stenosis, that would cause intubation difficulty, was incidentally revealed, concomitant tracheoplasty may not be required during open-heart surgery if the stenosis did not cause considerable symptoms or signs preoperatively.
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Affiliation(s)
- Seon Yong Bae
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul, Republic of Korea
| | - Jae Hong Lee
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul, Republic of Korea
| | - Hye Won Kwon
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul, Republic of Korea
| | - Sungkyu Cho
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul, Republic of Korea
- Department of Thoracic and Cardiovascular Surgery, College of Medicine, Seoul National University, Seoul, Republic of Korea
| | - Chiheon Kwon
- Department of Radiology, Seoul National University Hospital, Seoul, Republic of Korea
| | - Woong-Han Kim
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul, Republic of Korea
- Department of Thoracic and Cardiovascular Surgery, College of Medicine, Seoul National University, Seoul, Republic of Korea
| | - Jae Gun Kwak
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul, Republic of Korea
- Department of Thoracic and Cardiovascular Surgery, College of Medicine, Seoul National University, Seoul, Republic of Korea
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Blain OE, Patiño González CC, Romero Manteola EJ. Postintubation airway injury in the pediatric intensive care unit. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2023; 74:379-385. [PMID: 37330138 DOI: 10.1016/j.otoeng.2023.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Revised: 12/27/2022] [Accepted: 12/28/2022] [Indexed: 06/19/2023]
Abstract
INTRODUCTION AND OBJECTIVES Airway injury caused by endotracheal intubation (ETI) is a common event in children who require ETI in the pediatric intensive care unit (PICU). The main aim of our study was to determine the incidence and the predisposing factors for the development of airway injury in PICU patients who need ETI. Secondary objectives were to evaluate the reasons for the request of airway endoscopy examination and the tracheostomy rate in this population. MATERIALS AND METHODS A retrospective, observational, descriptive study was conducted evaluating 1854 patients who were intubated in the PICU of a tertiary-care center between May 2015 and April 2019. RESULTS The mean age of all intubated patients was 35.6 months and of those who required endoscopy 27.3 months (p = 0.04). Mean length of intubation was 7.2 days for all intubated patients and 23.5 days for those who required endoscopy (p = 0.0001). Extubation failure and stridor were significantly associated with the finding of airway injury (p = 0.0001 and p = 0.0006, respectively). CONCLUSIONS The incidence rate of ETI-related injury was 3%. Age younger than 27 months and intubation for more than 7 days were predisposing factors for the development of injury. The main indications for endoscopy were extubation failure and stridor, both related to the presence of injury. Tracheostomy rate in the PICU was 3.34%.
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Affiliation(s)
- Otilia E Blain
- Pediatric Surgery Department, Hospital de Niños de la Santísima Trinidad, Córdoba, Argentina.
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Fiz I, Filauro M, Sampieri C, Ioppi A, Vallin A, Fiz F, Koelmel JC, Lancini D, Piazza C, Sittel C, Peretti G. Analysis of Complications in (Crico-) Tracheal Resection Anastomosis in Adults: A Multicenter Study. Laryngoscope 2023; 133:2910-2919. [PMID: 36883671 DOI: 10.1002/lary.30635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2022] [Revised: 02/09/2023] [Accepted: 02/09/2023] [Indexed: 03/09/2023]
Abstract
OBJECTIVES The gold standard treatments for advanced laryngotracheal stenosis (LTS) are represented by partial crico-tracheal (PCTRA) or tracheal resection and anastomosis (TRA). These procedures are potentially burdened by high postoperative complication rates. We investigated the impact of the most common stenosis and patient-related characteristics on the onset of complications in a multicentric cohort. METHODS We retrospectively analyzed patients who underwent PCTRA or TRA for LTS of different etiologies in three referral centers. We tested the effectiveness of these procedures, the impact of complications on the outcomes, and identified factors causing postoperative complications. RESULTS A total of 267 patients were included in the study (130 females; mean age, 51.46 ± 17.64 years). The overall decannulation rate was 96.4%. Altogether, 102 (38.2%) patients presented at least one complication, whereas 12 (4.5%) had two or more. The only independent predictor of post-surgical complications was the presence of systemic comorbidities (p = 0.043). Patients experiencing complications needed additional surgery more frequently (70.1% vs. 29.9%, p < 0.001), and had a longer duration of hospitalization (20 ± 10.9 vs. 11.3 ± 4.1 days, p < 0.001). Six of 102 (5.9%) patients with complications had restenosis, although this event did not occur among patients without complications. CONCLUSION PCTRA and TRA have an excellent success rate even when performed for high-grade LTS. However, a significant percentage of patients may experience complications associated with a longer duration of hospitalization or the need for additional surgeries. The presence of medical comorbidities was independently related to an increased risk of complications. LEVEL OF EVIDENCE 4 Laryngoscope, 133:2910-2919, 2023.
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Affiliation(s)
- Ivana Fiz
- Department of Otorhinolaryngology, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Marta Filauro
- Unit of Otorhinolaryngology-Head and Neck Surgery, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
- Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, Genoa, Italy
| | - Claudio Sampieri
- Unit of Otorhinolaryngology-Head and Neck Surgery, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
- Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, Genoa, Italy
| | - Alessandro Ioppi
- Unit of Otorhinolaryngology-Head and Neck Surgery, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
- Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, Genoa, Italy
| | - Alberto Vallin
- Unit of Otorhinolaryngology-Head and Neck Surgery, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
- Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, Genoa, Italy
| | - Francesco Fiz
- Nuclear Medicine Department, Ente Ospedaliero "Ospedali Galliera", Genoa, Italy
- Department of Nuclear Medicine and Clinical Molecular Imaging, University Hospital, Tübingen, Germany
| | - Jan Costantin Koelmel
- Department of Otorhinolaryngology-Head and Neck Surgery, Klinikum Stuttgart, Stuttgart, Germany
| | - Davide Lancini
- Unit of Otorhinolaryngology-Head and Neck Surgery, ASST Spedali Civili of Brescia, Brescia, Italy
- Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Cesare Piazza
- Unit of Otorhinolaryngology-Head and Neck Surgery, ASST Spedali Civili of Brescia, Brescia, Italy
- Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Christian Sittel
- Department of Otorhinolaryngology-Head and Neck Surgery, Klinikum Stuttgart, Stuttgart, Germany
| | - Giorgio Peretti
- Unit of Otorhinolaryngology-Head and Neck Surgery, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
- Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, Genoa, Italy
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Ratwani AP, Chen H, Brown L, Schwartz EA, Patel K, Guttentag A, McLaren TA, Sandler KL, Rickman OB, Shojaee S, Lentz RJ, Maldonado F. Inter-rater reliability of a novel objective endpoint for benign central airway stenosis interventions: Segmentation-based volume rendering of computed tomography scans. PLoS One 2023; 18:e0290393. [PMID: 37878622 PMCID: PMC10599541 DOI: 10.1371/journal.pone.0290393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 08/08/2023] [Indexed: 10/27/2023] Open
Abstract
OBJECTIVES To evaluate the reliability of a novel segmentation-based volume rendering approach for quantification of benign central airway obstruction (BCAO). DESIGN A retrospective single-center cohort study. SETTING Data were ascertained using electronic health records at a tertiary academic medical center in the United States. PARTICIPANTS AND INCLUSION Patients with airway stenosis located within the trachea on two-dimensional (2D) computed tomography (CT) imaging and documentation of suspected benign etiology were included. Four readers with varying expertise in quantifying tracheal stenosis severity were selected to manually segment each CT using a volume rendering approach with the available free tools in the medical imaging viewing software OsiriX (Bernex, Switzerland). Three expert thoracic radiologists were recruited to quantify the same CTs using traditional subjective methods on a continuous and categorical scale. OUTCOME MEASURES The interrater reliability for continuous variables was calculated by the intraclass correlation coefficient (ICC) using a two-way mixed model with 95% confidence intervals (CI). RESULTS Thirty-eight patients met the inclusion criteria, and fifty CT scans were selected for measurement. The most common etiology of BCAO was iatrogenic in 22 patients (58%). There was an even distribution of chest and neck CT imaging within our cohort. The average ICC across all four readers for the volume rendering approach was 0.88 (95% CI, 0.84 to 0.93), suggesting good to excellent agreement. The average ICC for thoracic radiologists for subjective methods on the continuous scale was 0.38 (95% CI, 0.20 to 0.55), suggesting poor to fair agreement. The kappa for the categorical approach was 0.26, suggesting a slight to fair agreement amongst the raters. CONCLUSION In this retrospective cohort study, agreement was good to excellent for raters with varying expertise in airway cross-sectional imaging using a novel segmentation-based volume rendering approach to quantify BCAO. This proposed measurement outperformed our expert thoracic radiologists using conventional subjective grading methods.
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Affiliation(s)
- Ankush P. Ratwani
- Department of Medicine, Division of Allergy, Pulmonary and Critical Care, Vanderbilt University Medical Center, Nashville, TN, United States of America
| | - Heidi Chen
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, United States of America
| | - Leah Brown
- Department of Medicine, Division of Allergy, Pulmonary and Critical Care, Vanderbilt University Medical Center, Nashville, TN, United States of America
| | - Evan A. Schwartz
- Department of Medicine, Division of Pulmonary, Allergy and Critical Care Medicine, Duke University School of Medicine, Durham, NC, United States of America
| | - Khushbu Patel
- Department of Medicine, Division of Allergy, Pulmonary and Critical Care, Vanderbilt University Medical Center, Nashville, TN, United States of America
| | - Adam Guttentag
- Department of Radiology and Radiological Science, Vanderbilt University Medical Center, Nashville, TN, United States of America
| | - Thomas A. McLaren
- Department of Radiology and Radiological Science, Vanderbilt University Medical Center, Nashville, TN, United States of America
| | - Kim L. Sandler
- Department of Radiology and Radiological Science, Vanderbilt University Medical Center, Nashville, TN, United States of America
| | - Otis B. Rickman
- Department of Medicine, Division of Allergy, Pulmonary and Critical Care, Vanderbilt University Medical Center, Nashville, TN, United States of America
| | - Samira Shojaee
- Department of Medicine, Division of Allergy, Pulmonary and Critical Care, Vanderbilt University Medical Center, Nashville, TN, United States of America
| | - Robert J. Lentz
- Department of Medicine, Division of Allergy, Pulmonary and Critical Care, Vanderbilt University Medical Center, Nashville, TN, United States of America
| | - Fabien Maldonado
- Department of Medicine, Division of Allergy, Pulmonary and Critical Care, Vanderbilt University Medical Center, Nashville, TN, United States of America
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Li WX, Wang DD, Li X, Li WX, Han Y, Cai YR. Risk factors for difficult mask ventilation and difficult intubation among patients undergoing pharyngeal and laryngeal surgery. Heliyon 2023; 9:e14408. [PMID: 36938445 PMCID: PMC10018552 DOI: 10.1016/j.heliyon.2023.e14408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Revised: 02/20/2023] [Accepted: 03/03/2023] [Indexed: 03/08/2023] Open
Abstract
Background The prediction of difficult mask ventilation (DMV) and difficult intubation (DI) are key questions in anesthesia fields. DMV or DI related to pharyngeal and laryngeal diseases are a special kind of difficult airways. However, there is a lack of risk factors for prediction. Methods This study retrospectively collected data from patients who were admitted to the Eye & ENT Hospital of Fudan University from May 2014 to May 2018 and underwent laryngopharyngeal surgery under general anesthesia. Results A total of 126 patients were included. Twenty patients suffered from DMV. Preoperative laryngeal obstruction classification (OR = 7.46, 95% CI: 2.56-21.76, P < 0.001) and airway patency after sevoflurane inhalation (OR = 10.96, 95% CI: 2.70-44.43, p = 0.001) were independently associated with DMV. Seventy-six patients could be intubated at the first attempt. Preoperative laryngeal obstruction grade (OR = 0.28, 95% CI: 0.13-0.62, P = 0.002), neoplasm size (OR = 0.43, 95% CI: 0.22-0.82, P = 0.011), and airway patency after sevoflurane inhalation (OR = 0.14, 95% CI: 0.05-0.36, P < 0.001) were independently associated with first-attempt successful intubation. Conclusion Among patients with pharyngeal and laryngeal diseases, the degree of laryngeal obstruction before the operation and the degree of airway obstruction after inhaling sevoflurane are the risk factors of DMV. The degree of laryngeal obstruction before the operation, airway obstruction after inhaling sevoflurane, and the neoplasm size are the risk factors of DI.
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Affiliation(s)
| | | | | | | | - Yuan Han
- Corresponding author. Department of Anesthesiology, Eye & ENT Hospital, Fudan University, Xuhui District 200031, Shanghai, China.
| | - Yi-Rong Cai
- Corresponding author. Department of Anesthesiology, Eye & ENT Hospital, Fudan University, Xuhui District 200031, Shanghai, China.
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Kitamura T, Otani K. Airway Obstruction with Blunt Neck Trauma from an Accidental High Tackle in Rugby. Curr Sports Med Rep 2023; 22:100-104. [PMID: 36866953 DOI: 10.1249/jsr.0000000000001047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/04/2023]
Abstract
ABSTRACT Blunt neck trauma is an uncommon condition in sports yet life-threatening if left untreated; hence, early diagnosis and management is necessary once suspected. We report a collegiate rugby player tackled around the neck during intersquad scrimmage. He broke his cricoid and thyroid cartilage, resulting in cervical subcutaneous emphysema and pneumomediastinum and eventually, airway obstruction. Thus, he underwent cricothyroidotomy and emergency tracheotomy. After 20 d, the emphysema disappeared. However, dilation failure of the vocal cord remained, thereby requiring laryngeal reconstruction. In conclusion, blunt neck trauma can cause airway obstruction in various sports.
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Affiliation(s)
- Takuya Kitamura
- Department of Emergency Medicine, The Jikei University Daisan Hospital, Komae, Tokyo, Japan
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Lava CX, Martin TS, Leonard JA, Blumenthal DL, Scriven‐Weiner K, Chu E, Harley EH. Complications associated with costal cartilage harvest in pediatric laryngotracheal reconstruction. Laryngoscope Investig Otolaryngol 2023; 8:584-590. [PMID: 37090864 PMCID: PMC10116967 DOI: 10.1002/lio2.1028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Accepted: 01/23/2023] [Indexed: 03/08/2023] Open
Abstract
Objective We aimed to determine the rate of complications associated with autologous costal cartilage graft harvest for pediatric laryngotracheal reconstruction (LTR). Secondarily, we sought to identify risk factors associated with the harvest of autologous costal cartilage, as well as evaluate management strategies. Data Sources An electronic database search of Ovid MEDLINE, Ovid EMBASE, and PubMed was completed for articles pertaining to complications in autologous costal cartilage harvest for pediatric LTR. Review Methods This systematic review adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines. The study characteristics, operative information, and patient demographics were collected. The data concerning postoperative complications, risk factors, and management strategies were collected and analyzed for patterns. Results A total of 31 manuscripts representing 745 patients were included for analysis. The reported donor site complications included pneumothorax (n = 13, 1.74%), pleural tear (n = 5, 0.67%), infection (n = 8, 1.07%), and scar-related problems (n = 2, 0.26%). There were no reported cases of seroma, persistent pain, or chest wall deformity. Only five studies discussed the management of donor site complications, with intervention in 11 (39.28%) patients including chest tube drainage and steroid injection. Conclusion There is significant variability in the literature regarding complication rates in autologous costal cartilage harvest for pediatric LTR. The incidence of major postoperative complications is low and supports the use of autologous costal cartilage as graft material for pediatric LTR. Level of Evidence NA.
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Affiliation(s)
| | | | - James A. Leonard
- MedStar Georgetown University Hospital Department of Otolaryngology – Head and Neck Surgery Washington DC USA
| | - Daniel L. Blumenthal
- MedStar Georgetown University Hospital Department of Otolaryngology – Head and Neck Surgery Washington DC USA
| | - Kelly Scriven‐Weiner
- MedStar Georgetown University Hospital Department of Otolaryngology – Head and Neck Surgery Washington DC USA
| | - Eugenia Chu
- MedStar Georgetown University Hospital Department of Otolaryngology – Head and Neck Surgery Washington DC USA
| | - Earl H. Harley
- MedStar Georgetown University Hospital Department of Otolaryngology – Head and Neck Surgery Washington DC USA
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Functional outcomes after transoral CO 2 laser treatment for posterior glottic stenosis: a bicentric case series. Eur Arch Otorhinolaryngol 2023; 280:249-257. [PMID: 35819506 DOI: 10.1007/s00405-022-07516-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Accepted: 06/14/2022] [Indexed: 01/07/2023]
Abstract
PURPOSE The aim of this study is to evaluate functional outcomes in terms of decannulation rate and quality of life of patients affected by PGS (Grades I-IV) treated only by transoral CO2 laser microsurgery (TOLMS) in two tertiary centers. METHODS An observational retrospective study was carried out, enrolling 22 patients affected by PGS who were treated by a transoral approach at two tertiary referral centers. Surgical treatment included TOLMS with tailored laser resection of the scar tissue combined with posterior cordotomy, resurfacing of the raw area with mucosal microflap, or placement of a Montgomery T-tube or Keel stent. All patients were evaluated and staged preoperatively and postoperatively, at least 6 months after the surgery. Functional outcomes were objectively evaluated by the Airway-Dysphonia-Voice-Swallowing (ADVS) staging system, Voice Handicap Index-30 (VHI-30), and Eating Assessment Tool-10 (EAT-10) questionnaires. RESULTS Quality of life significantly improved as measured by the VHI-30 questionnaire with a median variation of - 31.0 (p = 0.003), the EAT-10 with a median variation of - 4.0 (p = 0.042), and the ADVS with a median variation of - 3.5 (p < 0.001). No significant changes were observed in swallowing scores. We were able to decannulate 7 of 9 patients (almost 80%) with previous tracheotomy. CONCLUSION In conclusion, even if there is still no general agreement on an exact therapeutic algorithm to treat PGS, our results confirm that transoral surgery, in terms of scar tissue removal, combined in selected patients with posterior cordotomy and pedicled local flaps and/or placement of stents, represents a safe and effective surgical approach even for more severe PGS.
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10
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Viana PB, Sousa FA, Pinto AIN, Leal TB. Anesthesia management of pediatric subglottic stenosis: A case report. Saudi J Anaesth 2023; 17:72-74. [PMID: 37032683 PMCID: PMC10077771 DOI: 10.4103/sja.sja_260_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Revised: 03/25/2022] [Accepted: 03/27/2022] [Indexed: 12/24/2022] Open
Abstract
Subglottic stenosis balloon dilation in selected patients may be an option for the treatment of acquired subglottic stenosis, reducing the need for open surgical approaches or tracheostomy. This treatment is a major challenge to otolaryngologists and anesthesiologists, with an interactive collaboration being critical throughout the procedure. When performed, it is fundamental that otolaryngologists and anesthesiologists communicate properly during the procedure to achieve acceptable results. The complex management of the airway and inherent delicacy and risks of the intervention may be challenging. A proper preparation of the procedure and familiarization with the step-by-step technique could optimize the results and prepare the team to deal with intervening complications. We report a case of management and treatment of an 8-month-old baby with subglottic stenosis proposed for endoscopic balloon dilation treatment from Porto, North of Portugal.
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Affiliation(s)
- Patrícia B. Viana
- Serviço de Anestesiologia, Centro Hospitalar e Universitário do Porto, Porto, Portugal
| | - Francisco A. Sousa
- Serviço de Otorrinolaringologia, Centro Hospitalar e Universitário do Porto, Porto, Portugal
| | - Ana I. N. Pinto
- Serviço de Otorrinolaringologia, Centro Hospitalar e Universitário do Porto, Porto, Portugal
| | - Teresa B. Leal
- Serviço de Anestesiologia, Centro Hospitalar e Universitário do Porto, Porto, Portugal
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Muacevic A, Adler JR, Kurnutala LN. Unanticipated Difficult Airway During Elective Surgery: A Case Report and Review of Literature. Cureus 2022; 14:e32996. [PMID: 36712753 PMCID: PMC9879068 DOI: 10.7759/cureus.32996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/26/2022] [Indexed: 12/28/2022] Open
Abstract
Difficult airway during anesthesia is responsible for several cases of morbidity and mortality worldwide, especially when it is unanticipated. Patients with either history of or with predictive factors of a difficult airway show better outcomes since all preventative measures will ensure patient safety. Approximately 30% of all deaths attributed to anesthesia are related to unsuccessful intubation. In this article, we discuss a patient who had a tracheostomy following an unanticipated difficult airway with undiagnosed subglottic stenosis and also reviewed the current literature on the difficult airway.
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12
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Manabe H, Murakami M, Kendall A, Fulkerson CV. Tracheal stenosis following endotracheal intubation in a dog. THE CANADIAN VETERINARY JOURNAL = LA REVUE VETERINAIRE CANADIENNE 2021; 62:1289-1291. [PMID: 34857963 PMCID: PMC8591574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
A 2-month-old intact female Rottweiler was presented for investigation of coughing and respiratory distress 9 d after an exploratory laparotomy for intestinal foreign body removal. Tracheal stenosis was suspected by radiography and confirmed with computed tomography (CT) and tracheoscopy. After 1 wk of medical management, clinical signs had resolved and the severity of the tracheal narrowing was markedly improved, as confirmed by radiography and tracheoscopy. Tracheal stenosis is a considerable complication of endotracheal intubation in veterinary medicine and may be medically managed, depending on the severity of the tracheal injury. Key clinical message: To our knowledge, this is the first clinical case report of tracheal stenosis resulting from endotracheal intubation in a dog and its resolution after medical management.
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Affiliation(s)
- Hitomi Manabe
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Purdue University, West Lafayette, Indiana 47907, USA
| | - Masahiro Murakami
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Purdue University, West Lafayette, Indiana 47907, USA
| | - Allison Kendall
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Purdue University, West Lafayette, Indiana 47907, USA
| | - Caroline V Fulkerson
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Purdue University, West Lafayette, Indiana 47907, USA
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陈 芳, 李 为, 徐 宏, 倪 坤, 范 文, 李 晓. [Cochlear implant and surgical intervention for CHARGE syndrome with laryngeal airway lesions]. LIN CHUANG ER BI YAN HOU TOU JING WAI KE ZA ZHI = JOURNAL OF CLINICAL OTORHINOLARYNGOLOGY, HEAD, AND NECK SURGERY 2021; 35:1018-1023. [PMID: 34886607 PMCID: PMC10128366 DOI: 10.13201/j.issn.2096-7993.2021.11.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Indexed: 06/13/2023]
Abstract
Objective:To evaluate the clinical efficacy of surgical intervention for laryngeal airway lesions with concurrent cochlear implantation in CHARGE syndrome concomitant laryngeal airway lesions, and provide clinical data for cochlear implantation in children with CHARGE syndrome concomitant laryngeal airway lesions. Methods:The medical records of five cases diagnosed with CHARGE syndrome were retrospectively reviewed, two of them treated with surgical intervention for laryngeal airway lesions and concurrent cochlear implantation. One child treated with balloon dilatation of laryngeal stenosis and Cochlear implant, and another case received with modified supraglottoplasty for laryngeal malacia and Cochlear implant. Results:Two cases of CHARGE syndrome concomitant laryngeal airway disease, who underwent Cochlear implant and concurrent surgical intervention, recovered well after treatment. The remining three cases treated with Cochlear implant, who previously received deformity-correction surgery. All of the five cases presented with CHD7 mutation. Conclusion:Cochlear implant concurrent with surgical intervention of laryngeal airway lesions for the treatment of CHARGE syndrome concomitant laryngeal airway disease was safe and efficient, which could be a treatment option for children in this situation.
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Affiliation(s)
- 芳 陈
- 上海市儿童医院 上海交通大学附属儿童医院耳鼻咽喉头颈外科(上海,200062)Department of Otolaryngology Head and Neck Surgery, Shanghai Children's Hospital, Children's Hospital of Shanghai Jiaotong University, Shanghai, 200062, China
| | - 为 李
- 唐山市妇幼保健院耳鼻咽喉科Department of Otorhinolaryngology, Tangshan Maternal and Child Health Hospital
| | - 宏鸣 徐
- 上海市儿童医院 上海交通大学附属儿童医院耳鼻咽喉头颈外科(上海,200062)Department of Otolaryngology Head and Neck Surgery, Shanghai Children's Hospital, Children's Hospital of Shanghai Jiaotong University, Shanghai, 200062, China
| | - 坤 倪
- 上海市儿童医院 上海交通大学附属儿童医院耳鼻咽喉头颈外科(上海,200062)Department of Otolaryngology Head and Neck Surgery, Shanghai Children's Hospital, Children's Hospital of Shanghai Jiaotong University, Shanghai, 200062, China
| | - 文焱 范
- 上海市儿童医院 上海交通大学附属儿童医院耳鼻咽喉头颈外科(上海,200062)Department of Otolaryngology Head and Neck Surgery, Shanghai Children's Hospital, Children's Hospital of Shanghai Jiaotong University, Shanghai, 200062, China
| | - 晓艳 李
- 上海市儿童医院 上海交通大学附属儿童医院耳鼻咽喉头颈外科(上海,200062)Department of Otolaryngology Head and Neck Surgery, Shanghai Children's Hospital, Children's Hospital of Shanghai Jiaotong University, Shanghai, 200062, China
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Yap T, Quick M, Moore P. Emergency tracheostomy for failed intubation due to glottic stenosis. BMJ Case Rep 2021; 14:14/2/e239806. [PMID: 33637501 PMCID: PMC7919554 DOI: 10.1136/bcr-2020-239806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Glottic stenosis can be an unexpected finding during an intubation, causing difficulties that may result in a 'can't intubate, can't ventilate' situation. We present a case of a patient who required an emergency tracheostomy, in the setting of a failed intubation secondary to glottic stenosis. The patient underwent open laryngotracheal reconstruction, followed by tracheostomy decannulation 2 months post-surgery. This paper highlights the importance of awareness of laryngeal pathology masquerading as respiratory conditions. It also outlines the critical approach to managing 'can't intubate, can't ventilate' situations.
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Affiliation(s)
- Tessa Yap
- ENT/Otolaryngology, Royal Perth Hospital, Perth, Western Australia, Australia
| | - Mark Quick
- ENT/Otolaryngology, Royal Perth Hospital, Perth, Western Australia, Australia
| | - Paige Moore
- ENT/Otolaryngology, Royal Perth Hospital, Perth, Western Australia, Australia
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Abstract
PURPOSE OF REVIEW Pediatric posterior glottic stenosis (PGS) is a challenging clinical entity with multiple treatment options. This review describes the evaluation of patients with PGS and discusses existing surgical techniques. RECENT FINDINGS PGS secondary to a distinct scar band between the vocal folds can often be effectively managed with endoscopic division and surveillance. More advanced glottic scarring that also involves the interarytenoid mucosa, cricoarytenoid joints, or subglottis merits a more thorough investigation and repair. A postcricoid mucosal advancement flap can be employed in select adolescent or adult PGS, but long-term cricoarytenoid joint mobility is difficult to restore once it has been fixed. Younger pediatric patients have smaller airways and frequent concurrent subglottic stenosis which is better addressed with cartilage grafting. SUMMARY Surgical success in pediatric PGS depends on careful preoperative airway assessment and the accurate characterization of airway stenosis. A surgical technique should be chosen based on the severity and extent of stenosis.
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