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Balouch B, Garabet R, Maxwell PJ, Sethi HK, Bress E, Ramadan O, Sataloff RT. The Safety and Efficacy of the 445-nm Blue Laser for Operative Management of Benign Nonvascular Laryngeal Lesions. J Voice 2023:S0892-1997(23)00286-2. [PMID: 37805300 DOI: 10.1016/j.jvoice.2023.09.010] [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: 08/30/2023] [Accepted: 09/12/2023] [Indexed: 10/09/2023]
Abstract
The 445-nm blue laser combines the features of photocoagulative vascular lasers and cutting lasers in one device. The purpose of the present study was to evaluate the safety and efficacy of the 445-nm blue laser for the treatment of benign laryngeal pathologies, other than vascular lesions. Outcomes were compared to those when already-established therapies were used. METHODS Adult voice center patients who underwent surgical intervention for vocal fold (VF) mass, VF scar, laryngeal stenosis, laryngeal web, or Reinke's edema were included in this retrospective study. Outcomes were compared to those achieved when traditional treatment modalities were used, including cold steel, CO2 laser, potassium-titanyl-phosphate (KTP) laser, and coblator. Strobovideolaryngoscopy footage was evaluated using a previously described model at four time points: postoperative visit #1: 1-14 days, postoperative visit #2: 30-60 days, postoperative visit #3: 61-365 days, postoperative visit #4: >365 days. RESULTS Eighty cases using the blue laser and 153 controls (n = 78 cold steel, n = 51 KTP laser, n = 22 CO2 laser, n = 2 coblator) were included in this study. Procedures performed using blue laser included VF mass excision (n = 45), VF scar reduction (n = 16), laryngeal stenosis resection/repair (n = 25), laryngeal web excision (n = 7), and reduction of Reinke's edema (n = 1). On postoperative strobovideolaryngoscopy examination, the surgical objective score did not differ significantly between the blue laser cohort and all controls at any postoperative visit. VF edema did not differ significantly between the blue laser cohort and all controls at any postoperative visit. VF hemorrhage scores were significantly lower in the blue laser cohort compared to all controls at the first postoperative visit, but hemorrhage had resolved almost entirely by the second postoperative visit in all groups. Postoperative VF stiffness was worse in the blue laser group at the third postoperative visit compared to controls, but both groups had improved to similar levels by the fourth postoperative visit. The rate of lesion recurrence (24.29% versus 17.19%) did not differ significantly between the blue laser cohort and controls on multivariate analysis (Odds ratio [OR] = 1.081 [0.461-2.536]). The complication rate (12.50% versus 10.46%) did not differ significantly between the blue laser cohort and all controls on multivariate analysis (OR = 0.992 [0.375-2.624]). The blue laser was associated with a lower rate of revision surgery (30.00% versus 34.64%) on multivariate analysis (OR = 0.380 [0.168-0.859]). CONCLUSION The 445-nm blue laser is safe and effective for the management of benign laryngeal lesions. It has efficacy and safety similar to those of traditional treatment modalities (including cold steel, CO2 laser, and KTP laser). Use of the blue laser may lead to lower rates of early postoperative hemorrhage and revision surgery. No adverse effects attributed directly to the use of the blue laser were observed in this study. Further research is encouraged to confirm or refute these findings.
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Affiliation(s)
- Bailey Balouch
- Division of Otolaryngology - Head and Neck Surgery, Cooper University Health Care and Cooper Medical School of Rowan University, Camden, New Jersey, USA
| | - Razmig Garabet
- Drexel University College of Medicine, Philadelphia, Pennsylvania, USA
| | - Philip J Maxwell
- Drexel University College of Medicine, Philadelphia, Pennsylvania, USA
| | - Harleen K Sethi
- Department of Otolaryngology, Facial Plastic Surgery and Head and Neck Surgery, Philadelphia College of Osteopathic Medicine, Philadelphia, Pennsylvania, USA
| | - Eli Bress
- Department of Otolaryngology, Facial Plastic Surgery and Head and Neck Surgery, Philadelphia College of Osteopathic Medicine, Philadelphia, Pennsylvania, USA
| | - Omar Ramadan
- Department of Otolaryngology - Head and Neck Surgery, Drexel University College of Medicine, Philadelphia, Pennsylvania, USA
| | - Robert T Sataloff
- Department of Otolaryngology - Head and Neck Surgery, Drexel University College of Medicine, Philadelphia, Pennsylvania, USA.
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Li C, Fang Y, Chen M, Chen J, Wu H, He P, Cheng L. Treatment with adult glottic stenosis using CO 2 laser surgery combined with self-made laryngeal dilator. Acta Otolaryngol 2023; 143:912-917. [PMID: 37975840 DOI: 10.1080/00016489.2023.2276884] [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: 09/14/2023] [Accepted: 10/22/2023] [Indexed: 11/19/2023]
Abstract
BACKGROUND/AIMS/OBJECTIVES To investigate the treatment for adult glottic stenosis using CO2 laser surgery combined with a self-made laryngeal dilator. MATERIAL AND METHODS A retrospective analysis was performed on 18 patients with glottic stenosis who were treated using CO2 laser surgery combined with a self-made laryngeal dilator in our hospital from January 2018 to December 2020. RESULTS 4 cases were caused by trauma and one by laryngophthisis. Laryngeal stenosis occurred in 4 and 9 patients respectively after CO2 laser surgery and open partial laryngectomy. Of them, one patient underwent postoperative radiotherapy. All patients were treated through CO2 laser surgery combined with a self-made laryngeal dilator under general anesthesia. 3-6 months later, the dilator was removed. Inflammation, ulceration and granulation were observed surrounding the dilator. But these complications would be cured and respiration was not affected. Finally, four patients could not be extubated and the decannulation rate achieved 78%. All patients successfully decannulated could normally intake. 13 cases had good voice quality and only one patient pronounced hoarsely. CONCLUSIONS AND SIGNIFICANCE It is demonstrated that the application of CO2 laser surgery combined with a laryngeal self-made dilator is feasible and effective for the treatment with adult glottic stenosis.
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Affiliation(s)
- Changjiang Li
- Department of Otorhinolaryngology, Head and Neck Surgery (Shanghai Key Clinical Disciplines of otorhinolaryngology, shslczdzk00801), Eye, Ear, Nose and Throat Hospital of Fudan University, Shanghai, China
| | - Yi Fang
- Department of Otorhinolaryngology, Head and Neck Surgery (Shanghai Key Clinical Disciplines of otorhinolaryngology, shslczdzk00801), Eye, Ear, Nose and Throat Hospital of Fudan University, Shanghai, China
| | - Min Chen
- Department of Otorhinolaryngology, Head and Neck Surgery (Shanghai Key Clinical Disciplines of otorhinolaryngology, shslczdzk00801), Eye, Ear, Nose and Throat Hospital of Fudan University, Shanghai, China
| | - Jian Chen
- Department of Otorhinolaryngology, Head and Neck Surgery (Shanghai Key Clinical Disciplines of otorhinolaryngology, shslczdzk00801), Eye, Ear, Nose and Throat Hospital of Fudan University, Shanghai, China
| | - Haitao Wu
- Department of Otorhinolaryngology, Head and Neck Surgery (Shanghai Key Clinical Disciplines of otorhinolaryngology, shslczdzk00801), Eye, Ear, Nose and Throat Hospital of Fudan University, Shanghai, China
| | - Peijie He
- Department of Otorhinolaryngology, Head and Neck Surgery (Shanghai Key Clinical Disciplines of otorhinolaryngology, shslczdzk00801), Eye, Ear, Nose and Throat Hospital of Fudan University, Shanghai, China
| | - Lei Cheng
- Department of Otorhinolaryngology, Head and Neck Surgery (Shanghai Key Clinical Disciplines of otorhinolaryngology, shslczdzk00801), Eye, Ear, Nose and Throat Hospital of Fudan University, Shanghai, China
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Sakihama N, Okada R, Takahashi N, Fushimi N, Ooka T, Kawabe H, Ariizumi Y, Ohno K, Ueki Y, Tayama N, Tsutsumi T, Asakage T. Post-intubation laryngeal injury after COVID-19 treatment causing dyspnea: A report of six cases. Auris Nasus Larynx 2022:S0385-8146(22)00235-8. [PMID: 36581538 PMCID: PMC9767890 DOI: 10.1016/j.anl.2022.12.007] [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] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Revised: 11/15/2022] [Accepted: 12/15/2022] [Indexed: 12/24/2022]
Abstract
Severe cases of COVID-19 often require orotracheal intubation (OTI) and mechanical ventilation, and post-intubation laryngeal injury (PI-LI) is one of the important complications of OTI. Some studies have claimed that the frequency of PI-LI may be higher in COVID-19 patients as compared with that in non-COVID-19 patients, because of the larger size of endotracheal tube used, the longer OTI time, use of prone positioning of the patients, etc. Herein, we describe six cases of PI-LI who presented with dyspnea after recovering from COVID-19. Five of the patients were male and the median OTI period was 9 days. All the patients showed abnormal endoscopic findings, including posterior glottic synechiae/stenosis or subglottic/posterior glottic granulomas. Four patients required surgical intervention, including tracheostomy, laryngomicrosurgery, or laterofixation of the vocal cord. Many post-COVID-19 patients experience persistent symptoms (post-COVID-19 syndrome), including dyspnea. Two of our patients with dyspnea had been treated by internists as cases of post-COVID-19 syndrome. Therefore, we wish to underscore the need for every healthcare professional to be aware of the possibility of PI-LI after OTI, especially during the ongoing COVID-19 pandemic. Otolaryngologists should undertake endoscopic assessment of the larynx in patients presenting with dyspnea after recovering from COVID-19.
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Affiliation(s)
- Naoyuki Sakihama
- Department of Otorhinolaryngology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Ryuhei Okada
- Department of Head and Neck Surgery, Tokyo Medical and Dental University, Tokyo, Japan,Corresponding author at: Department of Head and Neck Surgery, Tokyo Medical and Dental University, M&D Tower, N-907, 1-5-45, Bunkyo, Tokyo 113-8519, Japan
| | - Naoto Takahashi
- Department of Otorhinolaryngology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Naoki Fushimi
- Department of Otorhinolaryngology, Tokyo Medical and Dental University, Tokyo, Japan,Department of Otolaryngology, Center Hospital of the National Center for Global Health and Medicine, Tokyo, Japan
| | - Tomoki Ooka
- Department of Otorhinolaryngology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Hiroaki Kawabe
- Department of Head and Neck Surgery, Tokyo Medical and Dental University, Tokyo, Japan
| | - Yosuke Ariizumi
- Department of Head and Neck Surgery, Tokyo Medical and Dental University, Tokyo, Japan
| | - Kazuchika Ohno
- Department of Head and Neck Surgery, Tokyo Medical and Dental University, Tokyo, Japan
| | - Yutaka Ueki
- Department of Trauma and Acute Critical Care Medical Center, Tokyo Medical and Dental University, Tokyo, Japan
| | - Niro Tayama
- Department of Otolaryngology, Center Hospital of the National Center for Global Health and Medicine, Tokyo, Japan
| | - Takeshi Tsutsumi
- Department of Otorhinolaryngology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Takahiro Asakage
- Department of Head and Neck Surgery, Tokyo Medical and Dental University, Tokyo, Japan
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Alves Dos Santos Pertence LM, Souto Bittencourt PF, Furtado de Mendonça Picinin I, Maria de Lima Belizário Facury Lasmar L. Prevalence of laryngotracheal injury in chronically tracheostomized children at a large referral center. Int J Pediatr Otorhinolaryngol 2022; 154:111035. [PMID: 35074709 DOI: 10.1016/j.ijporl.2021.111035] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2021] [Accepted: 12/31/2021] [Indexed: 10/19/2022]
Abstract
OBJECTIVE To assess the prevalence and factors associated with laryngotracheal lesions in chronically tracheostomized children followed at a comprehensive care center for tracheostomized patients. STUDY DESIGN Cross-sectional study. SETTING Tertiary care hospital. METHODS Between 2011 and 2018, tracheostomized children were submitted to flexible bronchoscopy and divided into groups according to the findings: laryngotracheal injury without subglottic stenosis; laryngotracheal injury with subglottic stenosis; and normal airway. Multivariate analysis was performed with the covariates main indication for tracheostomy, age, duration of intubation, sex, and comorbidities. RESULTS A total of 195 children were included, the median age at tracheostomy was 12 months, and upper airway obstruction was the indication for tracheostomy in 63.1%. Of the 195 patients evaluated, 41 (21%) had laryngotracheal injury without subglottic stenosis, 132 (67.7%) had laryngotracheal injury with subglottic stenosis, and 22 (11.3%) had a normal airway. In the final multivariate analysis, being intubated for ≥21 days increased the overall risk of subglottic stenosis (OR = 6.98; 95% CI, 1.42-34.3), which was significantly more common among the patients with laryngotracheal injury and subglottic stenosis than among those with laryngotracheal injury only and those with a normal airway (OR = 5.82; 95% CI, 1.44-23.52). CONCLUSIONS In our sample, the most prevalent lesion was subglottic stenosis The duration of intubation appears to be associated with the occurrence of laryngotracheal injury in tracheostomized children.
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Affiliation(s)
- Ligia Maria Alves Dos Santos Pertence
- Graduate Program in Child and Adolescent Health Sciences, School of Medicine, Federal University of Minas Gerais, Belo Horizonte, Brazil; School of Medical Sciences of Minas Gerais, Belo Horizonte, Brazil.
| | - Paulo Fernando Souto Bittencourt
- School of Medicine, Federal University of Minas Gerais, Belo Horizonte, Brazil; Department of Digestive and Respiratory Endoscopy, João Paulo II Children's Hospital, Hospital Foundation of the State of Minas Gerais, Belo Horizonte, Brazil
| | - Isabela Furtado de Mendonça Picinin
- School of Medical Sciences of Minas Gerais, Belo Horizonte, Brazil; Center for the Comprehensive Care of Tracheostomized Patients, João Paulo II Children's Hospital, Hospital Foundation of the State of Minas Gerais, Belo Horizonte, Brazil
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Jung D, Gusti V, Vaghadia H. Novel application of AIRVO™ 2 for the management of postoperative hypoxemia due to severe laryngeal stenosis. J Clin Anesth 2020; 65:109872. [PMID: 32464477 DOI: 10.1016/j.jclinane.2020.109872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Accepted: 05/14/2020] [Indexed: 11/17/2022]
Affiliation(s)
- David Jung
- Department of Anaesthesia, Vancouver Coastal Health, Vancouver, BC V5Z 1M9, Canada.
| | - Vionarica Gusti
- Department of Anaesthesia, Vancouver Coastal Health, Vancouver, BC V5Z 1M9, Canada
| | - Himat Vaghadia
- Department of Anaesthesia, Vancouver Coastal Health, Vancouver, BC V5Z 1M9, Canada
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Redondo-Sedano J, Antón-Pacheco JL, Valverde RM, Díaz ML, Paredes CL, Guardia LM, Alelu RM, Huerta IJ, Gordo MIB, Fraile AG. Laryngeal stenosis in children: Types, grades and treatment strategies. J Pediatr Surg 2019; 54:1933-1937. [PMID: 30503025 DOI: 10.1016/j.jpedsurg.2018.09.027] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [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: 07/09/2018] [Revised: 09/15/2018] [Accepted: 09/17/2018] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Laryngeal stenosis is infrequent in children and usually secondary to endotracheal intubation. The aims of this study were to review the outcomes of the distinct endoscopic and surgical procedures and to suggest a technical modification for one of them. METHODS Retrospective review of patients with the diagnosis of laryngeal stenosis treated in an academic tertiary care institution between 2000 and 2017. The following variables were analyzed: demographic data, endoscopic findings including anatomic type and severity of the lesion, associated anomalies, type of treatment, outcomes, and time of follow-up. RESULTS Seventy-eight children were included in the study (39 boys) with a median age at diagnosis of 9 months, and 33 (42.3%) showed an associated anomaly. Lesions were acquired in 84.6% of cases and the subglottic region was most frequently involved (77%). Thirty patients (38.4%) had a severe stenosis (Myer-Cotton grades III and IV) and a tracheotomy was performed as an initial treatment in 38 patients (48.7%). Overall, 91% of endoscopically or surgically treated patients showed a good outcome and the decannulation rate in the series was 79.4%. Fourteen patients were managed conservatively. Median follow-up was 29 months (I.R. 10-60 m.) CONCLUSIONS: Laryngeal stenosis in children is usually acquired and exhibit a wide range of anatomic presentations. Endoscopic therapeutic procedures may be useful in the management of low grade immature stenosis. Reconstructive surgical techniques may provide a high success rate with an appropriate selection of candidates.
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Affiliation(s)
- Jesús Redondo-Sedano
- Pediatric Surgery Division, Hospital Universitario 12 de Octubre, Avda. De Córdoba s/n, Madrid 28041, Spain
| | - Juan L Antón-Pacheco
- Pediatric Airway Unit and Pediatric Surgery Division, Hospital Universitario 12 de Octubre, Avda. De Córdoba s/n, Madrid 28041, Spain, Universidad Complutense de Madrid.
| | - Rocio Morante Valverde
- Pediatric Airway Unit and Pediatric Surgery Division, Hospital Universitario 12 de Octubre, Avda. De Córdoba s/n, Madrid 28041, Spain
| | - María López Díaz
- Pediatric Airway Unit and Pediatric Surgery Division, Hospital Universitario 12 de Octubre, Avda. De Córdoba s/n, Madrid 28041, Spain
| | - Carmen Luna Paredes
- Pediatric Airway Unit and Division of Pediatrics, Hospital Universitario 12 de Octubre, Avda. De Córdoba s/n, Madrid 28041, Spain
| | - Leonor Melero Guardia
- Pediatric Surgery Division, Hospital Universitario 12 de Octubre, Avda. De Córdoba s/n, Madrid 28041, Spain
| | - Rubén Martín Alelu
- Pediatric Surgery Division, Hospital Universitario 12 de Octubre, Avda. De Córdoba s/n, Madrid 28041, Spain
| | - Ignacio Jiménez Huerta
- Pediatric Airway Unit and ENT Division, Hospital Universitario 12 de Octubre, Avda. De Córdoba s/n, Madrid 28041, Spain
| | | | - Andrés Gómez Fraile
- Pediatric Surgery Division, Hospital Universitario 12 de Octubre, Avda. De Córdoba s/n, Madrid 28041, Spain
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Scatolini ML, Cocciaglia A, Pérez CG, Rodríguez HA. Laryngeal reconstruction in children with recurrent respiratory papillomatosis. Int J Pediatr Otorhinolaryngol 2018; 115:120-124. [PMID: 30368371 DOI: 10.1016/j.ijporl.2018.09.028] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Revised: 09/25/2018] [Accepted: 09/25/2018] [Indexed: 11/18/2022]
Abstract
OBJETIVES To describe our experience in reconstructive laryngeal surgery in patients with recurrent respiratory papillomatosis (RRP). INTRODUCTION RRP is a rare laryngeal disease requiring multiple surgical endoscopic interventions during its course. These interventions may cause secondary lesions that may compromise airway patency. Open larynx reconstructive surgery, as tracheostomy, is a procedure considered to potentially favor extralaryngeal papilloma dissemination. In patients with RRP, the use of endoscopic posterior cricoid split and rib grafting has not been previously described. METHODS The clinical charts of 230 patients with RRP seen between 1996 and 2017 were reviewed. All patients who underwent airway expansion procedures either by open or endoscopic approach were included in the study. RESULTS Four patients with RRP underwent laryngeal surgery for laryngeal stenosis were included. A double-stage open approach was used in two patients and a single-stage endoscopic approach in the remaining two. The two tracheostomized patients were decannulated while tracheostomy was avoided in the two patients who underwent a single-stage endoscopic procedure. Two patients had active papillomatous lesions limited to the larynx at the time of surgery; no dissemination was observed during follow-up (cases 1 and 3). One patient had extralaryngeal disseminated papilomatosis; surgery did not lead to an increased lesion load compared to presurgical lesions (case 4). The patient who did not have active lesions did not have recurrence (case 2). CONCLUSIONS Reconstructive laryngeal surgery is a safe and effective option in the management of stenotic sequelae resulting from the surgical treatment of RRP, allowing for decannulation or avoiding tracheostomy.
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Affiliation(s)
- M L Scatolini
- Department of Respiratory Endoscopy, Hospital de Pediatría Juan P. Garrahan, Buenos Aires, Argentina.
| | - A Cocciaglia
- Department of Respiratory Endoscopy, Hospital de Pediatría Juan P. Garrahan, Buenos Aires, Argentina
| | - C G Pérez
- Department of Respiratory Endoscopy, Hospital de Pediatría Juan P. Garrahan, Buenos Aires, Argentina
| | - H A Rodríguez
- Department of Respiratory Endoscopy, Hospital de Pediatría Juan P. Garrahan, Buenos Aires, Argentina
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Meleca JB, Hanick A, Lamarre E, Bryson PC. Post-treatment sequelae and management of primary laryngeal NK/T-cell lymphoma: A case report. Am J Otolaryngol 2018; 39:781-784. [PMID: 30076020 DOI: 10.1016/j.amjoto.2018.07.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 07/21/2018] [Accepted: 07/24/2018] [Indexed: 11/28/2022]
Abstract
OUTCOME OBJECTIVES METHODS: Case Report, April 2016. RESULTS A 27-year-old female presented with a three-week history of flu-like symptoms including sore throat, myalgia and insidious nasal congestion. Her hospital course was complicated by pancytopenia, extensive GI bleed of unknown origin and fever. Radiographic studies revealed multifocal centrilobular ground-glass lung nodules, splenomegaly, frontal and paranasal sinus opacification and mucosal thickening and inflammatory process of false and true vocal cords with concentric multi-level narrowing. Extensive rheumatologic, hematologic and infectious workup failed to demonstrate an etiology. Flexible laryngoscopic and bronchoscopic examinations with biopsies exhibited a diffuse supraglottic and glottic exophytic, "heaped-up" infiltration; limited vocal cord motion; and airway narrowing to 3 mm. Pathology yielded NK/T-Cell lymphoma with PET/CT confirming nasopharyngeal and laryngeal involvement sparing the brain and other distant structures. During treatment, the patient's airway became increasingly compromised requiring tracheostomy. Flexible laryngoscopic examination after four rounds of SMILE (dexamethasone, methotrexate, ifosfamide, l-asparaginase, and etoposide) chemotherapy and subsequent radiotherapy with 50 Gy in 25 fractions revealed complete glottic stenosis with alteration of the laryngeal anatomy and a pin-hole aperture seen posteriorly through the tracheostomy. Two dilation procedures performed one month apart, improved her airway considerably which allowed for successful decannulation. She continues to be disease-free post treatment but has persistent supraglottic and glottic scar and has developed tracheal stenosis at her tracheostomal site. CONCLUSIONS NK/T-Cell lymphoma of the larynx has been rarely described. Herein, we describe the sequalae of treatment and the requisite airway management.
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Affiliation(s)
- Joseph B Meleca
- Cleveland Clinic, 9500 Euclid Ave, A-71, Cleveland, OH 44195, United States of America.
| | - Andrea Hanick
- Cleveland Clinic, 9500 Euclid Ave, A-71, Cleveland, OH 44195, United States of America.
| | - Eric Lamarre
- Cleveland Clinic, 9500 Euclid Ave, A-71, Cleveland, OH 44195, United States of America.
| | - Paul C Bryson
- Cleveland Clinic, 9500 Euclid Ave, A-71, Cleveland, OH 44195, United States of America.
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9
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Katsantonis NG, Kabagambe EK, Wootten CT, Ely EW, Francis DO, Gelbard A. Height is an independent risk factor for postintubation laryngeal injury. Laryngoscope 2018; 128:2811-2814. [PMID: 30325034 DOI: 10.1002/lary.27237] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [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: 08/30/2017] [Revised: 03/20/2018] [Accepted: 03/22/2018] [Indexed: 11/11/2022]
Abstract
OBJECTIVES/HYPOTHESIS Intubation is an essential component of intensive care, yet it does have potential complications. Posterior glottic stenosis (PGS) is among the most severe sequela. Risk factors are poorly understood. One hypothesis is that large endotracheal tubes (ETTs) in smaller airways may increase risk. Because tracheal diameter is proportional to height, we designed a case-control study to evaluate the association between intensive care unit (ICU)-patient height (proxy for tracheal diameter) and their risk of postintubation PGS. STUDY DESIGN Retrospective case-control study METHODS: Among patients who underwent intubation in an ICU at a single tertiary care medical center between 2001 and 2015, a convenience sample of all patients with confirmed PGS (cases) were enrolled. Cases were matched 1:1 by age, sex, and race with intubated non-PGS controls chosen from the same population of ventilated patients. Data on height, weight, comorbidities, size of ETT, and duration of intubation were abstracted from the medical record. Multivariate models were used to test the association between patient height and risk of PGS development. RESULTS In all, 106 PGS cases (mean age 48.9 years, 50.7% female, 79.2% Caucasian) were identified; 77 met inclusion criteria. Compared to matched controls, cases were significantly shorter (mean 166 cm vs. 173 cm, P = .001). Height and PGS showed an inverse relationship in multivariate models. Specifically, odds of PGS decreased 9% (95% confidence interval: 0.01%-16%) for each centimeter increase in height. CONCLUSIONS Shorter height is independently associated with increased odds of having PGS. Further work should consider whether height should be incorporated into ETT selection algorithms. LEVEL OF EVIDENCE 3b Laryngoscope, 128:2811-2814, 2018.
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Affiliation(s)
| | - Edmond K Kabagambe
- Department of Otolaryngology Head and Neck Surgery, Nashville, Tennessee.,Division of Epidemiology, Department of Medicine, Nashville, Tennessee
| | | | - E Wesley Ely
- Veteran's Affairs Geriatric Research Education Clinical Center for Tennessee Valley, Nashville, Tennessee.,Division of Pulmonary and Critical Care, Department of Medicine , Vanderbilt University Medical Center, Nashville, Tennessee
| | - David O Francis
- Division of Otolaryngology, Department of Surgery , University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, U.S.A
| | - Alexander Gelbard
- Department of Otolaryngology Head and Neck Surgery, Nashville, Tennessee
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10
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Koshkareva YA, Hughes WB, Soliman AMS. Laryngotracheal stenosis in burn patients requiring mechanical ventilation. World J Otorhinolaryngol Head Neck Surg 2018; 4:117-121. [PMID: 30101220 PMCID: PMC6074014 DOI: 10.1016/j.wjorl.2018.05.004] [Citation(s) in RCA: 3] [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] [Subscribe] [Scholar Register] [Received: 04/13/2018] [Accepted: 05/11/2018] [Indexed: 11/30/2022] Open
Abstract
Objective To identify the incidence of laryngotracheal stenosis (LTS) in burn patients requiring mechanical ventilation at a regional academic burn center. Methods A retrospective review of all burn patients requiring endotracheal intubation or tracheostomy for airway management between 2003 and 2009 was performed. A group of trauma patients requiring similar airway instrumentation during the same period of time was used as a control. Results None of the trauma patients and 2 of the burn patients developed LTS. Both presented with stridor and were diagnosed within 2–5 weeks after extubation. One patient underwent successful carbon dioxide laser radial incision and dilation and continues to do well. The other patient failed endoscopic treatment and required T-tube placement. The incidence of LTS in burn patients requiring mechanical ventilation was 2.98% overall and 4.76% among those with inhalational injury. Conclusions Patients become symptomatic within weeks of the initial injury. Treatment is challenging and multiple surgical procedures are often required. A larger study is necessary to determine if the incidence is higher among burn patients.
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Affiliation(s)
- Yekaterina A Koshkareva
- Department of Otolaryngology - Head & Neck Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia, PA, USA
| | - William B Hughes
- Temple Burn Center, Lewis Katz School of Medicine at Temple University, Philadelphia, PA, USA
| | - Ahmed M S Soliman
- Department of Otolaryngology - Head & Neck Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia, PA, USA
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11
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Johnson RF, Isaiah A. Laryngeal stenosis among hospitalized children: Results from a nationwide cross-sectional survey. Laryngoscope Investig Otolaryngol 2018; 3:244-248. [PMID: 30062142 PMCID: PMC6057228 DOI: 10.1002/lio2.153] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [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: 12/28/2017] [Revised: 02/27/2018] [Accepted: 03/08/2018] [Indexed: 01/08/2023] Open
Abstract
Objectives We aimed to study laryngeal stenosis among hospitalized children in the United States from 2003–2012. We hypothesized that the prevalence of laryngeal stenosis differs by race even when controlling for age, gender, and commonly associated disease conditions. Methods We report the results of a cross‐sectional survey of hospitalized patients with laryngeal stenosis. We utilized the Kids Inpatient Database (KID) to estimate the odds of laryngeal stenosis as a function of race using regression analysis. The effects of age, gender, and commonly associated conditions were controlled. Results There were 13,910 estimated discharges of patients with laryngeal stenosis (95% CI 13,715–14,105) within the study period. This accounts for 55 cases of laryngeal stenosis per 100,000 discharges (overall prevalence = 0.22%). After controlling for age and gender, Black children had the highest likelihood of laryngeal stenosis with OR of 1.9 (95% CI 1.8–2.0, P < .001) along with children classified as Other (OR = 1.2, 95% CI 1.0–1.3, P = .03). White (OR = 0.89, 95% CI 0.83–0.89, P < .001), Hispanic (OR = 0.86, 95% CI 0.80– 0.92, P < .001), and Asian (OR = 0.53, 95% CI 0.43–0.64, P < .001) children were less likely to be diagnosed with laryngeal stenosis while Native Americans (OR = 0.96, 95% CI 0.63–1.45, P = .51) were equally likely. Conclusions Laryngeal stenosis is more common among hospitalized Black children, while other racial groups appear to have lower risk. This elevated risk remained when controlling for age, gender, and commonly associated conditions with laryngeal stenosis. Level of Evidence 4
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Affiliation(s)
- Romaine F Johnson
- Department of Otolaryngology University of Texas Southwestern Medical Center Dallas Texas U.S.A
| | - Amal Isaiah
- Department of Otolaryngology University of Maryland School of Medicine Baltimore Maryland U.S.A
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Anis MM, Krynetskaia N, Zhao Z, Krynetskiy E, Soliman AMS. Determining Candidate Single Nucleotide Polymorphisms in Acquired Laryngotracheal Stenosis. Laryngoscope 2017; 128:E111-E116. [PMID: 29164621 DOI: 10.1002/lary.26981] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [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: 03/31/2017] [Revised: 08/10/2017] [Accepted: 09/29/2017] [Indexed: 01/30/2023]
Abstract
OBJECTIVES/HYPOTHESIS Despite wide adoption of strategies to prevent injury from prolonged intubation and tracheotomy, acquired laryngotracheal stenosis (ALTS) has not disappeared. ALTS' persistence may be due to patient factors that confer unique susceptibility for some. We sought to identify genetic markers in genes associated with wound healing that could be associated with ALTS. STUDY DESIGN Case-control study. METHODS One hundred thirty-eight patients were recruited, 53 patients with ALTS and 85 control patients who underwent intubation or tracheotomy without evidence of ALTS. The patients' DNA was isolated from whole blood. Custom primers were designed, and the TaqMan assay employing allele-specific polymerase chain reaction was used to interrogate single nucleotide polymorphisms (SNPs) rs1799750, rs522616, rs2276109, rs2569190, rs1800469, and rs1024611 of candidate wound healing genes MMP1, MMP3, MMP12, CD14, TGFβ1, and MCP1, respectively. A logistic regression model was used to examine the association of candidate gene polymorphisms with the presence or absence of ALTS. RESULTS All 138 patients were successfully genotyped. No significant association was found between candidate SNPs and development of ALTS in the overall group. However, subgroup analysis within each ethnicity identified SNPs that are associated with ALTS depending upon the ethnic background. CONCLUSIONS Patient factors such as variations in wound healing due to functional SNPs may shed light on the development of ALTS. There may be a difference in susceptibility to developing ALTS in different ethnic backgrounds. These preliminary findings need to be corroborated in larger population studies. LEVEL OF EVIDENCE 3b. Laryngoscope, 128:E111-E116, 2018.
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Affiliation(s)
- Mursalin M Anis
- Department of Otolaryngology-Head and Neck Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania.,Coastal Ear, Nose and Throat, Neptune, New Jersey
| | - Natalia Krynetskaia
- Department of Pharmaceutical Sciences, Temple University School of Pharmacy, Philadelphia, Pennsylvania
| | - Zhigen Zhao
- Department of Statistics, Fox School of Business, Temple University, Philadelphia, Pennsylvania, U.S.A
| | - Evgeny Krynetskiy
- Department of Pharmaceutical Sciences, Temple University School of Pharmacy, Philadelphia, Pennsylvania
| | - Ahmed M S Soliman
- Department of Otolaryngology-Head and Neck Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania
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Iravani K, Babaie Z, Ashraf MJ, Tanideh N. Effects of Steroids and Curcumin on Prevention of Laryngeal Stenosis Secondary to Trauma. Iran J Otorhinolaryngol 2016; 28:249-54. [PMID: 27602335 PMCID: PMC4994983] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
INTRODUCTION The aim of this study was to compare the preventive effects of corticosteroids and curcumin on subglottic stenosis in an animal model. MATERIALS AND METHODS Twenty-one male German Shepherd dogs were used for this study. After standardized trauma to the subglottic area, the dogs were divided into three groups. Group A received curcumin (450 mg/ day) for 15 days; Group B received beclomethasone (2 puffs/day, 50 µg/dose) for 15 days; Group C received saline spray only. At 6 weeks after the injury, the larynx specimens were examined histopathologically to assess epithelialization, inflammation, and fibrosis. RESULTS Complete epithelial covering of the steroid-treated group was significantly less than that of the control group. Despite inflammation and fibrosis, there was no significant difference between the steroid and control groups. In the curcumin-treated group, there was no significant difference between the groups. CONCLUSION Topically applied steroid decreases epithelialization after induced subglottic injury. It is recommended that further studies be conducted in order to investigate the effects of the two drugs on airway stenosis prevention.
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Affiliation(s)
- Kamyar Iravani
- Department of Otorhinolaryngology, Shiraz University of Medical Sciences, Shiraz, Iran.,Corresponding Authors Department of Otorhinolaryngology, Shiraz University of Medical Sciences, Shiraz, Iran. Tel:+987136291478, E-mail:
| | - Zahra Babaie
- Department of Otorhinolaryngology, Shiraz University of Medical Sciences, Shiraz, Iran.
| | | | - Nader Tanideh
- Stem cell and Transgenic Technology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.
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14
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Maeso-Plaza A, Dablanca-Blanco M, Ortega-Fernandez C, Ortega-Del Álamo P. Cicatricial posterior glottic stenosis. Our experience. Acta Otorrinolaringol Esp 2016; 67:330-338. [PMID: 27063587 DOI: 10.1016/j.otorri.2016.01.008] [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: 08/11/2015] [Revised: 01/17/2016] [Accepted: 01/21/2016] [Indexed: 11/19/2022]
Abstract
INTRODUCTION AND OBJECTIVES Presentation of the results obtained in the treatment of cicatricial posterior glottic stenosis. METHODS A retrospective study of 34 patients diagnosed and treated for cicatricial posterior glottic stenosis in our ENT Department. RESULTS In our series, 85.36% of our patients were decannulated. Of these, 80% of the patients with glottic stenosis were decannulated, while 92.9% of the patients with other associated laryngotracheal stenosis were paradoxically decannulated. Of all the patients, 70% required more than 1 surgical procedure, although most of these interventions were to resolve minor issues following our protocol. The number of subsequent interventions was determined by the location of the stenosis, with there being more interventions when the posterior glottic stenosis was associated with another type of laryngotracheal stenosis (p=.001). CONCLUSIONS The surgical results for treating cicatricial posterior glottic stenosis are quite positive. However, unlike other types of posterior glottic stenosis (such as neurogenic abductor paralysis), it requires a greater number of interventions to achieve definitive decannulation. Endoscopic procedures play an important role and represent our main tool.
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Affiliation(s)
- Ana Maeso-Plaza
- Servicio de Otorrinolaringología, Hospital Universitario de Móstoles, Móstoles, Madrid, España.
| | - María Dablanca-Blanco
- Servicio de Otorrinolaringología, Hospital Universitario de Móstoles, Móstoles, Madrid, España
| | - Consuelo Ortega-Fernandez
- Servicio de Otorrinolaringología, Hospital Infanta Sofía, San Sebastián de los Reyes, Madrid, España
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Nair S, Nilakantan A, Sood A, Gupta A, Gupta A. Challenges in the Management of Laryngeal Stenosis. Indian J Otolaryngol Head Neck Surg 2015; 68:294-9. [PMID: 27508129 DOI: 10.1007/s12070-015-0936-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [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: 03/24/2015] [Accepted: 12/07/2015] [Indexed: 11/24/2022] Open
Abstract
Laryngeal stenosis is one of the most complex and challenging problems in the field of head and neck surgery. The management involves a multidisciplinary approach with multiple complex procedures. In this study we discuss our experience of laryngeal stenosis with regards to patient characteristics, cause and management. A retrospective analysis of 35 patients of laryngeal stenosis treated at a tertiary care centre was evaluated. Inclusion criteria were all patients with laryngeal stenosis who required surgical intervention. Exclusion criteria were patients with associated tracheal stenosis and laryngeal stenosis due to cancer. Demographic data was recorded and findings relating to aetiology, characteristics of stenosis and the various aspects of therapeutic procedures performed are discussed with review of literature. Among 35 patients, 24 were males and 11 females of the age group 2-79 years. 2 (5.7 %) patients had supraglottic stenosis, 11 (31.4 %) had glottis stenosis, 16 (45.7 %) had subglottic stenosis and 6 (17.1 %) had combined multiple sites stenosis. Each patient underwent an average of 3.22 surgical procedures like microlaryngoscopy and excision with cold instrument, CO2 laser excision or open procedures like laryngofissure and excision and laryngoplasty. Montgomery t tube insertion was a common procedure in 17 patients (48.6 %). Of the total 35 patients with severe LS, 27 (77.1 %) patients were successfully decanulated. The results of glottic (100 %) and supraglottic stenosis (100 %) are excellent as compared to subglottic (68.8 %) and combined stenosis (50 %) of multiple sites. Laryngeal stenosis with airway compromise causes significant morbidity to the patients and is a difficult condition to treat in both adult and pediatric population. The need for multiple surgical procedures is common in the treatment of laryngeal stenosis with the t-tube being an important aid in the management of this condition. Trauma especially post intubation trauma is the commonest cause of laryngeal stenosis and the involvement of subglottis has poor outcome as compared to other subsites.
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Affiliation(s)
- Satish Nair
- Department of ENT-HNS, Army Hospital (R&R), Delhi Cantt, India
| | | | - Amit Sood
- Department of ENT-HNS, Army Hospital (R&R), Delhi Cantt, India
| | - Atul Gupta
- Department of ENT-HNS, Army Hospital (R&R), Delhi Cantt, India
| | - Abhishek Gupta
- Department of ENT-HNS, Army Hospital (R&R), Delhi Cantt, India
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Izadi F, Ahmadi A, Zobairy H, Bakhti S, Hirbod H, Safdarian M. Fraser syndrome with laryngeal webs: Report of two cases and a review of the literature. Int J Pediatr Otorhinolaryngol 2015; 79:1959-62. [PMID: 26384833 DOI: 10.1016/j.ijporl.2015.08.043] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [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: 06/19/2015] [Revised: 08/28/2015] [Accepted: 08/29/2015] [Indexed: 11/30/2022]
Abstract
Fraser syndrome is a rare genetic disorder characterized by cryptophthalmos, syndactyly and laryngeal atresia. Although laryngeal webs occur uncommonly, they are the main cause of death in the first week of life in these patients. In this paper, we report two cases of Fraser syndrome with laryngeal webs. One of them was a twelve-year-old girl, primarily diagnosed with a supraglottic laryngeal web. In the course of treatment, a second web was also identified at the level of vocal cords, which is to our knowledge the first case of Fraser syndrome with two laryngeal webs in different levels.
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Affiliation(s)
- Farzad Izadi
- Department of Otolaryngology, Head and Neck Surgery, Iran University of Medical Sciences, Tehran, Iran.
| | - Aslan Ahmadi
- Department of Otolaryngology, Head and Neck Surgery, Iran University of Medical Sciences, Tehran, Iran.
| | - Hosna Zobairy
- Department of Otolaryngology, Head and Neck Surgery, Iran University of Medical Sciences, Tehran, Iran
| | - Sepideh Bakhti
- Department of Otolaryngology, Head and Neck Surgery, Iran University of Medical Sciences, Tehran, Iran
| | - Hengameh Hirbod
- Department of Otolaryngology, Head and Neck Surgery, Iran University of Medical Sciences, Tehran, Iran
| | - Mahdi Safdarian
- Department of Otolaryngology, Head and Neck Surgery, Iran University of Medical Sciences, Tehran, Iran.
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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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