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Barbour MC, Amin SN, Friedman SD, Perez FA, Bly RA, Johnson KE, Parikh SR, Richardson CM, Dahl JP, Aliseda A. Surface Reconstruction of the Pediatric Larynx via Structure from Motion Photogrammetry: A Pilot Study. Otolaryngol Head Neck Surg 2024; 170:1195-1199. [PMID: 38168480 PMCID: PMC10960702 DOI: 10.1002/ohn.635] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 11/10/2023] [Accepted: 12/07/2023] [Indexed: 01/05/2024]
Abstract
Endoscopy is the gold standard for characterizing pediatric airway disorders, however, it is limited for quantitative analysis due to lack of three-dimensional (3D) vision and poor stereotactic depth perception. We utilize structure from motion (SfM) photogrammetry, to reconstruct 3D surfaces of pathologic and healthy pediatric larynges from monocular two-dimensional (2D) endoscopy. Models of pediatric subglottic stenosis were 3D printed and airway endoscopies were simulated. 3D surfaces were successfully reconstructed from endoscopic videos of all models using an SfM analysis toolkit. Average subglottic surface error between SfM reconstructed surfaces and 3D printed models was 0.65 mm as measured by Modified Hausdorff Distance. Average volumetric similarity between SfM surfaces and printed models was 0.82 as measured by Jaccard Index. SfM can be used to accurately reconstruct 3D surface renderings of the larynx from 2D endoscopy video. This technique has immense potential for use in quantitative analysis of airway geometry and virtual surgical planning.
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Affiliation(s)
- Michael C Barbour
- Department of Mechanical Engineering, University of Washington, Seattle, Washington, USA
| | - Shaunak N Amin
- Department of Otolaryngology-Head and Neck Surgery, University of Washington, Seattle, Washington, USA
| | - Seth D Friedman
- Center for Respiratory Biology and Therapeutics, Seattle Children's Hospital, Seattle, Washington, USA
| | - Francisco A Perez
- Department of Pediatric Radiology, Seattle Children's Hospital, Seattle, Washington, USA
| | - Randall A Bly
- Department of Otolaryngology-Head and Neck Surgery, University of Washington, Seattle, Washington, USA
- Division of Pediatric Otolaryngology-Head and Neck Surgery, Seattle Children's Hospital, Seattle, Washington, USA
| | - Kaalan E Johnson
- Department of Otolaryngology-Head and Neck Surgery, University of Washington, Seattle, Washington, USA
- Division of Pediatric Otolaryngology-Head and Neck Surgery, Seattle Children's Hospital, Seattle, Washington, USA
| | - Sanjay R Parikh
- Department of Otolaryngology-Head and Neck Surgery, University of Washington, Seattle, Washington, USA
- Division of Pediatric Otolaryngology-Head and Neck Surgery, Seattle Children's Hospital, Seattle, Washington, USA
| | - Clare M Richardson
- Division of Pediatric Otolaryngology-Head and Neck Surgery, Seattle Children's Hospital, Seattle, Washington, USA
- Division of Pediatric Otolaryngology-Head and Neck Surgery, Phoenix Children's Hospital, Phoenix, Arizona, USA
| | - John P Dahl
- Department of Otolaryngology-Head and Neck Surgery, University of Washington, Seattle, Washington, USA
- Division of Pediatric Otolaryngology-Head and Neck Surgery, Seattle Children's Hospital, Seattle, Washington, USA
| | - Alberto Aliseda
- Department of Mechanical Engineering, University of Washington, Seattle, Washington, USA
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Roma C, Sá A, Lemos L, Frada R, Mexedo C. Successful Application of Transnasal Humidified Rapid-Insufflation Ventilatory Exchange in a Case of Subglottic Stenosis. Cureus 2024; 16:e58050. [PMID: 38738004 PMCID: PMC11088393 DOI: 10.7759/cureus.58050] [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] [Accepted: 04/10/2024] [Indexed: 05/14/2024] Open
Abstract
We widely employ microlaryngeal surgery to treat diverse oropharyngeal and laryngeal conditions, but it presents challenges to shared airway management. This case report addresses the limitations of conventional techniques, such as tracheal intubation and jet ventilation, and explores the emerging interest in transnasal humidified rapid insufflation ventilatory exchange (THRIVE). While THRIVE offers advantages such as enhanced visualization and reduced airway trauma, its application is limited by the duration of apnea, with the literature referring to a maximum of 30 minutes of apnea. We present the successful application of THRIVE as the primary airway management technique in a patient undergoing a 55-minute dilation procedure for subglottic stenosis. Successful oxygenation was achieved, creating a tubeless field and improving visibility. The patient maintained oxygen saturation above 98%, demonstrating the effectiveness of THRIVE in managing prolonged apnea. Remarkably, intentional ventilation via a face mask at specific moments allowed extended apneic oxygenation without harmful carbon dioxide levels. This report complies with the growing evidence supporting the efficacy of THRIVE in providing extended apnea for tubeless surgery. The success demonstrated in our case highlights the feasibility and effectiveness of THRIVE in situations demanding prolonged apnea and complex airway management.
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Affiliation(s)
- Cristiana Roma
- Anesthesiology and Critical Care, Unidade Local de Saúde de Santo António, Porto, PRT
| | - Andreia Sá
- Anesthesiology and Critical Care, Unidade Local de Saúde de Santo António, Porto, PRT
| | - Leonor Lemos
- Anesthesiology and Critical Care, Unidade Local de Saúde de Santo António, Porto, PRT
| | - Rita Frada
- Anesthesiology and Critical Care, Unidade Local de Saúde de Santo António, Porto, PRT
| | - Carlos Mexedo
- Anesthesiology and Critical Care, Unidade Local de Saúde de Santo António, Porto, PRT
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Liang KY, Miller KM, Syed F, Li H, Tierney WS, Nelson RC, Benninger MS, Bryson PC, Lorenz RR. Laser Versus Cold Steel for Endoscopic Management of Subglottic Stenosis. Otolaryngol Head Neck Surg 2024. [PMID: 38509830 DOI: 10.1002/ohn.727] [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: 10/08/2023] [Revised: 02/07/2024] [Accepted: 02/25/2024] [Indexed: 03/22/2024]
Abstract
OBJECTIVE Endoscopic management of subglottic stenosis (SGS) includes a wide range of techniques. This 17-year review compares treatment outcomes between carbon dioxide (CO2) laser and cold steel. STUDY DESIGN Retrospective chart review. SETTING Single tertiary care center. METHODS A chart review was performed for all patients undergoing endoscopic treatment of SGS at Cleveland Clinic between July 12, 2000 and September 1, 2017. Data collected included demographics, stenosis etiology, stenosis severity, comorbidities, treatment modality, and airway procedure history. The primary endpoint was repeated treatment-free survival (RTFS) within 2 years using a Kaplan-Meier analysis and Cox proportional hazard model. RESULTS A total of 139 patients (median [interquartile range] aged 48.7 [37.8, 57.0] years; 83.4% female) were included in the analysis, with etiologies including idiopathic (56.8%), granulomatosis with polyangiitis (25.2%), and intubation (16.5%). All patients underwent either cold steel (107 patients) or CO2 laser (32 patients) lysis of stenosis with concurrent dilation. RTFS within 2 years was 50.2% for CO2 laser and 31.9% for cold steel (hazard ratio [HR] and 95% confidence interval [CI]: 1.69, 0.96-2.97, P = .07). In patients with no prior airway procedures, there was no difference in RTFS between laser and cold knife (P = .41). However, in patients with prior airway procedures, RTFS was significantly greater in the laser group, even after adjusting for age, smoking history, and stenosis etiology (50.0% vs 16.8%, adjusted HR and CI: 2.82, 1.14-6.98, P = .025). CONCLUSION Endoscopic lysis of SGS with CO2 laser should be considered in revision cases.
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Affiliation(s)
- Kevin Y Liang
- Department of Otolaryngology-Head and Neck Surgery, Head and Neck Institute, Cleveland Clinic, Ohio, Cleveland, USA
| | - Katherine M Miller
- Department of Otolaryngology-Head and Neck Surgery, Head and Neck Institute, Cleveland Clinic, Ohio, Cleveland, USA
| | - Faez Syed
- Department of Neurology, Neurologic Institute, Cleveland Clinic, Ohio, Cleveland, USA
| | - Hong Li
- Department of Quantitative Health Sciences, Lerner Research Institute, Cleveland Clinic, Ohio, Cleveland, USA
| | - William S Tierney
- Department of Otolaryngology-Head and Neck Surgery, Head and Neck Institute, Cleveland Clinic, Ohio, Cleveland, USA
| | - Rebecca C Nelson
- Department of Otolaryngology-Head and Neck Surgery, Head and Neck Institute, Cleveland Clinic, Ohio, Cleveland, USA
| | - Michael S Benninger
- Department of Otolaryngology-Head and Neck Surgery, Head and Neck Institute, Cleveland Clinic, Ohio, Cleveland, USA
| | - Paul C Bryson
- Department of Otolaryngology-Head and Neck Surgery, Head and Neck Institute, Cleveland Clinic, Ohio, Cleveland, USA
| | - Robert R Lorenz
- Department of Otolaryngology-Head and Neck Surgery, Head and Neck Institute, Cleveland Clinic, Ohio, Cleveland, USA
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Mattioli F, Serafini E, Andreani A, Cappiello G, De Maria F, Marchioni D, Pinelli M, Marchioni A. Lipoaspirate Injection in Relapsing Idiopathic Subglottic Stenosis: Preliminary Results. Ann Otol Rhinol Laryngol 2024:34894241237021. [PMID: 38444374 DOI: 10.1177/00034894241237021] [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] [Indexed: 03/07/2024]
Abstract
OBJECTIVES The management of idiopathic subglottic stenosis (iSGS) poses a clinical challenge due to high recurrence rates following both endoscopic and open approaches, often leading to tracheostomy. The activation of abnormal T-cells and cytokine pathways has been linked to iSGS pathogenesis. Autologous adipose tissue centrifugation yields lipoaspirate, offering optimal anti-inflammatory effects and biocompatibility widely utilized in various medical settings. This report presents the first 3 cases employing endoscopic dilation (ED) in combination with local lipoaspirate injection to address recurrent iSGS. METHODS A prospective observational study was conducted, involving multidisciplinary evaluation by the Tracheal Team at the University of Modena. Patients meeting specific criteria were directed to undergo ED + lipoaspirate injection. RESULTS Three patients fulfilled the inclusion criteria. The mean number of prior endoscopic procedures performed was 8. Endoscopic examination revealed 90% stenosis in patient A, 60% stenosis in patient B, and 60% stenosis in patient C. All patients presented inflammatory tissue or incipient granulations at the stenotic site, with an average time of 6 months between previous procedures. After 15 months, none of the patients required further procedures, and endoscopic examination revealed a significant reduction or disappearance of inflammatory tissue with a stable airway lumen. CONCLUSIONS The observed results are encouraging in terms of reducing local inflammation and halting stenosis progression, especially in cases of short-term relapsing iSGS.
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Affiliation(s)
- Francesco Mattioli
- Department of Otolaryngology Head and Neck Surgery, University Hospital of Modena, Modena, Italy
| | - Edoardo Serafini
- Department of Otolaryngology Head and Neck Surgery, University Hospital of Modena, Modena, Italy
| | - Alessandro Andreani
- University Hospital of Modena, Respiratory Diseases Unit, Department of Medical and Surgical Sciences, University of Modena Reggio Emilia, Modena, Italy
| | - Gaia Cappiello
- University Hospital of Modena, Respiratory Diseases Unit, Department of Medical and Surgical Sciences, University of Modena Reggio Emilia, Modena, Italy
| | - Federico De Maria
- Department of Medical and Surgical Sciences, Division of Plastic Surgery, University of Modena and Reggio Emilia, Policlinico of Modena, Modena, Italy
| | - Daniele Marchioni
- Department of Otolaryngology Head and Neck Surgery, University Hospital of Modena, Modena, Italy
| | - Massimo Pinelli
- Department of Medical and Surgical Sciences, Division of Plastic Surgery, University of Modena and Reggio Emilia, Policlinico of Modena, Modena, Italy
| | - Alessandro Marchioni
- University Hospital of Modena, Respiratory Diseases Unit, Department of Medical and Surgical Sciences, University of Modena Reggio Emilia, Modena, Italy
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Sax L, Sharma S, Benedict J, Guy K, Mandybur I, Bittner M, Sinacori J, Rubinstein B. Comparison of Hemodynamics in Jet Ventilation vs. Intermittent Apnea for Airway Stenosis Surgery. Laryngoscope 2024; 134:1343-1348. [PMID: 37724978 DOI: 10.1002/lary.31045] [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: 03/05/2023] [Revised: 07/23/2023] [Accepted: 08/22/2023] [Indexed: 09/21/2023]
Abstract
OBJECTIVE The objective of this study is to assess the impact of two different ventilation techniques, jet ventilation and apneic anesthesia with intermittent ventilation (AAIV), on patient hemodynamics and operative time during endoscopic laryngotracheal stenosis surgery. METHODS Retrospective chart review of patients who underwent airway dilation for laryngotracheal stenosis by a single surgeon at a single institution from October 1, 2000 through January 2, 2020. Logistic regression, Mann-Whitney U tests and chi square analysis were used to determine statistical significance. RESULTS A total of 157 patients, 43 (27.4%) male and 114 (72.6%) female, and 605 total encounters were included for analysis. There were no significant differences in hemodynamic outcomes when comparing the AAIV and jet ventilation groups. Specifically, there was no significant difference in either peak end-tidal CO2 or nadir O2 saturation between the AAIV and jet ventilation groups (p = 0.4016) and (p = 0.1357), respectively. The patients in the AAIV group had a significantly higher median BMI 32.93 (27.40-39.40) compared with 28.80 (24.1-32.65) (p = 0.0001). Although not necessarily clinically significant, patients with higher BMI had lower median O2 nadirs (97.8%) than non-obese patients (99.2%) (p < 0.0001). The median total procedure time was equivalent when comparing the two ventilation techniques. CONCLUSION AAIV is a safe method of ventilation for patients undergoing endoscopic laryngotracheal stenosis surgery with no significant differences in patient hemodynamics or procedure time when compared with jet ventilation. AAIV was the preferred method of ventilation for obese patients undergoing endoscopic laryngotracheal stenosis surgery. LEVEL OF EVIDENCE 3 Laryngoscope, 134:1343-1348, 2024.
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Affiliation(s)
- Leah Sax
- Department of Otolaryngology, Eastern Virginia Medical School, Norfolk, Virginia, U.S.A
| | - Shaan Sharma
- Eastern Virginia Medical School, Norfolk, Virginia, U.S.A
| | - Jacob Benedict
- Department of Otolaryngology, Eastern Virginia Medical School, Norfolk, Virginia, U.S.A
| | - Kevin Guy
- Eastern Virginia Medical School, Norfolk, Virginia, U.S.A
| | - Ian Mandybur
- Eastern Virginia Medical School, Norfolk, Virginia, U.S.A
| | | | - John Sinacori
- Department of Otolaryngology, Eastern Virginia Medical School, Norfolk, Virginia, U.S.A
| | - Benjamin Rubinstein
- Department of Otolaryngology, Eastern Virginia Medical School, Norfolk, Virginia, U.S.A
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Miller KM, Liang KY, Nero N, Benninger MS, Nelson RC, Tierney WS, Lorenz RR, Bryson PC. Surgical Management of Airway Stenosis During Pregnancy: A Scoping Review. Laryngoscope 2024; 134:1014-1022. [PMID: 37632727 DOI: 10.1002/lary.30994] [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: 03/25/2023] [Revised: 07/11/2023] [Accepted: 08/03/2023] [Indexed: 08/28/2023]
Abstract
OBJECTIVE There are several options for surgical management of subglottic stenosis, including endoscopic and open procedures. However, treatment algorithms, outcomes, and anesthetic management of subglottic stenosis during pregnancy are not well described. DATA SOURCES MEDLINE, EMBASE, and the Cochrane databases. REVIEW METHODS A scoping review of management of subglottic stenosis during pregnancy was performed, and then reported in compliance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Inclusion criteria consisted of those with subglottic or tracheal stenosis aged greater than 18 years, those in whom management was performed during pregnancy, and those who reported delivery related outcomes. RESULTS After systematic review and detailed search of 330 identified articles, 15 articles met inclusion criteria and were included in the final analysis. All studies were case reports or case series (level 4 evidence). This study identified 27 patients. The median age was 29 and the median gestational age at intervention was 28 weeks. Left lateral positioning and fetal heart rate monitoring were used in nearly every case. The most common intervention performed was endoscopic balloon dilation. In many cases, jet ventilation or transnasal humidified rapid insufflation ventilatory exchange was satisfactory for maintenance of the airway. Three women ultimately required tracheostomy prior to labor and delivery. There was no fetal death or complications reported in these studies, and all but one woman proceeded to deliver at term. CONCLUSION Endoscopic balloon dilation during pregnancy is safe and effective, resulting in optimized respiratory outcomes for the mother and safe delivery of the fetus. The third trimester appears to be safe for airway intervention. Laryngoscope, 134:1014-1022, 2024.
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Affiliation(s)
| | - Kevin Y Liang
- Cleveland Clinic, Head & Neck Institute, Cleveland, Ohio, U.S.A
| | - Neil Nero
- Cleveland Clinic, Education Institute, Cleveland, Ohio, U.S.A
| | | | | | | | - Robert R Lorenz
- Cleveland Clinic, Head & Neck Institute, Cleveland, Ohio, U.S.A
| | - Paul C Bryson
- Cleveland Clinic, Head & Neck Institute, Cleveland, Ohio, U.S.A
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Awadallah A, Armstrong M, Aden A, Weidermann J, Bayan SL, Ekbom DC. Life-Threatening Subglottic Thrombus Formation after Administration of Nebulized Tranexamic Acid. Laryngoscope 2024; 134:1356-1358. [PMID: 37622726 DOI: 10.1002/lary.30973] [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: 07/26/2023] [Accepted: 07/28/2023] [Indexed: 08/26/2023]
Abstract
We present a case of subglottic thrombus formation after administration of nebulized tranexamic acid (TXA) for postoperative hemoptysis following CO2 laser wedge excision of subglottic stenosis. Although other factors certainly could have resulted in postoperative bleeding and subsequent thrombus formation, the patient's rapid decompensation following administration of nebulized TXA suggests a direct effect. We recommend implementing an airway action plan regarding TXA use for patients presenting to the emergency department with postoperative hemorrhage following otolaryngology procedures. Laryngoscope, 134:1356-1358, 2024.
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Affiliation(s)
| | - Michael Armstrong
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Aisha Aden
- Alix School of Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Joshua Weidermann
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Semirra L Bayan
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Dale C Ekbom
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, USA
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Wei C, Wreh D, Gressen J, Nguyen A. Anesthetic Management of Unanticipated Subglottic Stenosis in a Patient Undergoing Coronary Artery Bypass Graft Surgery. Cureus 2024; 16:e56110. [PMID: 38618313 PMCID: PMC11014738 DOI: 10.7759/cureus.56110] [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] [Accepted: 03/13/2024] [Indexed: 04/16/2024] Open
Abstract
A 62-year-old female presented for a scheduled coronary artery bypass graft (CABG) and was found to have an unexpected subglottic stenosis during routine intubation. The case was aborted and six days later, the patient underwent lasering of the stenotic subglottic region and airway balloon dilation. In this case report, causes of subglottic stenosis and surgical/anesthetic management of the condition are discussed. The management of subglottic stenosis in this patient was complicated by concurrent severe coronary artery disease (CAD) involving the left main coronary artery and timing of airway surgery relative to interventions for her CAD. In situations of undiagnosed subglottic stenosis, anesthesiologists should be familiar with airway management based on the location and severity of the stenosis. Close multidisciplinary team management is required for patients who have other complex comorbidities.
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Affiliation(s)
- Claudia Wei
- Anesthesiology, Baylor College of Medicine, Houston, USA
| | - Dominique Wreh
- Anesthesiology, Baylor College of Medicine, Houston, USA
| | - Jacy Gressen
- Anesthesiology, Baylor College of Medicine, Houston, USA
| | - Anvinh Nguyen
- Anesthesiology, Baylor College of Medicine, Houston, USA
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Feng M, Watson W, Arom G, Damazo B, Krishna P. More Than 1 Way to Put in A T-Tube: A Review of Different Techniques Used in Insertion of Montgomery T-Tubes. Ann Otol Rhinol Laryngol 2024; 133:205-213. [PMID: 37706490 DOI: 10.1177/00034894231198756] [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] [Indexed: 09/15/2023]
Abstract
OBJECTIVE The Montgomery T-tube is a commonly used device initially designed as a temporary airway stent, but also used as a long-term airway solution for stenosis. For patients undergoing either endoscopic or open airway procedures, proper techniques for inserting these tubes are well documented. This review compiles the techniques used for insertion of the Montgomery T-tube stent. METHODS The NCBI Pubmed database was queried using the keywords: "stent," "Montgomery," "T-tube," "stenosis," "technique." A total of 33 papers were reviewed with 12 papers selected for the study. Papers were selected based on inclusion criteria of English language and whether the paper described a technique for insertion of a Montgomery T-tube into the airway. Papers were excluded if they did not describe the technique of insertion of Montgomery T-tubes or dealt with another aspect of T-tube management. RESULTS The 12 selected papers each described a different technique for insertion of a Montgomery T-tube stent. Though nearly all the selected studies described using a modified Seldinger technique for insertion of the T-tube, there were discrepancies and a wide array of different instruments used. The instrument and/or technique that was selected was often determined by the individual need of the patient. Several studies addressed the challenge of interrupting ventilation while inserting or exchanging a T-tube in the operating room. These studies described attaching the T-tube to the endotracheal tube to pass the T-tube into the airway while allowing for continuous ventilation. Yet other studies used optical forceps or rigid bronchoscopes to allow placement of the T-tube with direct visualization. CONCLUSION There are many techniques used for the insertion of a Montgomery T-tube. Nearly all studies described using a modified Seldinger technique and all the studies agreed on the necessity of a team approach for placement of the Montgomery T-tube.
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Affiliation(s)
- Max Feng
- Department of Otolaryngology-Head and Neck Surgery, Loma Linda University, Loma Linda, CA, USA
| | - WayAnne Watson
- Department of Otolaryngology-Head and Neck Surgery, Loma Linda University, Loma Linda, CA, USA
| | - Gabriel Arom
- Department of Otolaryngology-Head and Neck Surgery, Loma Linda University, Loma Linda, CA, USA
| | - Benjamin Damazo
- Department of Otolaryngology-Head and Neck Surgery, Loma Linda University, Loma Linda, CA, USA
| | - Priya Krishna
- Department of Otolaryngology-Head and Neck Surgery, Loma Linda University, Loma Linda, CA, USA
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10
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Dabbous H, Chorney SR, Johnson RF, Kou YF. Surgical Outcomes by Early Airway Endoscopy Findings after Pediatric Staged Laryngotracheoplasty. Laryngoscope 2024; 134:963-967. [PMID: 37458330 DOI: 10.1002/lary.30875] [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: 06/13/2023] [Accepted: 06/27/2023] [Indexed: 01/18/2024]
Abstract
OBJECTIVES To determine how initial postoperative airway endoscopy findings after stent removal predict successful decannulation in children undergoing double-staged laryngotracheoplasty (dsLTP). Secondary objectives assessed timing of decannulation and number of endoscopic interventions needed after dsLTP. METHODS A case series with chart review included children who underwent dsLTP at a tertiary children's hospital between 2008 and 2021. Rates of decannulation, time to decannulation, and number of interventions after dsLTP were recorded for children with high- or low-grade stenosis at the first bronchoscopy after stent removal. RESULTS Of the 65 children who were included, 88% had high-grade stenosis and 98% had a preoperative tracheostomy. Successful decannulation happened in 74% of the children, and 44% of the children were decannulated within 12 months of surgery. For children with low-grade stenosis at the first endoscopy after stent removal, 84% were successfully decannulated compared with 36% of the children with high-grade stenosis (p = 0.001). After dsLTP, children with high-grade stenosis required 7.5 interventions (SD: 3.3) compared with 4.0 interventions (SD: 3.0) for children with low-grade stenosis (p < 0.001). Decannulated children with high-grade stenosis necessitated more endoscopic procedures (7.0 vs. 3.7, p = 0.02). Time to decannulation was similar between children with high- and low-grade early postoperative stenosis (21.9 vs. 17.8 months, p = 0.63). CONCLUSIONS Higher grade stenosis identified on the first airway endoscopy after suprastomal stent removal is correlated with lower decannulation rates and more postoperative endoscopic interventions. Although time to decannulation was not impacted by early stenosis grade, surgeons might utilize these early airway findings to counsel families and prognosticate possible surgical success. LEVEL OF EVIDENCE 4 Laryngoscope, 134:963-967, 2024.
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Affiliation(s)
- Helene Dabbous
- Department of Otolaryngology-Head & Neck Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Stephen R Chorney
- Department of Otolaryngology-Head & Neck Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA
- Department of Pediatric Otolaryngology, Children's Medical Center Dallas, Dallas, Texas, USA
| | - Romaine F Johnson
- Department of Otolaryngology-Head & Neck Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA
- Department of Pediatric Otolaryngology, Children's Medical Center Dallas, Dallas, Texas, USA
| | - Yann-Fuu Kou
- Department of Otolaryngology-Head & Neck Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA
- Department of Pediatric Otolaryngology, Children's Medical Center Dallas, Dallas, Texas, USA
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11
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Gehret PM, Dumas AA, Jacobs IN, Gottardi R. A Pilot Study of Decellularized Cartilage for Laryngotracheal Reconstruction in a Neonatal Pig Model. Laryngoscope 2024; 134:807-814. [PMID: 37658705 PMCID: PMC11046979 DOI: 10.1002/lary.31017] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2023] [Revised: 06/30/2023] [Accepted: 08/03/2023] [Indexed: 09/03/2023]
Abstract
OBJECTIVE Severe subglottic stenosis develops as a response to intubation in 1% of the >200,000 neonatal intensive care unit infants per year and may require laryngotracheal reconstruction (LTR) with autologous hyaline cartilage. Although effective, LTR is limited by comorbidities, severity of stenosis, and graft integration. In children, there is a significant incidence of restenosis requiring revision surgery. Tissue engineering has been proposed to develop alterative grafting options to improve outcomes and eliminate donor-site morbidity. Our objective is to engineer a decellularized, channel-laden xenogeneic cartilage graft, that we deployed in a proof-of-concept, neonatal porcine LTR model. METHODS Meniscal porcine cartilage was freeze-thawed and washed with pepsin/elastase to decellularize and create microchannels. A 6 × 10-mm decellularized cartilage graft was then implanted in 4 infant pigs in an anterior cricoid split. Airway patency and host response were monitored endoscopically until sacrifice at 12 weeks, when the construct phenotype, cricoid expansion, mechanics, and histomorphometry were evaluated. RESULTS The selective digestion of meniscal components yielded decellularized cartilage with cell-size channels. After LTR with decellularized meniscus, neonatal pigs were monitored via periodic endoscopy observing re-epithelization, integration, and neocartilage formation. At 12 weeks, the graft appeared integrated and exhibited airway expansion of 4 mm in micro-CT and endoscopy. Micro-CT revealed a larger lumen compared with age-matched controls. Finally, histology showed significant neocartilage formation. CONCLUSION Our neonatal porcine LTR model with a decellularized cartilage graft is a novel approach to tissue engineered pediatric LTR. This pilot study sets the stage for "off-the-shelf" graft procurement and future optimization of MEND for LTR. LEVEL OF EVIDENCE NA Laryngoscope, 134:807-814, 2024.
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Affiliation(s)
- Paul M Gehret
- Department of Surgery, Division of Otolaryngology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, U.S.A
- Department of Bioengineering, School of Engineering and Applied Science, University of Pennsylvania, Philadelphia, Pennsylvania, U.S.A
| | - Alexandra A Dumas
- Department of Surgery, Division of Otolaryngology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, U.S.A
- Department of Bioengineering, School of Engineering and Applied Science, University of Pennsylvania, Philadelphia, Pennsylvania, U.S.A
| | - Ian N Jacobs
- Department of Surgery, Division of Otolaryngology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, U.S.A
- Department of Otorhinolaryngology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, U.S.A
| | - Riccardo Gottardi
- Department of Surgery, Division of Otolaryngology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, U.S.A
- Department of Bioengineering, School of Engineering and Applied Science, University of Pennsylvania, Philadelphia, Pennsylvania, U.S.A
- Department of Otorhinolaryngology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, U.S.A
- Department of Pediatrics, Division of Pulmonary and Sleep Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, U.S.A
- Department of Orthopaedic Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, United States
- Ri.MED Foundation, Palermo, Italy
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12
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Almuhanna A, Almahboob A, Alhussien A, Aljurayyed R, Alammar A. Current Therapeutic Approaches to Subglottic Stenosis in Patients With GPA: A Systematic Review. Ear Nose Throat J 2024; 103:117-125. [PMID: 34392732 DOI: 10.1177/01455613211036246] [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] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND The management of subglottic stenosis (SGS) in granulomatosis patients with polyangiitis (GPA) has no clear guidelines. This systematic review aimed to identify different surgical techniques and evaluate the outcomes of applied procedures. METHODS An electronic search was performed using 3 major databases, CINAHL, PubMed, and Clinical key, to include relevant studies published from the databases from inception through January 2017. All primary studies reporting treatment of SGS in cases with GPA were included. Articles were excluded if not relevant to the research topic or if they were duplicates, review articles, editorials, short comments, unpublished data, conference abstracts, case reports, animal studies, or non-English studies. RESULTS Thirteen papers were included in our systematic review with a total of 267 cases for the qualitative review Endoscopic approaches showed favorable outcomes with the need to use multiple procedures to achieve remission. The open transcervical approach showed excellent results mainly after failure of other endoscopic techniques. Tracheostomy was necessary for severe respiratory obstruction symptoms. Medical treatment was essential for stabilizing the active disease and therefore may enhance the success rate postoperatively. CONCLUSION Subglottic stenosis in patients with GPA requires a multidisciplinary approach to provide optimal management regarding disease activity, grade of stenosis, and severity of symptoms.
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Affiliation(s)
- Ashjan Almuhanna
- Otolaryngology and Head & Neck Surgery, Ministry of Health Kingdom of Saudi Arabia, Riyadh, Saudi Arabia
| | - Ayshah Almahboob
- Department of Otorhinolaryngology, Head and Neck Surgery, King Abdul-Aziz University Hospital, Riyadh, Saudi Arabia
| | - Ahmed Alhussien
- Department of Otorhinolaryngology, Head and Neck Surgery, King Abdul-Aziz University Hospital, Riyadh, Saudi Arabia
| | - Reem Aljurayyed
- Otolaryngology and Head & Neck Surgery, Ministry of Health Kingdom of Saudi Arabia, Riyadh, Saudi Arabia
| | - Ahmed Alammar
- Department of Otorhinolaryngology, Head and Neck Surgery, King Abdul-Aziz University Hospital, Riyadh, Saudi Arabia
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13
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Singh E, Hullfish H, Fils A, Ma R, Rosow D. Predictors of Clinical Outcomes in Adult Laryngotracheal Stenosis. Laryngoscope 2024; 134:257-263. [PMID: 37497850 DOI: 10.1002/lary.30908] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Revised: 05/27/2023] [Accepted: 06/23/2023] [Indexed: 07/28/2023]
Abstract
OBJECTIVES Sequelae of laryngotracheal stenosis (LTS) can be devastating, often necessitating tracheostomy. This study aims to describe the characteristics and outcomes of patients with LTS and identify risk factors for long-term tracheostomy dependence stratified by etiology. METHODS A retrospective chart review was performed on 215 patients diagnosed with LTS from 09/01/2011 to 12/31/2020. Patients were grouped based on the cause of LTS. Patient factors were compared to evaluate risk factors for long-term tracheostomy dependence. RESULTS Of the 215 patients, 129 (60%) were classified as iatrogenic, 41 (19%) idiopathic, 10 (4.7%) cancer treatment, 18 (8.3%) autoimmune, and 17 (8%) patients unknown. Idiopathic patients were significantly less likely to be tracheostomy-dependent compared with iatrogenic patients (p < 0.001) and cancer patients (p < 0.05). The mortality rate did not significantly differ among the categories (p = 0.1078). Significant improvement was seen after treatment, as the median percent of stenosis at presentation was 52.5%, and the median percent of stenosis at the most recent visit was 10% (p < 0.001). The autoimmune group received the most steroid injections (mean = 6.56; SD = 11.96). The idiopathic group had the longest surgery-free interval (mean = 30.8 months; SD = 27.7). CONCLUSION Iatrogenic and cancer patients were more likely to be tracheostomy-dependent. There was a significant improvement in percent and length of stenosis after treatment, with the idiopathic group having the longest surgery-free interval. Mortality risk did not differ among the different etiologies of LTS. LEVEL OF EVIDENCE 3 Laryngoscope, 134:257-263, 2024.
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Affiliation(s)
- Eshita Singh
- Department of Otolaryngology, University of Miami Miller School of Medicine, Miami, Florida, U.S.A
| | - Haley Hullfish
- Department of Otolaryngology, University of Miami Miller School of Medicine, Miami, Florida, U.S.A
| | - Aaron Fils
- Department of Otolaryngology, University of Miami Miller School of Medicine, Miami, Florida, U.S.A
| | - Ruixuan Ma
- Division of Biostatistics, Department of Public Health Sciences, Biostatistics Collaboration and Consulting Core, University of Miami Miller School of Medicine, Miami, Florida, U.S.A
| | - David Rosow
- Department of Otolaryngology, University of Miami Miller School of Medicine, Miami, Florida, U.S.A
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14
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Jakiel AT, Berreta K, Sahhar HS, Rishmawi S. Recurrent Subglottic Stenosis in a 16-Month-Old Male in the Setting of Influenza A, Intubation, and Honey Consumption. Cureus 2024; 16:e52315. [PMID: 38357061 PMCID: PMC10866550 DOI: 10.7759/cureus.52315] [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] [Accepted: 01/10/2024] [Indexed: 02/16/2024] Open
Abstract
Recurrent episodes of subglottic stenosis are rare in the literature, and the etiologic causes are misunderstood but can be congenital, idiopathic, or iatrogenic in nature. Complications of intubation can result in subsequent inflammation and reactive processes. This case involves a 16-month-old male who suffered from a recurrent episode of subglottic stenosis in the setting of croup, influenza, and honey consumption. He had presented to the emergency department in respiratory distress after ingesting a home remedy of onion juice and honey. He had been discharged one day prior from the pediatric intensive care unit after four days of intubation and a seven-day hospital course with evidence of croup on imaging. He was readmitted, and subglottic edema and narrowing were confirmed via endoscopy, which prompted antibiotic treatment and close monitoring. After three days of monitoring and re-evaluation by bronchoscopy, the patient's condition began to improve, and no intubation was necessary. It is unclear what the cause of recurrent subglottic stenosis is due to the patient's clinical picture being clouded by a potential allergic reaction to honey versus an inflammatory reactive process post-intubation from the previous admission days prior. This case emphasizes the need for further research on the prevalence and etiology of recurrent subglottic stenosis and a deeper understanding of how to optimize diagnosis and treatment.
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Affiliation(s)
- Allison T Jakiel
- Pediatric Intensive Care Unit, Edward Via College of Osteopathic Medicine, Blacksburg, USA
| | - Krisdaniel Berreta
- Pediatric Intensive Care Unit, Edward Via College of Osteopathic Medicine, Spartanburg, USA
| | - Hanna S Sahhar
- Pediatric Medicine, Edward Via College of Osteopathic Medicine, Spartanburg, USA
- Pediatric Intensive Care Unit, Spartanburg Regional Healthcare System, Spartanburg, USA
| | - Sami Rishmawi
- Pediatric Medicine, Edward Via College of Osteopathic Medicine, Spartanburg, USA
- Pediatric Intensive Care Unit, Spartanburg Regional Healthcare System, Spartanburg, USA
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15
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Shen S, Ding AS, Zhao J, Seo S, Ng K, Walsh J. Utilizing a Functional Lumen Imaging Probe for Evaluation of the Pediatric Airway, A Pilot Study. Laryngoscope 2024; 134:108-112. [PMID: 37194663 PMCID: PMC10654256 DOI: 10.1002/lary.30745] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 03/30/2023] [Accepted: 04/24/2023] [Indexed: 05/18/2023]
Abstract
OBJECTIVES Accurate and reproducible measurements of the pediatric airway are critical for diagnostic evaluation and management of subglottic and tracheal stenosis. The endoluminal functional lumen imaging probe (EndoFLIP) is a catheter-based imaging probe which utilizes impedance planimetry to calculate luminal parameters, including cross-sectional area and compliance. Herein, we demonstrate the feasibility of this system for multidimensional evaluation of the pediatric airway. METHODS 3D-printed pediatric laryngotracheal models were created based on computed tomography scans, then artificially deformed to simulate both circumferential and posterior subglottic stenosis. Two observers made six measurements of the minimum cross-sectional area (MCSA) and length of stenosis of each model with EndoFLIP. Agreement between observer measurements and model dimensions was evaluated using Lin's concordance correlation coefficient; inter-observer reliability was assessed using intraclass correlation. RESULTS Four models were created: two without pathology (MCSA: 132.4, 44.3 mm2 ) and two with subglottic stenosis (MCSA: 28.7, 59.7 mm2 , stenotic length 27.8, 24.4 mm). Observer measurements of MCSA and length of stenosis demonstrated high concordance with the models (r = 0.99, 0.95, p < 0.001) with a mean error of 4.5% and 18.2% respectively. There was a low coefficient of variation (0.6%-2.8%) for measurements, indicating high precision. Interrater reliability was high for both MCSA and stenotic length (ICC: 0.99, 0.98). CONCLUSIONS The EndoFLIP system allows for accurate and reproducible measurements of cross-sectional area and stenotic length in pediatric airway models. This method may provide further advantages in the evaluation of airway distensibility, as well as measurements of asymmetric airway pathology. LEVEL OF EVIDENCE NA Laryngoscope, 134:108-112, 2024.
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Affiliation(s)
- Sarek Shen
- Johns Hopkins School of Medicine, Department of Otolaryngology-Head and Neck Surgery. Baltimore, Maryland. USA
| | - Andy S. Ding
- Johns Hopkins School of Medicine, Department of Otolaryngology-Head and Neck Surgery. Baltimore, Maryland. USA
| | - Jared Zhao
- Johns Hopkins School of Medicine. Baltimore, Maryland. USA
| | - Stefanie Seo
- Johns Hopkins School of Medicine. Baltimore, Maryland. USA
| | - Kenneth Ng
- Johns Hopkins School of Medicine, Department of Pediatrics. Baltimore, Maryland. USA
| | - Jonathan Walsh
- Johns Hopkins School of Medicine, Department of Otolaryngology-Head and Neck Surgery. Baltimore, Maryland. USA
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16
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Soldatskiy YL, Nikitina DN, Polunin MM, Edgem SR, Krugovskaya NL, Subbotina AS. [Balloon dilation as an alternative to tracheotomy for acquired subglottic stenosis in children of the first year of life]. Vestn Otorinolaringol 2024; 89:10-15. [PMID: 38506019 DOI: 10.17116/otorino20248901110] [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] [Indexed: 03/21/2024]
Abstract
OBJECTIVE To study the efficacy and safety of balloon dilation as the first choice method in the treatment of children of the first year of life with acquired subglottic stenosis. MATERIAL AND METHODS A retrospective analysis of the treatment of 25 patients aged 27 days to 11 months of life (average age 5.3±3.76 months) with subglottic stenosis caused by prolonged intubation, in whom balloon dilation was the first method of treatment. Grade III Cotton-Myer stenosis was preoperatively detected in 22 children, the remaining 3 had grade II stenosis. RESULTS The success rate of balloon dilation was 100%; tracheotomy was not required in any case, the absence of stenosis during a follow-up examination in the catamnesis was recorded in 14 (56%) children, the remaining 11 (44%) had grade 0-I stenosis and did not cause respiratory disorders. In 1 child (1.5 years old), a subglottic cyst was removed after balloon dilation. One dilation was required in 18 (72%) children, two - in 5 (20%), three and four - respectively for 1 patient. If additional intervention was necessary, the operation was repeated 10 days - 3 months after the previous one. There were no postoperative complications. CONCLUSION Balloon dilation is a highly effective and safe alternative to traditional surgical interventions for acquired subglottic stenosis in children of the first year of life and can be recommended as a method of first choice.
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Affiliation(s)
- Yu L Soldatskiy
- Morozovskaya Children's City Clinical Hospital, Moscow, Russia
| | - D N Nikitina
- Morozovskaya Children's City Clinical Hospital, Moscow, Russia
| | - M M Polunin
- Morozovskaya Children's City Clinical Hospital, Moscow, Russia
- Pirogov Russian National Research Medical University, Moscow, Russia
| | - S R Edgem
- Morozovskaya Children's City Clinical Hospital, Moscow, Russia
| | - N L Krugovskaya
- Morozovskaya Children's City Clinical Hospital, Moscow, Russia
| | - A S Subbotina
- Pirogov Russian National Research Medical University, Moscow, Russia
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17
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Langlie JA, Pasick LJ, Rosow DE. Cost-Effectiveness of Steroids for Prolonging the Surgery-Free Interval in Subglottic Stenosis. Laryngoscope 2023; 133:3436-3442. [PMID: 37278490 DOI: 10.1002/lary.30800] [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: 01/29/2023] [Revised: 05/15/2023] [Accepted: 05/20/2023] [Indexed: 06/07/2023]
Abstract
OBJECTIVES Repeat endoscopic dilation (ED) in the operating room for subglottic stenosis (SGS) remains an economic burden to patients. The cost-effectiveness (CE) of adjuvant serial intralesional steroid injections (SILSI) to prolong the surgery-free interval (SFI) in SGS patients requiring ED has yet to be studied. METHODS Details of the cost of SILSI and ED were received from our tertiary academic center. SFI, cost of intervention, and the effect of SILSI on prolonging SFI were collected from a systematic review by Luke et al. SGS etiologies in the review included idiopathic, iatrogenic, or autoimmune. A break-even analysis, comparing the cost of SILSI alone with the cost of repeat ED, was performed to determine if SILSI injections were cost-effective in prolonging the SFI. RESULTS Average extension of the SFI with SILSI was an additional 219.3 days compared to ED alone based on a systematic review of the literature. 41/55 (74.5%) cases did not require further ED once in-office SILSI management began. SILSI administered in a 4-dose series in 3-to-7-week intervals (~$7,564.00) is CE if the reported recurrence rate of SGS requiring ED (~$39,429.00) has an absolute risk reduction (ARR) of at least 19.18% with the use of SILSI. Based on the literature, SILSI prevents ~3 out of every 4 cases of SGS at sufficient follow-up from undergoing repeat ED, resulting in an ARR of ~75%. CONCLUSIONS SILSI is economically reasonable if it prolongs the SFI of at least one case of recurrence out of 5. SILSI, therefore, can be CE in extending the interval for surgical ED. LEVEL OF EVIDENCE NA Laryngoscope, 133:3436-3442, 2023.
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Affiliation(s)
- Jake A Langlie
- Department of Otolaryngology, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Luke J Pasick
- Department of Otolaryngology, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - David E Rosow
- Department of Otolaryngology, University of Miami Miller School of Medicine, Miami, Florida, USA
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18
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D'Oto A, Baker H, Mau T, Childs LF, Tibbetts KM. Characteristics of Idiopathic Subglottic Stenosis in the Elderly. Laryngoscope 2023; 133:3075-3079. [PMID: 37166144 DOI: 10.1002/lary.30742] [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: 03/02/2023] [Revised: 04/19/2023] [Accepted: 04/26/2023] [Indexed: 05/12/2023]
Abstract
OBJECTIVE To compare characteristics of patients ≥65 years presenting with idiopathic subglottic stenosis (iSGS) to patients diagnosed at <65 years. We hypothesize that the groups have similar comorbidities and disease courses. DATA SOURCES Medical records of patients treated for iSGS at a tertiary care institution from January 2005-September 2022. REVIEW METHODS Patient demographics, time from symptom onset to diagnosis, medical history and comorbidities, and treatment modalities/intervals were recorded and analyzed. Characteristics of patients ≥65 and <65 years at presentation were compared using Chi-square analysis for non-numeric values and the Mann-Whitney U-test for numeric values. RESULTS One hundred seven patients with iSGS were identified and 16 (15%) were aged ≥65 years (mean age 72.6, 15 female) at presentation. These patients were compared to 91 patients aged <65 years (mean age = 47.6, 90 female). Patients ≥65 years had higher rates of type 2 diabetes mellitus (T2DM) (p = 0.004) and tobacco use (p = 0.004). There were no significant differences in body mass index, gastroesophageal reflux disease, hormone replacement therapy, time from symptom onset to presentation, or length of operative treatment intervals. CONCLUSION Patients ≥65 years with iSGS have higher rates of tobacco use, suggesting that alterations in wound healing may play a role in the development of iSGS in this age group. Although rates of T2DM were higher in the elderly group, clinical significance may be limited given the overall higher rate of diabetes mellitus in the elderly population. LEVEL OF EVIDENCE 4 Laryngoscope, 133:3075-3079, 2023.
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Affiliation(s)
- Alexandra D'Oto
- Department of Otolaryngology- Head and Neck Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Hayley Baker
- Department of Otolaryngology- Head and Neck Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Ted Mau
- Department of Otolaryngology- Head and Neck Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Lesley F Childs
- Department of Otolaryngology- Head and Neck Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Kathleen M Tibbetts
- Department of Otolaryngology-Head and Neck Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
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19
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Lau RJ, Lackey TG, Samedi V, Fink DS. Nontuberculous Mycobacterial Infection of Larynx and Cervical Trachea. Ann Otol Rhinol Laryngol 2023; 132:1487-1492. [PMID: 36951110 DOI: 10.1177/00034894231161871] [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] [Indexed: 03/24/2023]
Abstract
OBJECTIVES To present a patient with the first case of NTM (nontuberculous mycobacteria) infection of the larynx extending to cervical trachea, and the first case of subglottic stenosis associated with an NTM infection. METHODS Case report and review of the literature. RESULTS A 68-year-old female with history of prior smoking, gastroesophageal reflux disease, asthma, bronchiectasis, and tracheobronchomalacia presented with a 3-month history of shortness of breath, exertional inspiratory stridor, and hoarseness. Flexible laryngoscopy demonstrated ulceration of medial aspect of right vocal fold and subglottic tissue abnormality with crusting and ulceration extending through the upper trachea. Microdirect laryngoscopy with tissue biopsies and carbon dioxide (CO2) laser ablation of disease completed, and intraoperative culture revealed positive Aspergillus and acid-fast bacilli with Mycobacterium abscessus (type of NTM). Patient began antimicrobial treatment of cefoxitin, imipenem, amikacin, azithromycin, clofazimine, and itraconazole. Fourteen months after initial presentation, patient developed subglottic stenosis with limited extension into the proximal trachea prompting CO2 laser incision, balloon dilation, and steroid injection of the subglottic stenosis. Patient remains disease free without further subglottic stenosis. CONCLUSION Laryngeal NTM infections are exceedingly rare. Failure to consider NTM infection in the differential diagnosis when presented with an ulcerative, exophytic mass in patients with increased risk factors (structural lung disease, Pseudomonas colonization, chronic steroid use, prior NTM positivity) may result in insufficient tissue evaluation, delayed diagnosis, and disease progression.
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Affiliation(s)
- Ryan J Lau
- Department of Otolaryngology - Head & Neck Surgery, University of Colorado, Aurora, CO, USA
| | - Taylor G Lackey
- Department of Otolaryngology - Head & Neck Surgery, University of Colorado, Aurora, CO, USA
| | - Von Samedi
- Department of Pathology, University of Colorado, Aurora, CO, USA
| | - Daniel S Fink
- Department of Otolaryngology - Head & Neck Surgery, University of Colorado, Aurora, CO, USA
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20
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Gombert E, Gorostidi F, Sandu K. Congenital Malformations of the Cricoid Cartilage: Upper Airway Obstruction and Treatment Strategy. Laryngoscope 2023; 133:3185-3191. [PMID: 36856166 DOI: 10.1002/lary.30626] [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: 08/25/2022] [Revised: 01/18/2023] [Accepted: 02/04/2023] [Indexed: 03/02/2023]
Abstract
OBJECTIVES To review treatment and outcomes in patients with congenital cricoid cartilage malformation. METHODS Retrospective analysis of patients with diagnosis of congenital cricoid malformation (CCM) treated in a single tertiary pediatric referral center between 1985 and 2022. Patients were grouped according to the morphology of the cricoid cartilage that was diagnosed during endoscopy. We reviewed the treatment strategy(s), decannulation rate, complications, and functional outcomes. RESULTS Twenty-nine patients were grouped into four morphological subtypes of cricoid cartilage: 10 patients had a hypoplastic cricoid, eight had an elliptic shape, five had severe anterior thickening, and six an accentuated V-shape posterior cricoid plate. Twenty-four patients underwent surgery, and five were closely followed up without surgical treatment. Eight patients had a tracheostomy prior to surgery, and the majority had a hypoplastic cricoid. Most patients (20 out of 24) required additional procedures postoperatively to achieve an age-appropriate airway. Thirteen patients needed endoscopic dilatation(s) and granulation tissue removal; four needed more aggressive treatment, and three patients required revision open surgery. Decannulation was achieved after a median of 4.5 months in all previously tracheostomized patients. Endoscopy at the last follow-up showed an age-appropriate airway in 27 patients; 20 patients had normal oral feeding, and 11 patients had a normal voice. CONCLUSION Endoscopy is important to diagnose CCM and most of the time patients would need only watchful waiting. In this report, surgery was required for patients who continued to remain symptomatic and had a compromised airway. The type of surgery depends on the type of cricoid malformation and the grade of stenosis. LEVEL OF EVIDENCE 4 Laryngoscope, 133:3185-3191, 2023.
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Affiliation(s)
- Edwige Gombert
- Centre Hospitalier Universitaire Vaudois, ENT - Lausanne, Lausanne, Switzerland
| | - Francois Gorostidi
- Centre Hospitalier Universitaire Vaudois, ENT - Lausanne, Lausanne, Switzerland
| | - Kishore Sandu
- Centre Hospitalier Universitaire Vaudois, ENT - Lausanne, Lausanne, Switzerland
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21
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O'Dell K, Huang V, Acevedo J, Reder L, Johns M, Ding L. Serial In-Office Steroid Injections for Airway Stenosis: Long-Term Benefit and Cost Analysis. Laryngoscope 2023; 133:2673-2679. [PMID: 36692123 DOI: 10.1002/lary.30578] [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: 09/02/2022] [Revised: 11/20/2022] [Accepted: 01/02/2023] [Indexed: 01/25/2023]
Abstract
OBJECTIVES To evaluate the long-term benefit of serial in-office steroid injections (SISI) in the treatment of subglottic and proximal tracheal stenosis (SG/PTS). Evaluate cost of SISI compared to endoscopic dilation (ED). STUDY DESIGN Retrospective study and cost analysis. METHODS All patients with SGS/PTS with at least two consecutive in-office steroid injections between 2013 and 2021 were evaluated. Patients with less than 2 years of follow-up data after the initial SISI series were excluded. Demographics, etiology of stenosis, total injections performed, time between steroid series, surgery-free interval (SFI) and adverse events were collected. For patients with known surgical history before SISI, pre-SISI SFI was compared. Institutional billing records and the national CMS average reimbursement were evaluated. Total charges for three treatment strategies (ED alone, ED with post-operative SISI and primary intervention with SISI) were also compared. RESULTS Forty-nine patients were included; 29 (59%) idiopathic, 11 (22%) traumatic and 9 (18%) rheumatologic. Mean (SD) follow-up time after the first SISI was 3.41 years (1.5), range (2.08-7.25 years). 79% (39/49) did not require additional surgery during the entire follow-up period. The SFI improved from a mean 13.5 months (SD 12.6; range 2-42 months) pre-SISI to a mean (SD) of 42 months (SD 20.2; range 10-87 months) (p < 0.0001) after SISI. Annual average charges for ED alone in our cohort was $15,383.28, compared to $7,070.04 for SISI. CONCLUSIONS SISI are an effective treatment for patients with SG/PTS. In-office steroid injections could offer cost savings for the patient. LEVEL OF EVIDENCE 4 Laryngoscope, 133:2673-2679, 2023.
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Affiliation(s)
- Karla O'Dell
- Department of Otolaryngology-Head and Neck Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Valerie Huang
- Department of Otolaryngology-Head and Neck Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Joseph Acevedo
- Department of Otolaryngology-Head and Neck Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Lindsay Reder
- Department of Otolaryngology, Head and Neck Surgery, Kaiser Permanente Baldwin Park, Los Angeles, California, USA
| | - Michael Johns
- Department of Otolaryngology-Head and Neck Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Li Ding
- Department of Otolaryngology-Head and Neck Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
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22
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Patrick Eisenberg A, Collier V, Mangano A, Shergill K, Yos E. Subglottic Stenosis as a Presentation of Antineutrophil Cytoplasmic Antibody-Associated Glomerulonephritis. Cureus 2023; 15:e46899. [PMID: 37954789 PMCID: PMC10636656 DOI: 10.7759/cureus.46899] [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] [Accepted: 10/12/2023] [Indexed: 11/14/2023] Open
Abstract
Granulomatosis with polyangiitis (GPA), previously Wegener's granulomatosis, is a necrotizing vasculitic disease process affecting the small- and medium-sized blood vessels. GPA is frequently associated with damage to the respiratory tract and kidneys but often affects other organ systems including the eyes, nasopharynx, and nervous system. Due to the vague nature of presenting symptoms and the progressive nature of GPA, it is essential to keep a broad differential to mitigate the high morbidity and mortality associated with the disease. Here we introduce a case of a GPA presenting as respiratory distress, stridor, and renal injury. We also review common clinical presentations, diagnostic evaluation, and treatment options.
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Affiliation(s)
| | - Victor Collier
- Internal Medicine, Grand Strand Medical Center, Myrtle Beach, USA
| | - Andrew Mangano
- Internal Medicine, Mary Washington Healthcare, Fredericksburg, USA
| | | | - Ellen Yos
- Internal Medicine, Grand Strand Medical Center, Myrtle Beach, USA
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23
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Vakili Ojarood M, Samady Khanghah A. Successful removal of an aspirated broken metal tracheostomy tube from the right main bronchus: a case report. Ann Med Surg (Lond) 2023; 85:4547-4552. [PMID: 37663683 PMCID: PMC10473327 DOI: 10.1097/ms9.0000000000000379] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Accepted: 02/25/2023] [Indexed: 09/05/2023] Open
Abstract
Introduction and importance Tracheostomy has been done since ancient Greece, but in today's modern format, it has been accepted for over one and a half centuries. Improvements in medical care and treatments have survived disabled patients who died in the past decades. Among these, tracheostomy tube (TT) segment aspiration was as rare as less than 100 cases have already been documented. We reported a case of aspirated metal TT to the right main bronchus from a 12-year-old teenage girl and then reviewed the available literature. Case presentation The patient suffered from subglottic stenosis affected after adenotonsillectomy remained for 6 years. She was referred to the emergency department for acute respiratory distress and cyanosis. Immediately underwent rigid bronchoscopy, and on the way to the operating room, she was oxygenated from the tracheal orifice. The detached part was successfully removed. Clinical discussion The common tracheostomy indications in children involve congenital or acquired airway stenosis, some conditions needing long-term ventilation, bilateral vocal fold insufficiency, and infectious compromise of the upper airway. Metal TTs for long-lasting are preferred to synthetic ones. Nevertheless, it has some potential complications. Conclusion Careful inspecting, especially metallic TTs, after every disinfection and regular follow-up by the surgeon, is highly recommended to prevent potential casualties.
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Affiliation(s)
| | - Ali Samady Khanghah
- Department of Surgery, Fatemi Hospital, Ardabil University of Medical Sciences, Ardabil, Iran
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24
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Shah VD, Grube JG, Reichert L. Subglottic Stenosis After Endonasal Resection of Juvenile Nasopharyngeal Angiofibroma. Cureus 2023; 15:e43922. [PMID: 37746363 PMCID: PMC10512874 DOI: 10.7759/cureus.43922] [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] [Accepted: 08/21/2023] [Indexed: 09/26/2023] Open
Abstract
Subglottic stenosis (SGS), the narrowing of the upper trachea, can be an acquired condition in pediatric patients. Presenting with varying degrees of dyspnea and stridor, acquired SGS is most commonly due to intubation. Airway stenosis is often not considered a surgical complication, and no literature on acquired SGS after endoscopic sinus surgery exists. We present a unique case of a 13-year-old male with juvenile nasopharyngeal angiofibroma (JNA), who developed SGS in the setting of progressive dyspnea six weeks after endonasal resection of his mass. He required urgent intubation prior to preoperative embolization and endonasal surgery, which prolonged his total intubation period. After the patient was found to have acquired SGS, he eventually required serial dilation to treat his stenosis. The presentation and operative course of this patient, along with images and pathologic findings, are discussed. Based on an extensive literature review of PubMed, Medline, and Google Scholar, there have been no cases discussing SGS development post-intubation after endonasal surgery or in association with JNA. Acquired SGS can present as a life-threatening airway obstruction in pediatric patients. With the rise of endoscopic skull base surgery and the prevalence of JNA, this case study sheds light on the detection and management of SGS post-operatively.
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Affiliation(s)
- Virali D Shah
- Otolaryngology - Head and Neck Surgery, Albany Medical College, Albany, USA
| | - Jordon G Grube
- Otolaryngology - Head and Neck Surgery, Albany Medical Center, Albany, USA
| | - Lara Reichert
- Otolaryngology - Head and Neck Surgery, Albany Medical Center, Albany, USA
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25
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Pappal RB, Burruss CP, Witt MA, Harryman C, Ali SZ, Bush ML, Fritz MA. Risk factors for developing subglottic and tracheal stenosis from the medical intensive care unit. Laryngoscope Investig Otolaryngol 2023; 8:699-707. [PMID: 37342110 PMCID: PMC10278098 DOI: 10.1002/lio2.1051] [Citation(s) in RCA: 1] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Accepted: 03/27/2023] [Indexed: 06/22/2023] Open
Abstract
Objective Endotracheal intubation is a common procedure in the medical intensive care unit (MICU), but it carries risk of complications including, but not limited to, subglottic stenosis (SGS) and tracheal stenosis (TS). Current literature suggests identifiable risk factors for the development of airway complications. This study is a comprehensive evaluation of potential risk factors in patients who developed SGS and TS following endotracheal intubation in our MICU. Methods Patients intubated in our MICU were identified from 2013 to 2019. Diagnoses of SGS or TS within 1 year of MICU admission were identified. Data extracted included age, sex, body measurements, comorbidities, bronchoscopies, endotracheal tube size, tracheostomy, social history, and medications. Patients with prior diagnosis of airway complication, tracheostomy, or head and neck cancer were excluded. Univariate and multivariate logistic regressions were performed. Results A total of 136 patients with TS or SGS were identified out of a sample of 6603 patients intubated in the MICU. Cases were matched to controls who did not develop airway stenosis based on identical Charlson Comorbidity Index scores. Eighty six controls were identified with a complete record of endotracheal/tracheostomy tube size, airway procedures, sociodemographic data, and medical diagnosis. Regression analysis showed that SGS or TS were associated with tracheostomy, bronchoscopy, chronic obstructive pulmonary disease, current tobacco use, gastroesophageal reflux disease, systemic lupus erythematosus, pneumonia, bronchitis, and numerous medication classes. Conclusion Various conditions, procedures, and medications are associated with an increased risk of developing SGS or TS. Level of evidence 4.
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Affiliation(s)
- Robin B. Pappal
- Department of Otolaryngology‐Head and Neck SurgeryUniversity of KentuckyLexingtonKentuckyUSA
| | - Clayton Prakash Burruss
- Department of Otolaryngology‐Head and Neck SurgeryUniversity of KentuckyLexingtonKentuckyUSA
| | - Michael A. Witt
- Department of Otolaryngology‐Head and Neck SurgeryUniversity of KentuckyLexingtonKentuckyUSA
| | - Christopher Harryman
- Department of Otolaryngology‐Head and Neck SurgeryUniversity of KentuckyLexingtonKentuckyUSA
| | - Syed Z. Ali
- Department of AnesthesiologyUniversity of KentuckyLexingtonKentuckyUSA
| | - Matthew L. Bush
- Department of Otolaryngology‐Head and Neck SurgeryUniversity of KentuckyLexingtonKentuckyUSA
| | - Mark A. Fritz
- Department of Otolaryngology‐Head and Neck SurgeryUniversity of KentuckyLexingtonKentuckyUSA
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26
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Figaro NJ, Figaro KA, Juman JS, Arozarena R, Davis King K, Juman S. Pediatric-Onset Relapsing Polychondritis With Otolaryngeal Manifestations. Cureus 2023; 15:e40085. [PMID: 37425495 PMCID: PMC10327613 DOI: 10.7759/cureus.40085] [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] [Accepted: 06/07/2023] [Indexed: 07/11/2023] Open
Abstract
Relapsing polychondritis (RP) is a rare autoimmune disease that can present with various clinical manifestations. Among the affected sites, the ear, nose, and throat cartilages are frequently involved, often leading to subtle and episodic symptoms that can be challenging to diagnose. A high index of suspicion is necessary for the early identification of these subtle signs, which can aid in early diagnosis and prompt management. In this report, we present a rare case of pediatric-onset relapsing polychondritis that was initially misdiagnosed as laryngotracheobronchitis.
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Affiliation(s)
- Nicholas J Figaro
- Otolaryngology-Head and Neck Surgery, Eric Williams Medical Sciences Complex, Champ Fleurs, TTO
| | - Keegan A Figaro
- Medicine, Eric Williams Medical Sciences Complex, Champ Fleurs, TTO
| | - Jibran S Juman
- Otolaryngology-Head and Neck Surgery, Eric Williams Medical Sciences Complex, Champ Fleurs, TTO
| | - Rodolfo Arozarena
- Otolaryngology-Head and Neck Surgery, The University of the West Indies, Saint Augustine, TTO
| | - Keisha Davis King
- Rheumatology, Eric Williams Medical Sciences Complex, Champ Fleurs, TTO
| | - Solaiman Juman
- Otolaryngology-Head and Neck Surgery, The University of the West Indies, Saint Augustine, TTO
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27
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Xu Z. [Consensus recommendations on the evaluation and treatment of laryngotracheal anomalies in infants and young children]. Lin Chuang Er Bi Yan Hou Tou Jing Wai Ke Za Zhi 2023; 37:403-408. [PMID: 37253511 PMCID: PMC10495801 DOI: 10.13201/j.issn.2096-7993.2023.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Indexed: 06/01/2023]
Abstract
Infants with laryngotracheal anomalies are clinically manifested as stridor or noisy breathing, choking, hoarseness, feeding difficulties, and cyanotic spells, followed by developmental and growth retardation and other health issues; in severe cases, patients may present with severe dyspnea, which is associated with high mortality. A timely diagnosis as well as appropriate strategy for laryngotracheal anomalies is still challenging for pediatric otolaryngologists. This consensus statement, evolved from expert opinion by the members of the Pediatric Otorhinolaryngology Professional Committee of the Pediatrician Branch of the Chinese Medical Doctor Association, provides comprehensive recommendations and standardized guidance for otolaryngologists who manage infants and young children with laryngotracheal anomalies in evaluation and treatment based on symptomatology, physical and laboratory examinations.
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28
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Hernández-García E, Hernández-Sandemetrio R, Quintana-Sanjuás A, Zapater-Latorre E, González-Herranz R, Sanz L, Reboll R, Pallarés-Martí B, Ollé-Moliner M, Martínez-Pascual P, Gotxi I, Chacón-Uribe A, Plaza G. Laryngotracheal Complications after Intubation for COVID-19: A Multicenter Study. Life (Basel) 2023; 13:life13051207. [PMID: 37240852 DOI: 10.3390/life13051207] [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: 02/27/2023] [Revised: 05/13/2023] [Accepted: 05/16/2023] [Indexed: 05/28/2023] Open
Abstract
Many of the patients with COVID-19 have suffered respiratory distress requiring prolonged endotracheal intubation (ETI) resulting in laryngotracheal complication with an impact on breathing, phonation, and swallowing. Our aim is to describe laryngeal injuries diagnosed after ETI in patients with COVID-19 in a multicentre study. METHODS A prospective descriptive observational study was conducted from January 2021 to December 2021, including COVID-19 patients with laryngeal complications due to ETI diagnosed in several Spanish hospitals. We analyzed the epidemiological data, previous comorbidities, mean time to ICU admission and ETI, need for tracheostomy, mean time on invasive mechanical ventilation until tracheostomy or weaning, mean time in ICU, type of residual lesions, and their treatment. RESULTS We obtained the collaboration of nine hospitals during the months of January 2021 to December 2021. A total of 49 patients were referred. Tracheostomy was performed in 44.9%, being late in most cases (more than 7-10 days). The mean number of days of ETI until extubation was 17.63 days, and the main post-intubation symptoms were dysphonia, dyspnea, and dysphagia, in 87.8%, 34.7%, and 42.9%, respectively. The most frequent injury was altered laryngeal mobility, present in 79.6%. Statistically, there is a greater amount of stenosis after late ETI and after delayed tracheostomy, not observing the data with the immobility alterations. CONCLUSION The mean number of days of ETI was long, according to the latest guidelines, with the need for several cycles of pronation. This long ETI may have had an impact on the increase of subsequent laryngeal sequelae, such as altered laryngeal mobility or stenosis.
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Affiliation(s)
- Estefanía Hernández-García
- Department of Otorhinolaryngology, Hospital Universitario de Fuenlabrada, Universidad Rey Juan Carlos, 28042 Madrid, Spain
| | | | - Ana Quintana-Sanjuás
- Department of Otorhinolaryngology, Hospital Universitario Lucus Augusti, 27003 Lugo, Spain
| | | | - Ramón González-Herranz
- Department of Otorhinolaryngology, Hospital Universitario de Fuenlabrada, Universidad Rey Juan Carlos, 28042 Madrid, Spain
| | - Lorena Sanz
- Department of Otorhinolaryngology, Hospital Universitario Torrejón, 28850 Madrid, Spain
| | - Rosa Reboll
- Department of Otorhinolaryngology, Hospital Universitario Sagunto, 46115 Valencia, Spain
| | - Beatriz Pallarés-Martí
- Department of Otorhinolaryngology, Consorci Corporació Sanitaria Parc Taulí Sabadell, 08208 Sabadell, Spain
| | | | - Paula Martínez-Pascual
- Department of Otorhinolaryngology, Hospital Universitario Severo Ochoa, 28914 Madrid, Spain
| | - Itziar Gotxi
- Department of Otorhinolaryngology, Hospital de Galdakao-Usansolo, 48960 Bizkaia, Spain
| | - Araly Chacón-Uribe
- Department of Otorhinolaryngology, Hospital Universitario Fundación Jiménez Diaz, 28042 Madrid, Spain
| | - Guillermo Plaza
- Department of Otorhinolaryngology, Hospital Universitario de Fuenlabrada, Universidad Rey Juan Carlos, 28042 Madrid, Spain
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29
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Hampton T, Ghazal Asswad R, Bhat J, Stevens K, Whitehall E, Milinis K, De S, Donne A, Krishnan M. Recurrent croup is a good indicator of underlying paediatric airway issues: A 10-year retrospective cohort study of airway endoscopy. Ear Nose Throat J 2023:1455613231170087. [PMID: 37141917 DOI: 10.1177/01455613231170087] [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] [Indexed: 05/06/2023] Open
Abstract
OBJECTIVE Children with a history of recurrent croup alert the ENT clinician to the potential for underlying laryngotracheal pathology. There is equipoise about the likelihood of identifying any underlying structural issues or subglottic stenosis in those children who undergo airway assessment. METHODS A retrospective cohort study in a tertiary UK paediatric hospital of a decade of children with recurrent croup who underwent a rigid laryngo-tracheo-bronchoscopy (airway endoscopy). MAIN OUTCOME(S) airway pathology seen on endoscopy and need for further airway surgery. RESULTS In ten years, 139 children underwent airway endoscopy for recurrent croup. Operative findings were abnormal in 62 (45 %) cases. Twelve cases (9%) had subglottic stenosis. Although recurrent croup was more common in males (78% of cases), this was not found to predispose them to operative findings. Children with previous intubations had >2 times the risk of abnormal findings and children born prematurely (<37 wks) had a trend towards abnormal operative findings versus children with no airway findings in our cohort. Even in those patients with abnormal findings, none necessitated further airway surgery. CONCLUSIONS Surgeons and parents can be reassured that rigid airway endoscopy for children with recurrent croup demonstrated high diagnostic utility but will rarely lead to further surgical intervention. Greater understanding about recurrent croup may require consensus clarification about definitions of recurrent croup and/or a universal adoption of a minimum standard operative record or grading system after rigid endoscopy for recurrent croup.
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Affiliation(s)
- Thomas Hampton
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
- ENT Department, Alder Hey Children's NHS Foundation Trust, Liverpool, UK
- Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK
| | - Randa Ghazal Asswad
- ENT Department, Alder Hey Children's NHS Foundation Trust, Liverpool, UK
- University of Liverpool School of Medicine, University of Liverpool, Liverpool, UK
| | - Jaya Bhat
- ENT Department, Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | - Kate Stevens
- ENT Department, Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | - Emma Whitehall
- ENT Department, Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | | | - Su De
- ENT Department, Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | - Adam Donne
- ENT Department, Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | - Madhan Krishnan
- ENT Department, Alder Hey Children's NHS Foundation Trust, Liverpool, UK
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30
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Buras M, DeSisto N, Holdgraf R. Effect of COVID-19 on the incidence of postintubation laryngeal lesions. Proc AMIA Symp 2023; 36:453-457. [PMID: 37334095 PMCID: PMC10269381 DOI: 10.1080/08998280.2023.2204544] [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: 01/30/2023] [Revised: 04/01/2023] [Accepted: 04/04/2023] [Indexed: 06/20/2023] Open
Abstract
Background Critically ill patients intubated in the intensive care unit experience prolonged intubation leading to increased frequency of laryngeal injuries. This study aimed to demonstrate a suspected increase in vocal fold injury in patients who were intubated with COVID-19 as compared with patients intubated for other reasons. Methods A retrospective review of medical records was performed to identify patients examined using flexible endoscopic evaluation of swallowing exams. The study included 25 patients with COVID-19 and 27 without COVID-19 at Baylor Scott & White Medical Center in Temple, Texas. Various injuries were evaluated, ranging from granulation tissue to vocal cord paralysis. Severe lesions were those causing clinically significant airway obstruction or requiring operative intervention. The incidence of laryngeal injury in patients intubated for COVID-19 was then compared with that of patients intubated for other reasons. Results The increased presence of severe injury in COVID-positive patients appeared clinically significant but was not statistically significant (P = 0.06). Interestingly, patients who received pronation therapy had 4.6 times the odds of more severe injury compared with patients who did not (P = 0.009). Conclusion Lower thresholds for performing flexible laryngoscopy on postintubated patients who are proned may allow for earlier intervention and reduce morbidity in an already at-risk population.
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Affiliation(s)
- Madison Buras
- Department of Otolaryngology, Baylor Scott & White Medical Center – Temple, Temple, Texas
| | - Nicole DeSisto
- School of Medicine, Texas A&M Health Sciences Center, Dallas, Texas
| | - Randall Holdgraf
- Department of Otolaryngology, Baylor Scott & White Medical Center – Temple, Temple, Texas
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31
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McCoul ED, Megwalu UC, Joe S, Gray R, O'Brien DC, Ference EH, Lee VS, Patel PS, Figueroa-Morales MA, Shin JJ, Brenner MJ. Systemic Steroids for Otolaryngology-Head and Neck Surgery Disorders: An Evidence-Based Primer for Clinicians. Otolaryngol Head Neck Surg 2023; 168:643-657. [PMID: 35349383 DOI: 10.1177/01945998221087664] [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: 11/30/2021] [Accepted: 02/26/2022] [Indexed: 12/12/2022]
Abstract
OBJECTIVE To offer pragmatic, evidence-informed guidance on the use of systemic corticosteroids (SCS) for common otolaryngologic disorders. DATA SOURCES PubMed, Cochrane Library, and American Academy of Otolaryngology-Head and Neck Surgery Foundation clinical practice guidelines. REVIEW METHODS A comprehensive search of published literature through November 2021 was conducted on the efficacy of SCS, alone or in combination with other treatments, for managing disorders in otolaryngology and the subdisciplines. Clinical practice guidelines, systematic reviews, and randomized controlled trials, when available, were preferentially retrieved. Interventions and outcomes of SCS use were compiled to generate summary tables and narrative synthesis of findings. CONCLUSIONS Evidence on the effectiveness of SCS varies widely across otolaryngology disorders. High-level evidence supports SCS use for Bell's palsy, sinonasal polyposis, and lower airway disease. Conversely, evidence is weak or absent for upper respiratory tract infection, eustachian tube dysfunction, benign paroxysmal positional vertigo, adenotonsillar hypertrophy, or nonallergic rhinitis. Evidence is indeterminate for acute laryngitis, acute pharyngitis, acute sinusitis, angioedema, chronic rhinosinusitis without polyps, Ménière's disease, postviral olfactory loss, postoperative nerve paresis/paralysis, facial pain, and sudden sensorineural hearing loss. IMPLICATIONS FOR PRACTICE Clinicians should bring an evidence-informed lens to SCS prescribing to best counsel patients regarding the risks, anticipated benefits, and limited data on long-term effects. Alternate routes of corticosteroid administration-such as sprays, drops, inhalers, and intralesional injections-may be preferable for many disorders, particularly those that are self-limited or require a prolonged duration of therapy. Prudent use of SCS reduces the risk of medication-related adverse effects. Clinicians who are conversant with high-level evidence can achieve optimal outcomes and stewardship when prescribing SCS.
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Affiliation(s)
- Edward D McCoul
- Department of Otorhinolaryngology, Ochsner Clinic, New Orleans, Louisiana, USA
| | - Uchechukwu C Megwalu
- Department of Otolaryngology-Head and Neck Surgery, School of Medicine, Stanford University, Stanford, California
| | - Stephanie Joe
- Department of Otolaryngology-Head and Neck Surgery, University of Illinois Chicago, Chicago, Illinois, USA
| | - Raluca Gray
- Department of Otolaryngology-Head and Neck Surgery, University of Minnesota, Minneapolis, Minnesota, USA
| | - Daniel C O'Brien
- Division of Otolaryngology-Head and Neck Surgery, University of Alberta, Edmonton, Canada
| | - Elisabeth H Ference
- Caruso Department of Otolaryngology-Head and Neck Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, California, USA
| | - Victoria S Lee
- Department of Otolaryngology-Head and Neck Surgery, University of Illinois Chicago, Chicago, Illinois, USA
| | - Prayag S Patel
- Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Marco A Figueroa-Morales
- Department of Otolaryngology-Head and Neck Surgery, Mexican Social Security Institute, Mexico City, Mexico
| | - Jennifer J Shin
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear Infirmary and Harvard Medical School, Boston, Massachusetts, USA
| | - Michael J Brenner
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan Medical School, Ann Arbor, Michigan, USA
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32
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Pinzas LA, Bedwell JR, Ongkasuwan J. Glottic and Subglottic Injury and Development of Pediatric Airway Stenosis. Otolaryngol Head Neck Surg 2023; 168:469-477. [PMID: 35608918 DOI: 10.1177/01945998221100829] [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: 11/24/2021] [Accepted: 04/28/2022] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To determine how often children with airway injury at the time of tracheostomy develop airway stenosis. STUDY DESIGN A 7-year retrospective review of a prospectively maintained database of pediatric patients who underwent endotracheal intubation followed by tracheostomy with concurrent and follow-up direct laryngoscopy. SETTING Tertiary care hospital. METHODS Outcomes included glottic or subglottic injury and progression to stenosis. Univariate and multivariate analyses were performed via SPSS. RESULTS Of the 222 patients (median age at surgery, 0.6 years; 54% male) who met study criteria, 46% had airway injury at the time of tracheostomy. Patients with congenital cardiovascular disease had 2.33-times increased risk of developing airway injury (P = .01). Patients with airway injury on initial direct laryngoscopy developed stenosis significantly more frequently than those without injury (30% vs 12%, P < .01). Risks factors for developing stenosis in children with airway injury include prematurity (P = .02), younger age at time of surgery (P < .01), endotracheal tube size (P < .01), Down syndrome (P = .03), and neonatal (P = .02) and/or congenital cardiovascular (P < .01) diagnosis. However, none of these variables were significant on multivariate analysis. CONCLUSIONS Intubated patients with evidence of glottic or subglottic injury at the time of tracheotomy are more likely to develop airway stenosis than those without. Congenital heart disease was associated with twice the risk of developing airway injury, while progression to stenosis was associated with younger age, prematurity, and/or comorbid diagnoses.
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Affiliation(s)
| | - Joshua R Bedwell
- Department Otolaryngology-Head and Neck Surgery, Baylor College of Medicine, Houston, Texas, USA
| | - Julina Ongkasuwan
- Department Otolaryngology-Head and Neck Surgery, Baylor College of Medicine, Houston, Texas, USA
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33
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Park M, Tie K, Davis H, Hall J, Buckmire RA, Shah RN. Can the Remote Use of a Peak Flow Meter Predict Severity of Subglottic Stenosis and Surgical Timing? Laryngoscope 2023; 133:628-633. [PMID: 35748567 PMCID: PMC9789194 DOI: 10.1002/lary.30257] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Revised: 05/24/2022] [Accepted: 06/01/2022] [Indexed: 12/26/2022]
Abstract
OBJECTIVE We aimed to assess the relationship between patient-performed and patient-reported peak flow meter (PFM) measurements with pulmonary function testing (PFT) and Dyspnea Index (DI) scores as a tool for monitoring Subglottic stenosis (SGS) disease progression remotely. METHODS Thirty-five SGS patients were prospectively enrolled. Patients were given PFMs to report serial measurements from home. DI scores and PFT were recorded at serial clinic visits. Data were analyzed to determine the correlation between PFM measurements and PFT data. Pre-operative and post-operative PFM measurements, PFT, and DI scores were analyzed for patients who underwent operative intervention. Receiver operating characteristic (ROC) curves were created for PFM measurements, PFT data, and DI scores to predict the likelihood of surgery. RESULTS PFM measurements had a "strong" correlation with the peak expiratory flow rate (PEFR), r = 0.78. Means of PEFR, PIFR, EDI, PFM measurements, and DI scores all significantly improved after the operative intervention (p ≤ 0.05). The area under the curve for ROC curves for DI scores, PFM measurements, and EDI were highest in our cohort with values of 0.896, 0.823, and 0.806, respectively. CONCLUSION In our SGS cohort, PFM measurements correlate strongly with PEFR measurements. PFM measurements can adequately demonstrate disease progression and predict the need for surgery in this patient population. Together, DI scores and PFM measurements may be a useful tool to remotely follow patients with SGS and inform timing of in-person assessments. LEVEL OF EVIDENCE 2 Laryngoscope, 133:628-633, 2023.
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Affiliation(s)
- Meredith Park
- University of North Carolina School of Medicine Chapel Hill, North Carolina
| | - Kevin Tie
- University of North Carolina School of Medicine Chapel Hill, North Carolina
- Division of Otolaryngology-Head and Neck Surgery, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Heather Davis
- UNC Department of Otolaryngology-Head & Neck Surgery Chapel Hill, North Carolina
| | - Joseph Hall
- UNC Department of Otolaryngology-Head & Neck Surgery Chapel Hill, North Carolina
| | - Robert A. Buckmire
- UNC Department of Otolaryngology-Head & Neck Surgery Chapel Hill, North Carolina
| | - Rupali N. Shah
- UNC Department of Otolaryngology-Head & Neck Surgery Chapel Hill, North Carolina
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34
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Han SH, Kim M, Ji JY, Kwon SK. Analysis of clinical features and risk factors of subglottic cysts in children: a clinical experience using the spontaneous respiration technique. Clin Exp Otorhinolaryngol 2023; 16:177-183. [PMID: 36822198 DOI: 10.21053/ceo.2023.00031] [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: 01/03/2023] [Accepted: 02/17/2023] [Indexed: 02/19/2023] Open
Abstract
Objective Subglottic cyst (SGC) is one of the rare causes of respiratory distress caused by upper airway obstruction in infants and young children. Risk factors other than prematurity with a history of endotracheal intubation have not yet been well elucidated. Therefore, we aimed to describe the clinical features and analyze the risk factors of SGC. Methods A retrospective review of medical records of pediatric patients who underwent marsupialization for SGCs between January 2017 and March 2022 was undertaken. These records were then compared with those of controls with a history of neonatal intubation with a case to control ratio of 1:3. Results Eleven patients (8 males and 3 females) diagnosed with SGCs and 33 control patients (26 males and 7 females) were included. All patients had a history of premature birth and neonatal intubation. Symptoms of SGC appeared at a mean age of 8.2 months (1-14 months) after extubation. The mean duration of intubation was 21.5 days (2-90 days), and the intubation period was longer in patients with SGC than in controls (21.5±24.8 days vs. 5.3±7.1 days; p<0.001). Furthermore, gestational age (28.3±4.2 weeks vs. 33.8±4.4 weeks; p=0.001) and birth weight (1134.1±515.1 g vs. 2178.2±910.1 g; p=0.001) were significantly lower in patients with SGC than in controls. In multivariable analysis, intubation period was identified as an independent risk factor. Conclusion This study showed that gestational age, birth weight, and intubation period were significantly associated with development of SGC. Pediatric patients presenting with progressive dyspnea with the corresponding risk factors should undergo early laryngoscopy for the differential diagnosis of SGC.
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Affiliation(s)
- Seung Hoon Han
- Department of Otorhinolaryngology-Head and Neck Surgery, Hallym University Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong, Korea, Hwaseong, Korea
| | - Minju Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea, Seoul, Korea
| | - Jeong-Yeon Ji
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea, Seoul, Korea
| | - Seong Keun Kwon
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea, Seoul, Korea
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Sood S, Ganatra HA, Perez Marques F, Langner TR. Complications during mechanical ventilation-A pediatric intensive care perspective. Front Med (Lausanne) 2023; 10:1016316. [PMID: 36817772 PMCID: PMC9928727 DOI: 10.3389/fmed.2023.1016316] [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: 08/10/2022] [Accepted: 01/16/2023] [Indexed: 02/04/2023] Open
Abstract
Mechanical ventilation is a common procedure performed in pediatric intensive care units, with over 20% of patients requiring invasive ventilator support. The most common indication for endotracheal intubation and ventilation in the pediatric population is respiratory failure either due to respiratory embarrassment or neurologic pathology. Despite the use of ventilation modes that are lung protective in the pediatric population, complications of mechanical ventilation occur frequently. These include atelectasis, post-extubation stridor, perioral tissue damage, ventilator associated pneumonia, mucus plugging, pneumothorax, pneumomediastinum, and ICU neuromyopathy. The purpose of this review is to discuss the risk factors, presentation and management of complications associated with mechanical ventilation in the pediatric population.
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Tierney WS, Huang LC, Chen SC, Berry LD, Anderson C, Amin MR, Benninger MS, Blumin JH, Bock JM, Bryson PC, Castellanos PF, Clary MS, Cohen SM, Crawley BK, Dailey SH, Daniero JJ, de Alarcon A, Donovan DT, Edell ES, Ekbom DC, Fink DS, Franco RA, Garrett CG, Guardiani EA, Hillel AT, Hoffman HT, Hogikyan ND, Howell RJ, Johns MM, Kasperbauer JL, Khosla SM, Kinnard C, Kupfer RA, Langerman AJ, Lentz RJ, Lorenz RR, Lott DG, Makani SS, Maldonado F, Matrka L, McWhorter AJ, Merati AL, Mori M, Netterville JL, O'Dell K, Ongkasuwan J, Postma GN, Reder LS, Rohde SL, Richardson BE, Rickman OB, Rosen CA, Rohlfing M, Rutter MJ, Sandhu GS, Schindler JS, Schneider GT, Shah RN, Sikora AG, Sinard RJ, Smith ME, Smith LJ, Soliman AMS, Sveinsdóttir S, Veivers D, Verma SP, Weinberger PM, Weissbrod PA, Wootten CT, Shyr Y, Francis DO, Gelbard A. Comparative Treatment Outcomes for Idiopathic Subglottic Stenosis: 5-Year Update. Otolaryngol Head Neck Surg 2023; 168:1570-1575. [PMID: 36939627 DOI: 10.1002/ohn.190] [Citation(s) in RCA: 1] [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: 02/25/2022] [Revised: 08/18/2022] [Accepted: 09/10/2022] [Indexed: 01/20/2023]
Abstract
The North American Airway Collaborative (NoAAC) previously published a 3-year multi-institutional prospective cohort study showing variation in treatment effectiveness between 3 primary surgical techniques for idiopathic subglottic stenosis (iSGS). In this report, we update these findings to include 5 years of data evaluating treatment effectiveness. Patients in the NoAAC cohort were re-enrolled for 2 additional years and followed using the prespecified published protocol. Consistent with prior data, prospective observation of 487 iSGS patients for 5 years showed treatment effectiveness differed by modality. Cricotracheal resection maintained the lowest rate of recurrent operation (5%), followed by endoscopic resection with adjuvant medical therapy (30%) and endoscopic dilation (50%). These data support the initial observations and continue to provide value to providers and patients navigating longitudinal decision-making. Level of evidence: 2-prospective cohort study.
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Affiliation(s)
- William S Tierney
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Li-Ching Huang
- Department of Biostatistics, Vanderbilt University, Nashville, Tennessee, USA
| | - Sheau-Chiann Chen
- Department of Biostatistics, Vanderbilt University, Nashville, Tennessee, USA
| | - Lynn D Berry
- Department of Biostatistics, Vanderbilt University, Nashville, Tennessee, USA
| | - Catherine Anderson
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Milan R Amin
- Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Michael S Benninger
- Department of Otolaryngology-Head and Neck Surgery, New York University, New York, New York, USA
| | - Joel H Blumin
- Department of Otolaryngology-Head and Neck Surgery, Cleveland Clinic, Cleveland, Ohio, USA
| | - Jonathan M Bock
- Department of Otolaryngology-Head and Neck Surgery, Cleveland Clinic, Cleveland, Ohio, USA
| | - Paul C Bryson
- Department of Otolaryngology-Head and Neck Surgery, New York University, New York, New York, USA
| | - Paul F Castellanos
- Department of Otolaryngology-Head and Neck Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Matthew S Clary
- Department of Otolaryngology-Head and Neck Surgery, Mercy Health-St. Rita's Ear, Nose and Throat, Lima, Ohio, USA
| | - Seth M Cohen
- Department of Otolaryngology-Head and Neck Surgery, University of Colorado School of Medicine, Denver, Colorado, USA
| | - Brianna K Crawley
- Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, Duke University, Durham, North Carolina, USA
| | - Seth H Dailey
- Department of Otolaryngology-Head and Neck Surgery, Loma Linda University Health, Loma Linda, California, USA
| | - James J Daniero
- Department of Otolaryngology-Head and Neck Surgery, University of Virginia, Charlottesville, Virginia, USA
| | - Alessandro de Alarcon
- Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati, Cincinnati, Ohio, USA
| | - Donald T Donovan
- Department of Otolaryngology-Head and Neck Surgery, Baylor University, Houston, Texas, USA
| | - Eric S Edell
- Department of Pulmonology, Mayo Clinic, Rochester, Minnesota, USA
| | - Dale C Ekbom
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Daniel S Fink
- Department of Otolaryngology-Head and Neck Surgery, Mercy Health-St. Rita's Ear, Nose and Throat, Lima, Ohio, USA
| | - Ramon A Franco
- Department of Otolaryngology-Head and Neck Surgery, Harvard University, Boston, Massachusetts, USA
| | - Catherine Gaelyn Garrett
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Elizabeth A Guardiani
- Department of Otolaryngology-Head and Neck Surgery, University of Maryland, Baltimore, Maryland, USA
| | - Alexander T Hillel
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University, Baltimore, Maryland, USA
| | - Henry T Hoffman
- Department of Otolaryngology-Head and Neck Surgery, University of Iowa, Iowa City, Iowa, USA
| | - Norman D Hogikyan
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Rebecca J Howell
- Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati, Cincinnati, Ohio, USA
| | - Michael M Johns
- Department of Otolaryngology-Head and Neck Surgery, University of Southern California, Los Angeles, California, USA
| | - Jan L Kasperbauer
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Sid M Khosla
- Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati, Cincinnati, Ohio, USA
| | - Cheryl Kinnard
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Robbi A Kupfer
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Alexander J Langerman
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Robert J Lentz
- Department of Medicine, Division of Pulmonology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Robert R Lorenz
- Department of Otolaryngology-Head and Neck Surgery, New York University, New York, New York, USA
| | - David G Lott
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Phoenix, Arizona, USA
| | - Samir S Makani
- Scripps Health, Coastal Pulmonary Associates, Encinitas, California, USA
| | - Fabien Maldonado
- Department of Medicine, Division of Pulmonology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Laura Matrka
- Department of Otolaryngology-Head and Neck Surgery, Ohio State University, Columbus, Ohio, USA
| | - Andrew J McWhorter
- Department of Otolaryngology-Head and Neck Surgery, Louisiana State University, Baton Rouge, Louisiana, USA
| | - Albert L Merati
- Department of Otolaryngology-Head and Neck Surgery, University of Washington, Seattle, Washington, USA
| | - Matthew Mori
- Department of Otolaryngology-Head and Neck Surgery, Mount Sinai, New York, New York, USA
| | - James L Netterville
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Karla O'Dell
- Department of Otolaryngology-Head and Neck Surgery, University of Southern California, Los Angeles, California, USA
| | - Julina Ongkasuwan
- Department of Otolaryngology-Head and Neck Surgery, Baylor University, Houston, Texas, USA
| | - Gregory N Postma
- Department of Otolaryngology-Head and Neck Surgery, Augusta University Health, Augusta, Georgia, USA
| | - Lindsay S Reder
- Department of Otolaryngology-Head and Neck Surgery, University of Southern California, Los Angeles, California, USA
| | - Sarah L Rohde
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Brent E Richardson
- Department of Otolaryngology-Head and Neck Surgery, Bastian Voice Institute for Voice, Swallowing, and Airway Disorders, Downers Grove, Illinois, USA
| | - Otis B Rickman
- Department of Medicine, Division of Pulmonology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Clark A Rosen
- Department of Otolaryngology-Head and Neck Surgery, University of California-San Francisco, San Francisco, California, USA
| | - Matthew Rohlfing
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Michael J Rutter
- Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati, Cincinnati, Ohio, USA
| | - Guri S Sandhu
- Department of Otolaryngology-Head and Neck Surgery, The London Clinic, London, England
| | - Joshua S Schindler
- Department of Otolaryngology-Head and Neck Surgery, Oregon Health Sciences University, Portland, Oregon, USA
| | - Glenn Todd Schneider
- Department of Otolaryngology-Head and Neck Surgery, University of Rochester Medical Center, Rochester, New York, USA
| | - Rupali N Shah
- Department of Otolaryngology-Head and Neck Surgery, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Andrew G Sikora
- Department of Otolaryngology-Head and Neck Surgery, Baylor University, Houston, Texas, USA
| | - Robert J Sinard
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Marshall E Smith
- Division of Otolaryngology-Head and Neck Surgery, University of Utah, Salt Lake City, Utah, USA
| | - Libby J Smith
- Department of Otolaryngology-Head and Neck Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Ahmed M S Soliman
- Department of Otolaryngology-Head and Neck Surgery, Temple University, Philadelphia, Pennsylvania, USA
| | - Sigríður Sveinsdóttir
- Department of Otolaryngology-Head and Neck Surgery, National University Hospital of Iceland, Reykjavik, Iceland, UK
| | - David Veivers
- Ear Nose and Throat, University of Sydney, Sydney, Australia
| | - Sunil P Verma
- Department of Otolaryngology-Head and Neck Surgery, University of California-Irvine, Irvine, California, USA
| | - Paul M Weinberger
- Department of Otolaryngology-Head and Neck Surgery, Ark-La-Tex Center for Voice, Airway & Swallowing, Shreveport, Louisiana, USA
| | - Philip A Weissbrod
- Department of Otolaryngology-Head and Neck Surgery, University of California-San Diego, San Diego, California, USA
| | - Christopher T Wootten
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Yu Shyr
- Department of Biostatistics, Vanderbilt University, Nashville, Tennessee, USA
| | - David O Francis
- Department of Otolaryngology-Head and Neck Surgery, Loma Linda University Health, Loma Linda, California, USA
| | - Alexander Gelbard
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
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Liang KY, Nelson RC, Bryson PC, Lorenz RR. High Tracheal Resection With Intralaryngeal Extension as an Alternative to Cricotracheal Resection for Treatment of Subglottic Stenosis. Otolaryngol Head Neck Surg 2023; 168:1139-1145. [PMID: 36939535 DOI: 10.1002/ohn.180] [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: 07/23/2022] [Revised: 09/28/2022] [Accepted: 10/08/2022] [Indexed: 01/21/2023]
Abstract
OBJECTIVE Some patients with subglottic stenosis (SGS) require open airway reconstruction, which traditionally involves resection of the anterior cricoid cartilage. As an alternative, we present a novel technique: cricoid-sparing high tracheal resection with excision of subglottic stenotic tissue from below. A novel set of posterior circumferential cricoid sutures is used to reline the exposed cricoid plate. STUDY DESIGN Retrospective chart review. SETTING Single tertiary care center. METHODS The surgical technique is described and illustrated. A chart review was performed for all patients who underwent surgery between January 1, 2016, and June 30, 2021. RESULTS Fourteen patients (100% female) underwent this airway resection and reconstruction surgery during the study time period. After a mean follow-up of 12 months, no patients required tracheostomy. Twelve of 14 patients (86%) had durable airways. Two patients (14%) have required repeated endoscopic procedures for recurrent stenosis and are considered treatment failures. None exhibited postoperative dysfunction to suggest posterior cricoarytenoid muscle injury. Thirteen patients (93%) had a postoperative normal voice or only transient dysphonia. One patient had permanent unilateral vocal fold paralysis. CONCLUSION Cricoid-sparing high tracheal resection is a safe and effective alternative to cricotracheal resection, especially for predominantly posterior SGS. The cricoid cartilage and cricothyroid muscles are left undisturbed, potentially decreasing the risk of postoperative dysphonia, namely lowered fundamental frequency. This is especially meaningful in the setting of a predominantly female patient population.
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Affiliation(s)
- Kevin Y Liang
- Head and Neck Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | | | - Paul C Bryson
- Head and Neck Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Robert R Lorenz
- Head and Neck Institute, Cleveland Clinic, Cleveland, Ohio, USA
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Nakano Y, Ueno Y, Ishitani E, Sato K, Sato H, Momota K, Bando N, Akimoto Y, Nunomura T, Ishihara M, Tane N, Itagaki T, Kitamura Y, Oto J. Repetitive postoperative extubation failure due to dynamic inspiratory airway collapse concomitant with subglottic stenosis in a patient who previously underwent tracheostomy. J Med Invest 2023; 70:301-305. [PMID: 37164740 DOI: 10.2152/jmi.70.301] [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] [Indexed: 05/12/2023]
Abstract
BACKGROUND This report describes a case of dynamic inspiratory airway collapse concomitant with subglottic stenosis in a patient who previously underwent tracheostomy that led to repeated post-operative extubation failure. CASE PRESENTATION A 43-year-old woman who had undergone tracheostomy 25 years previously was admitted to our intensive-care unit (ICU) after coronary artery bypass graft surgery. On postoperative day (POD) 0, she was extubated, but stridor was observed. We suspected upper airway obstruction and she was therefore reintubated. Before reintubation, urgent laryngotracheoscopy revealed dynamic inspiratory airway collapse and obstruction concomitant with subglottic stenosis. Preoperative computed tomography showed mild subglottic stenosis. Although intravenous corticosteroids were administered to prevent tracheal mucosal edema and a cuff leak test was confirmed to be negative, she developed extubation failure on POD6. On POD12, we performed tracheostomy to reduce mechanical irritation from the endotracheal tube. Mechanical ventilation was withdrawn and she discharged from the ICU. On POD33, her tracheostomy tube was removed and she remained clinically asymptomatic. CONCLUSIONS We should be aware of the history of tracheostomy, especially at high tracheostomy sites, even in the absence of respiratory symptoms as risk factors for dynamic inspiratory airway collapse concomitant with subglottic stenosis contributing to repeated respiratory failure after extubation. J. Med. Invest. 70 : 301-305, February, 2023.
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Affiliation(s)
- Yuki Nakano
- Emergency Department, Tokushima Prefectural Miyoshi Hospital, 815-2, Miyoshi, Tokushima, 778-8503, Japan
| | - Yoshitoyo Ueno
- Emergency and Critical Care Medicine, Tokushima University Hospital, 2-50-1, Kuramoto, Tokushima, 770-8503, Japan
| | - Emi Ishitani
- Otolaryngology, Tokushima University Graduate School of Biomedical Sciences, 3-18-15, Kuramoto, Tokushima, 770-8503, Japan
| | - Koji Sato
- Emergency and Critical Care Medicine, Tokushima University Hospital, 2-50-1, Kuramoto, Tokushima, 770-8503, Japan
| | - Hiroki Sato
- Emergency and Disaster Medicine, Tokushima University Hospital, 2-50-1, Kuramoto, Tokushima, 770-8503, Japan
| | - Kazuki Momota
- Emergency and Critical Care Medicine, Tokushima University Hospital, 2-50-1, Kuramoto, Tokushima, 770-8503, Japan
| | - Natsuki Bando
- Emergency and Critical Care Medicine, Tokushima University Hospital, 2-50-1, Kuramoto, Tokushima, 770-8503, Japan
| | - Yusuke Akimoto
- Emergency Department, Tokushima Prefectural Miyoshi Hospital, 815-2, Miyoshi, Tokushima, 778-8503, Japan
| | - Toshiyuki Nunomura
- Emergency and Disaster Medicine, Tokushima University Hospital, 2-50-1, Kuramoto, Tokushima, 770-8503, Japan
| | - Manabu Ishihara
- Emergency and Critical Care Medicine, Tokushima University Graduate School of Biomedical Sciences, 3-18-15, Kuramoto, Tokushima, 770-8503, Japan
| | - Natsuki Tane
- Emergency and Critical Care Medicine, Tokushima University Graduate School of Biomedical Sciences, 3-18-15, Kuramoto, Tokushima, 770-8503, Japan
| | - Taiga Itagaki
- Emergency and Disaster Medicine, Tokushima University Hospital, 2-50-1, Kuramoto, Tokushima, 770-8503, Japan
| | - Yoshiaki Kitamura
- Otolaryngology, Tokushima University Graduate School of Biomedical Sciences, 3-18-15, Kuramoto, Tokushima, 770-8503, Japan
| | - Jun Oto
- Emergency and Critical Care Medicine, Tokushima University Graduate School of Biomedical Sciences, 3-18-15, Kuramoto, Tokushima, 770-8503, Japan
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Tang MM, Xu Z, Ren J, Zou J, Chen G. Superimposed high-frequency jet ventilation used for endolaryngotracheal surgery in a child with congenital subglottic stenosis: a case report. Transl Pediatr 2022; 11:2057-2062. [PMID: 36643668 PMCID: PMC9834946 DOI: 10.21037/tp-22-218] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Accepted: 11/03/2022] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Airway management and anesthesia during endolaryngotracheal surgery in patients with obstructive airway diseases pose a major challenge for anesthesiologists, especially in pediatric patients. Children with obstructive airway disease often have a potentially difficult airway. Adequate airway assessment and preparation before anesthesia is essential. In the formulation of the entire anesthesia strategy, the choice of ventilation mode is the most critical. Superimposed high-frequency jet ventilation (SHFJV) is an enormous step forward in the progress of difficult surgery of the larynx and trachea in neonates, infants and children. However, due to objective factors, it has not been extensively applied worldwide. CASE DESCRIPTION In this article, our airway management strategy and clinical anesthesia experience is presented in a precisely designed, non-invasive and "tubeless" supraglottic SHFJV technique. This technique was used during a successful endolaryngotracheal surgery in a 3-year-old child with congenital subglottic stenosis under total intravenous anesthesia (TIVA) with propofol and remifentanil. Ultimately, the entire procedure and anesthesia were successful, and the child received effective treatment. CONCLUSIONS By summarizing and sharing our airway management strategy and clinical anesthesia experience in this case, anesthesiologists may have a clearer understanding of the challenges in this type of surgery. This case may add a valuable reference for the extensive application of SHFJV in endolaryngotracheal surgery.
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Affiliation(s)
- Miao-Miao Tang
- Department of Anesthesiology, West China Hospital, Sichuan University & The Research Units of West China (2018RU012), Chinese Academy of Medical Sciences, Chengdu, China
| | - Zhao Xu
- Department of Anesthesiology, West China Hospital, Sichuan University & The Research Units of West China (2018RU012), Chinese Academy of Medical Sciences, Chengdu, China
| | - Jia Ren
- Department of Otorhinolaryngology, Head & Neck Surgery, West China Hospital, Sichuan University & The Research Units of West China (2018RU012), Chinese Academy of Medical Sciences, Chengdu, China
| | - Jian Zou
- Department of Otorhinolaryngology, Head & Neck Surgery, West China Hospital, Sichuan University & The Research Units of West China (2018RU012), Chinese Academy of Medical Sciences, Chengdu, China
| | - Guo Chen
- Department of Anesthesiology, West China Hospital, Sichuan University & The Research Units of West China (2018RU012), Chinese Academy of Medical Sciences, Chengdu, China
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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] [What about the content of this article? (0)] [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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Lina IA, Tsai H, Berges AJ, Ospino RA, Davis RJ, Motz KM, Collins S, Ghosh B, Sidhaye V, Gelbard A, Hillel AT. Phenotypic Epithelial Changes in Laryngotracheal Stenosis. Laryngoscope 2022; 132:2194-2201. [PMID: 35141889 PMCID: PMC9363526 DOI: 10.1002/lary.30040] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [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: 09/15/2021] [Revised: 12/13/2021] [Accepted: 01/19/2022] [Indexed: 12/31/2022]
Abstract
OBJECTIVE Characterize and quantify epithelium in multiple etiologies of laryngotracheal stenosis (LTS) to better understand its role in pathogenesis. STUDY DESIGN Controlled in vitro cohort study. METHODS Endoscopic brush biopsy samples of both normal (non-scar) and scar were obtained in four patients with idiopathic subglottic stenosis (iSGS) and four patients with iatrogenic LTS (iLTS). mRNA expression of basal, ciliary, and secretory cell markers were evaluated using quantitative PCR. Cricotracheal resection tissue samples (n = 5 per group) were also collected, analyzed using quantitative immunohistochemistry, and compared with rapid autopsy tracheal samples. RESULTS Both iSGS and iLTS-scar epithelium had reduced epithelial thickness compared with non-scar control epithelium (P = .0009 and P = .0011, respectively). Basal cell gene and protein expression for cytokeratin 14 was increased in iSGS-scar epithelium compared with iLTS or controls. Immunohistochemical expression of ciliary tubulin alpha 1, but not gene expression, was reduced in both iSGS and iLTS-scar epithelium compared with controls (P = .0184 and P = .0125, respectively). Both iSGS and iLTS-scar had reductions in Mucin 5AC gene expression (P = .0007 and P = .0035, respectively), an epithelial goblet cell marker, with reductions in secretory cells histologically (P < .0001). CONCLUSIONS Compared with non-scar epithelium, the epithelium within iSGS and iLTS is morphologically abnormal. Although both iSGS and iLTS have reduced epithelial thickness, ciliary cells, and secretory cells, only iSGS had significant increases in pathological basal cell expression. These data suggest that the epithelium in iSGS and iLTS play a common role in the pathogenesis of fibrosis in these two etiologies of laryngotracheal stenosis. SETTING Tertiary referral center (2017-2020). LEVEL OF EVIDENCE NA Laryngoscope, 132:2194-2201, 2022.
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Affiliation(s)
- Ioan A. Lina
- Department of Otolaryngology‐Head and Neck SurgeryJohns Hopkins University School of MedicineBaltimoreMarylandU.S.A.
| | - Hsiu‐Wen Tsai
- Department of Otolaryngology‐Head and Neck SurgeryJohns Hopkins University School of MedicineBaltimoreMarylandU.S.A.
| | - Alexandra J. Berges
- Department of Otolaryngology‐Head and Neck SurgeryJohns Hopkins University School of MedicineBaltimoreMarylandU.S.A.
| | - Rafael A. Ospino
- Department of Otolaryngology‐Head and Neck SurgeryJohns Hopkins University School of MedicineBaltimoreMarylandU.S.A.
| | - Ruth J. Davis
- Department of Otolaryngology‐Head and Neck SurgeryJohns Hopkins University School of MedicineBaltimoreMarylandU.S.A.
| | - Kevin M. Motz
- Department of Otolaryngology‐Head and Neck SurgeryJohns Hopkins University School of MedicineBaltimoreMarylandU.S.A.
| | - Samuel Collins
- Department of Otolaryngology‐Head and Neck SurgeryJohns Hopkins University School of MedicineBaltimoreMarylandU.S.A.
| | - Baishakhi Ghosh
- Department of Environmental Health and EngineeringJohns Hopkins Bloomberg School of Public HealthBaltimoreMarylandU.S.A.
| | - Venkataramana Sidhaye
- Department of Environmental Health and EngineeringJohns Hopkins Bloomberg School of Public HealthBaltimoreMarylandU.S.A.,Department of Pulmonary and Critical Care MedicineJohns Hopkins School of MedicineBaltimoreMarylandU.S.A.
| | - Alexander Gelbard
- Department of Otolaryngology‐Head and Neck SurgeryVanderbilt University School of MedicineNashvilleTennesseeU.S.A.
| | - Alexander T. Hillel
- Department of Otolaryngology‐Head and Neck SurgeryJohns Hopkins University School of MedicineBaltimoreMarylandU.S.A.
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Wijermars LGM, Hoekstra CEL, Nguyen TTT, Stevens MF, Dikkers FG. New Treatment Strategy for Subglottic Stenosis Using the Trachealator, a Novel Non-occlusive Balloon. Laryngoscope 2022; 132:2202-2205. [PMID: 35634800 PMCID: PMC9796555 DOI: 10.1002/lary.30234] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Revised: 04/18/2022] [Accepted: 05/14/2022] [Indexed: 01/01/2023]
Affiliation(s)
- Leonie G. M. Wijermars
- Department of Otorhinolaryngology, Amsterdam UMCUniversity of AmsterdamAmsterdamThe Netherlands
| | - Carlijn E. L. Hoekstra
- Department of Otorhinolaryngology, Amsterdam UMCUniversity of AmsterdamAmsterdamThe Netherlands
| | - Thao T. T. Nguyen
- Department of Anesthesiology, Amsterdam UMCUniversity of AmsterdamAmsterdamThe Netherlands
| | - Markus F. Stevens
- Department of Anesthesiology, Amsterdam UMCUniversity of AmsterdamAmsterdamThe Netherlands
| | - Frederik G. Dikkers
- Department of Otorhinolaryngology, Amsterdam UMCUniversity of AmsterdamAmsterdamThe Netherlands
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Mitra S, Kalra M, Purkait S, Mishra P, Mohanty PK, Som TK, Adhya AK, Das P. Congenital Acinar Cystic Transformation of the Pancreas with Proximal Jejunal Atresia and Hepatic Iron Overload: An Autopsy Case. Fetal Pediatr Pathol 2022; 41:828-836. [PMID: 34414844 DOI: 10.1080/15513815.2021.1966859] [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] [Indexed: 10/20/2022]
Abstract
Introduction: Acinar cystic transformation (ACT) of the pancreas is characterized by multiple cysts lined by dual ductal and acinar-type of epithelium. ACT is typically a disease of adulthood and has not been described in a neonate. Case report: Autopsy of this term 3-day old male demonstrated cystic transformation of the entire pancreas measuring 42 mm in its largest dimension. The main pancreatic duct was patent. The numerous variable-sized cysts were lined by both ductal (CK7-positive) and acinar (trypsin-positive) epithelium. Congenital hemochromatosis of the liver, complete proximal jejunal atresia, gangrene of the post-atretic jejunum, and subglottic stenosis were associated features. Discussion/Conclusion: ACT may occur in the neonate in association with other abnormalities.
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Affiliation(s)
- Suvradeep Mitra
- Department of Pathology and Lab Medicine, AIIMS, Bhubaneswar, India
| | - Manisha Kalra
- Department of Pathology and Lab Medicine, AIIMS, Bhubaneswar, India
| | - Suvendu Purkait
- Department of Pathology and Lab Medicine, AIIMS, Bhubaneswar, India
| | | | | | | | - Amit Kumar Adhya
- Department of Pathology and Lab Medicine, AIIMS, Bhubaneswar, India
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Bensoussan Y, Martinez E, Van Der Woerd B, Johns M, Nguyen C, Watts S, O'Dell K. The Effect of Subglottic Steroid injection on Blood Glucose in a Cohort of Patients With Subglottic Stenosis. Laryngoscope 2022. [PMID: 36165684 DOI: 10.1002/lary.30392] [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: 04/13/2022] [Revised: 08/16/2022] [Accepted: 08/19/2022] [Indexed: 11/10/2022]
Abstract
OBJECTIVE The objective of this work was to assess the effect of a single intralesional subglottic steroid injection on fasting blood glucose over 7 days in a cohort of patients with subglottic stenosis. METHODS A prospective cohort study of patients undergoing intralesional steroid injections at a tertiary academic center. Patients had baseline bloodwork performed, including fasting blood glucose (FBG), and hemoglobin A1C levels. Demographic data and risk factors were collected. Fasting capillary glucose (FCG) was measured using a capillary glucometer and performed by patients daily from days 0 to 7 after a single injection of Triamcinolone into the subglottic airway. Data were analyzed using descriptive and comparative statistics. RESULTS Eleven patients were enrolled, and 10 completed data collection over 7 days. All were female, with a mean age of 52.6 years (SD 17.5). Two patients were diabetic (non-insulin dependent). There was a statistically significant increase in FCG on day 1 post-injection (mean = 122.4 mg/dl compared to 100.7 mg/dl) that normalized for all patients within 24-72 h. The mean increase in FCG was 21.5% (SD 22.5%) of the initial value for the cohort. The diabetic group had statistically significant higher glucose values on day 1 compared to the non-diabetic group (146.5 mg/dl compared to 117.0 mg/dl). CONCLUSION A single subglottic steroid injection appears to cause a transient increase in FCG 1 day post injection, which resolves after 24-72 h and can be more pronounced in diabetic patients. LEVEL OF EVIDENCE 4 Laryngoscope, 2022.
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Affiliation(s)
- Yael Bensoussan
- USF Health Voice Center, Department of Otolaryngology-Head and Neck Surgery, University of South Florida, Tampa, Florida, U.S.A
| | - Eduardo Martinez
- University of Southern California, Los Angeles, California, U.S.A
| | - Benjamin Van Der Woerd
- USC Voice Center, Department of Otolaryngology-Head and Neck Surgery, University of Southern California, Los Angeles, California, U.S.A
| | - Michael Johns
- USC Voice Center, Department of Otolaryngology-Head and Neck Surgery, University of Southern California, Los Angeles, California, U.S.A
| | - Caroline Nguyen
- Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine, University of Southern California, Los Angeles, California, USA
| | - Stephanie Watts
- USF Health Voice Center, Department of Otolaryngology-Head and Neck Surgery, University of South Florida, Tampa, Florida, U.S.A
| | - Karla O'Dell
- USC Voice Center, Department of Otolaryngology-Head and Neck Surgery, University of Southern California, Los Angeles, California, U.S.A
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Alshareef WA, Aldriweesh BA, Almutairi NK, Alsini AY, Zakzouk AS, Aljasser AI, Alammar AY. Adverse Respiratory Events After Pediatric Endoscopic Airway Surgeries. Ear Nose Throat J 2022:1455613221128111. [PMID: 36112766 DOI: 10.1177/01455613221128111] [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] [Indexed: 12/22/2023] Open
Abstract
OBJECTIVE Perioperative risk stratification of pediatric patients undergoing airway intervention remains crucial in identifying those at a higher risk of requiring postoperative intensive care unit (ICU) care. Here we determined the likelihood of and possible risk factors for developing perioperative adverse respiratory events (PAREs) requiring ICU care after various pediatric endoscopic airway surgeries (EASs). METHODS We conducted a retrospective chart review of pediatric patients who were aged <18 years and underwent EAS between 2015 and 2021. Early postoperative adverse events within 24 h of surgery were recorded and analyzed. RESULTS Overall, 99 patients who underwent EAS were included. The age at the time of the intervention ranged from 8 months to 18 years. Fifty-eight patients, median age was 4.83 years, underwent papilloma debulking with no high likelihood of PARE in this patient subgroup (OR = 0.48; 0.16-1.44). Twenty-five patients, median age was 9.72 years, underwent balloon dilation of laryngotracheal stenosis with no increase in the likelihood of PARE in this patient population (OR = 2.02; 0.65-6.28). Early postoperative respiratory events occurred in 16 patients (16.2%). Most of these events (75%) manifested within 4 h after surgery. In a univariate analysis, intervention at the level of the subglottis or 2 or more laryngeal subsites increased the risk of PARE (OR = 6.57; 1.11-12.52 and OR = 3.73; 1.93-22.34, respectively). In a multivariate analysis, only intervention in the subglottic area maintained its effect (OR = 6.84; 1.82-25.65). CONCLUSION Respiratory adverse events following pediatric EAS are not uncommon, and the majority are encountered shortly after surgery. Intervention in the subglottic area was an independent predictor of PARE.
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Affiliation(s)
- Waleed A Alshareef
- Department of Otolaryngology-Head and Neck Surgery, King Saud University Medical City, Riyadh, Saudi Arabia
| | - Bshair A Aldriweesh
- Department of Otolaryngology-Head and Neck Surgery, King Fahad Specialist Hospital-Dammam, Dammam, Saudi Arabia
| | - Nasser K Almutairi
- Department of Otolaryngology-Head and Neck Surgery, King Saud University Medical City, Riyadh, Saudi Arabia
- Department of Otolaryngology-Head and Neck Surgery, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Albaraa Y Alsini
- Department of Otolaryngology, Head and Neck Surgery, Al-Hada Armed Forces Hospital, Taif, Saudi Arabia
| | - Abdulmajeed S Zakzouk
- Department of Otolaryngology-Head and Neck Surgery, King Saud University Medical City, Riyadh, Saudi Arabia
| | - Abdullah I Aljasser
- Department of Otolaryngology-Head and Neck Surgery, King Saud University Medical City, Riyadh, Saudi Arabia
| | - Ahmed Y Alammar
- Department of Otolaryngology-Head and Neck Surgery, King Saud University Medical City, Riyadh, Saudi Arabia
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Azwal N, Lokanathan Y, Azman M, Ng MH, Mohamed AS, Baki MM. Serum interleukin 1β in patients with acquired laryngotracheal stenosis. Acta Otorhinolaryngol Ital 2022; 42:250-256. [PMID: 35880366 PMCID: PMC9330755 DOI: 10.14639/0392-100x-n1981] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Accepted: 03/20/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVES To determine the serum levels of interleukin-1beta (IL-1β) in patients with acquired laryngotracheal stenosis (ALTS) and healthy volunteers and compare levels between serum and tissue of the stenotic segment. MATERIALS AND METHODS An exploratory cohort study included 20 participants with ALTS and 5 healthy volunteers. ALTS group was categorised into mild and severe according to grade of stenosis and presence of tracheostomy. Comparisons of serum levels of IL-1β between pre- and post-surgical intervention and between blood and tissue samples in the severe ALTS group were made. Correlation of IL-1β levels between blood and tissue was assessed using Spearman's correlation. RESULTS Severe ALTS patients showed higher serum levels of IL-1β compared to mild ALTS and healthy volunteers (p = 0.045). IL-1β was higher before surgical intervention than after surgical intervention (p = 0.003). There was a strong positive correlation of IL-1β between serum and tissue (r = 0.74, p = 0.035). CONCLUSION Serum levels of IL-1β are higher in ALTS patients than in healthy controls and positively correlate with tissue levels. The decreasing trend of serum IL-1β observed following successful surgical intervention reflects the absence of ongoing inflammation at the stenotic segment.
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Affiliation(s)
- Norazwani Azwal
- Faculty of Medicine, National University of Malaysia, Kuala Lumpur, Malaysia
- Department of Otorhinolaryngology and Head & Neck Surgery, International Islamic University Malaysia
| | | | - Mawaddah Azman
- Faculty of Medicine, National University of Malaysia, Kuala Lumpur, Malaysia
| | - Min Hwei Ng
- Tissue Engineering Centre, National University of Malaysia, Kuala Lumpur, Malaysia
| | | | - Marina Mat Baki
- Faculty of Medicine, National University of Malaysia, Kuala Lumpur, Malaysia
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Mirza N, Veeraballi S, Rayad MN, Kamal F, Shaaban H, Lee D, Savopoulos A. A Rare Case of Aggressive Metastatic Laryngeal Chondrosarcoma Presenting as Bilateral Necrotizing Pneumonia. Ear Nose Throat J 2022:1455613221100005. [PMID: 35635129 DOI: 10.1177/01455613221100005] [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] [Indexed: 11/16/2022] Open
Abstract
Laryngeal chondrosarcomas are rare tumors that account for only 0.2% of malignant tumors of the larynx. Approximately 80% of these tumors are low grade and well differentiated and are associated with a good long-term prognosis. Herein, we report a case of a 77-year-old male presenting with acute hypoxic respiratory failure that required intubation and mechanical ventilation. Chest CT showed multiple pulmonary nodules and cavities. He then required a tracheostomy, and a soft tissue mass in the subglottic mass was discovered. A laryngoscopy-guided excisional biopsy of the mass was performed. Histopathological examination confirmed the diagnosis of laryngeal chondrosarcoma. Clinicians should consider metastatic laryngeal chondrosarcoma as a differential diagnosis for lung cavities. Overall, we believe this to be the first case of aggressive laryngeal chondrosarcoma with mediastinal and pulmonary metastasis mimicking necrotizing pneumonia.
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Affiliation(s)
- Noreen Mirza
- Internal Medicine, Saint Michael's Medical Center, Newark, NJ, USA
| | | | | | - Fatima Kamal
- Medical Education, Saint Michael's Medical Center, Newark, NJ, USA
| | - Hamid Shaaban
- Hematology Oncology, 22423Saint Michael's Medical Center, Newark, NJ, USA
| | - Derek Lee
- Otolaryngology/ENT, Saint Michael's Medical Center, Newark, NJ, USA
| | - Andreas Savopoulos
- Hematology Oncology, 22423Saint Michael's Medical Center, Newark, NJ, USA
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Carpenter DJ, Hamdi OA, Finberg AM, Daniero JJ. Laryngotracheal stenosis: Mechanistic review. Head Neck 2022; 44:1948-1960. [PMID: 35488503 PMCID: PMC9543412 DOI: 10.1002/hed.27079] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [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: 09/24/2021] [Revised: 04/19/2022] [Accepted: 04/22/2022] [Indexed: 11/24/2022] Open
Abstract
Background The purpose of this review article is to summarize the existing literature surrounding wound healing mechanisms in laryngotracheal stenosis. Methods A review of general wound healing pathophysiology, followed by a focused review of iatrogenic laryngotracheal stenosis (iLTS) and idiopathic subglottic stenosis (iSGS) as conditions of aberrant wound healing. Results iLTS is the scarring of the laryngotracheal complex, coming secondary to injury from prolonged intubation. iSGS is a chronic fibroinflammatory scarring and narrowing of the subglottic airway in the absence of any obvious preceding injury or trauma. They are both thought to result from a prolonged and dysregulated wound healing response that promotes the deposition of pathologic scar in the airway. Conclusions Understanding the mechanisms that underlie wound healing will help identify and intervene on the process early in its development and discover future therapies that target individual wound healing mechanisms limiting the incidence of this recalcitrant disease process.
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Affiliation(s)
- Delaney J Carpenter
- Department of Otolaryngology - Head and Neck Surgery, University of Virginia Health System, Charlottesville, Virginia, USA
| | - Osama A Hamdi
- Department of Otolaryngology - Head and Neck Surgery, University of Virginia Health System, Charlottesville, Virginia, USA
| | - Ariel M Finberg
- Department of Otolaryngology - Head and Neck Surgery, University of Virginia Health System, Charlottesville, Virginia, USA
| | - James J Daniero
- Department of Otolaryngology - Head and Neck Surgery, University of Virginia Health System, Charlottesville, Virginia, USA
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50
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Bosco S, Prijs K, Licata J, Schwartz SA, Lesser R. A Unique Case of Metastatic Prostate Carcinoma to the Subglottis. Ear Nose Throat J 2022:1455613221086528. [PMID: 35324324 DOI: 10.1177/01455613221086528] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
- Samuel Bosco
- Philadelphia College of Osteopathic Medicine, PA, USA
| | - Kristen Prijs
- Philadelphia College of Osteopathic Medicine, PA, USA
| | - Jordan Licata
- Philadelphia College of Osteopathic Medicine, PA, USA
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