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At least 217 records · Page 12Linked to original sources
PubMed1996

Experimental and clinical evaluation of laryngeal chondrosynthesis.

The aim of this study was to investigate and develop techniques for stabilization and reconstruction of laryngeal defects with a method similar to osteosynthesis. In an anatomical study, 400 extrusion forces of sutures and various screws (Howmedica) were measured in the thyroid cartilage of fresh cadavers. A new screw was then especially designed for cartilage and a new technique was developed for stabilizing cartilage, using a screw-nut made out of bone. To date, 30 patients have undergone chondrosynthetic reconstruction of the larynx. Measurements of extrusion forces were found to depend on the degree of calcification present in the area of the laryngeal skeleton examined and the type of fixation device used. Good clinical results were achieved in all 30 patients studied and depended on stabilization of the two sides of the thyroid cartilage after thyrotomies, bridging of laryngeal defects and splinting of laryngeal fractures. Besides the increased extrusion forces the advantages of chondrosynthesis lay within the possibilities of axial stabilization and exact bridging of defects with or without implants.

Adolescent↗
PubMed1989

[Morphology of "asphyxia-induced epiglottis form" in newborn infants, infants and young children].

A systematic histological study of cross-sections of the larynx from 52 fatalities (neonates, infants and young children) revealed a broad spectrum of anatomical variants in the epiglottis form, which were caused by variations in the epiglottic cartilage. There was no correlation between the epiglottis form and the age of the child. Furthermore, no differences in shape could be established between cases of SIDS and control cases. The term "asphyxial-related epiglottis form" appears to be inappropriate. The commonly found supraglottic laryngitis on the laryngeal aspect of the epiglottis was seen in combination with histologically proven infections in the upper and lower respiratory tract. Histological investigation of the larynx provides valuable information for the morphological diagnosis in fatal cases in early life.

Asphyxia Neonatorum↗
PubMed1990

Two-stage repair of extensive subglottic tracheal stenosis.

The authors describe an open technique that has been used over the past 25 years to reconstruct the subglottic tracheal region in two stages after extensive laryngotracheal stenosis. After submucosal resection of fibrous tissue and reconstruction of the subglottic and tracheal skeleton by means of two autologous osseous grafts, a large laryngotracheostomy is created during the initial stage. Some weeks later, in the second stage, the anterior wall is closed, using two cervical hinge-door flaps. Ten patients have undergone this procedure, with a minimum follow-up of 3 years. All of the patients were decannulated upon completion of the treatment without recurrence of stenosis during the follow-up period.

Bone Transplantation↗
PubMed1987

Stenosis of the larynx following Teflon injection.

Teflon is commonly used to adduct immobile vocal cords in cases of unilateral recurrent nerve paralysis. However, its use can lead to considerable chronic inflammation at the site of the injection. Since Teflon is not encapsulated, particles can also be carried off and disseminated through the lymphatic system. This occurrence was found following Teflon injection in a 48-year-old man, resulting in laryngeal stenosis with tissue histology showing an impressive diffuse distribution of the Teflon particles and severe chronic inflammation. Our experiences have caused us to prefer the implantation of autologous materials in cases of unilateral recurrent nerve paralysis, particularly when patients have a long life expectation.

Humans↗
PubMed1989

A historical overview of the aetiology and treatment of laryngeal stenosis.

A review of over a century of publication on laryngeal stenosis reveals much about the aetiology and treatment. The earlier aetiologies of infection and in particular diphtheria of the early part of the twentieth century have given way to more complex and insidious causes. Trauma, particularly from intubation by endotracheal, tracheal or nasogastric tubes, is now the primary cause of simple and complex laryngeal stenosis. The treatments over the past century have been varied and ingenious, ranging from simple dilatation and intubation of the 1800s to galvanocautery, endoscopic scar incision and heated bougienage of the early twentieth century. By the 1930s and 1940s the concept of laryngofissure, scar excision, stenting and skin grafting was the accepted approach to laryngeal stenosis. More recently endoscopic approaches, local flap placement and laser surgery have been advocated. The open approach, however, has stood the test of time. This review presents a comprehensive bibliography and from the reading of these texts a method of classification is presented. This classification is coupled to available modern treatments as described in the literature and so gives the surgeon the available options for the stenosis encountered. The choice remains with the surgeon; however, as in most complex clinical problems there is usually a safe, reliable, dependable procedure, and it is the author's opinion, from this literature review, that the open laryngofissure procedure fulfils these criteria.

Europe↗
PubMed1989

Surgical treatment of laryngotracheal stenosis in infants and children.

Laryngotracheal stenosis in children is difficult to manage, especially in cases of acquired lesions. Of 317 cases reviewed, 75 surgical cases are reported here: 28 were congenital and 47 acquired, mostly due to endotracheal intubation. A large variety of laryngotracheoplasty techniques have been used in reconstruction, depending on the age and status of the patient, the size of the laryngeal lumen, the exact site of the stenosis and any associated anomalies. The three main techniques used have been described by Evans, Cotton, and Rethi. Stenting relied on Silastic rolls, Montgomery T-tubes and Aboulker Teflon prostheses. The results in 65 patients showed a decannulation rate of 92% in cases of congenital stenosis and 80% in acquired ones. Improvements in therapy still seem necessary in order to reduce the cannulation time following treatment and the sequelae producing dysphonia.

Adolescent↗
PubMed1980

[Laryngeal and tracheal stenoses (author's transl)].

Following the recent literature and our clinical experiences we try to present a review of the most common reasons, the pathogenetic factors, and the preferred localisation of laryngeal and tracheal stenoses. We offer a therapeutic concept corresponding with our experimental findings and discuss the different surgical techniques as well as the clinical results we obtained.

Humans↗
PubMed1975

[Larynx lesions and sudden death (author's transl)].

Several recently observed cases of "Sudden Death" caused by larynx lesions give reason for a special discussion of this problem. At the Institute of Legal Medicine only six cases were found in 10.747 autopsies between 1949 and 1970. A brief description of the anatomical structure of the larynx is followed by a discussion of the 4 general pathological entities, which might be the etiological cause of laryngeal obstruction: 1. Abnormalities 2. Disturbances of circulation 3. Inflammations 4. Tumors Besides the question of the forensic-medical importance of such fatal cases, the difficulty of evaluating some of the patho-morphologic and histologic findings is discussed. Simultaneously attention is drawn to the frequent lack of a clinical history, so that life-supporting measures wuch as tracheotomy and others are applied very late or not at all. Finally the problem of forensic evaluation of larynx-cysts and their etiology is presented. In this context the clarification of a causal relationship with possible previous intubations of the larynx is of major importance.

Adult↗
PubMed1988

Subglottic cysts and asymmetrical subglottic narrowing on neck radiograph.

The congenital subglottic hemangioma typically appears as an asymmetric subglottic narrowing or mass on frontal neck radiographs. Therefore, soft tissue neck radiography has been advocated as a definitive non-operative approach for diagnosing these lesions. However, we have noted similar asymmetric subglottic narrowing in patients with acquired subglottic cysts. These retention cysts occur following long-term intubation in the neonate. The mechanism probably involves subglottic fibrosis which obstructs glands with subsequent cyst formation. Acquired subglottic cysts typically appear as an asymmetric narrowing on frontal or lateral soft tissue neck radiographs. These lesions may produce airway compromise but are effectively treated by forceps or laser removal. Acquired subglottic cysts must be included in the differential diagnosis of asymmetric subglottic narrowing. The definitive diagnosis is made by direct laryngoscopy, not soft tissue neck radiograph.

Airway Obstruction↗
PubMed1997

Endoscopic evolution of laryngeal injuries caused by translaryngeal intubation.

Despite improvements in tube design and materials, the longer survival rates of critically ill patients make laryngeal and tracheal lesions still common following prolonged translaryngeal intubation. The time of intubation is almost the only factor employed in deciding whether or not tracheotomy has to be performed. Some patients will not develop laryngeal lesions afer long intubation periods, whereas some already have clinical symptoms after short periods of time. If the conditions of the larynx and trachea could be assessed before irreversible complications take place, then timing of tracheotomy could be individualized to avoid laryngeal stenosis as well as unnecessary tracheostomies. We present the preliminary results of an endoscopic study of the early laryngeal changes that take place during translaryngeal intubation. The method of exploration is explained and tissue changes seen and their evolution after extubation are described, emphasizing those that could have a predictive value.

Adolescent↗
PubMed1991

Pharyngoesophageal bypass using a free jejunal graft for corrosive stricture--a case report.

The management of corrosive strictures of the esophagus involving the pharynx and/or larynx continues to be a challenge to surgeons. This paper presents a case of a corrosive stricture extending from the hypopharynx to the cervical esophagus associated with complete obstruction of the larynx, which was successfully treated by pharyngoesophageal bypass using a free jejunal graft. Postoperative recovery was smooth without any complications, and swallowing was restored. Three months after the bypass operation, the patient underwent laryngoplasty. Although aspiration occurred immediately after the laryngoplasty, six months later she was again able to tolerate the oral intake of semisolid food without any need for supplementary nutritional support. Reconstruction of a short segment of the pharyngoesophageal stricture by a free jejunal graft restores almost normal swallowing provided that dilatation of the lower esophagus is achieved.

Adult↗
PubMed1991

Platelet-activating factor detected in bronchoalveolar lavage fluids from an asthmatic patient.

It recently has been recognized that platelet-activating factor (PAF) may be a mediator of asthma exacerbation. We had the opportunity to analyze bronchoalveolar lavage fluids from an asthmatic infant, which were characterized by neutrophil infiltration. The patient's lungs were washed on three occasions with saline during asthmatic attacks. PAF was found in each case on the basis of its ability to cause the immediate aggregation of washed rabbit platelets. The PAF detected was equivalent to 1-1.4 pmol of 1-O-hexadecyl-2-acetyl-sn-glycero-3-phosphocholine, three quarters of which were recovered in cell-associated form. By contrast, we did not detect PAF in bronchoalveolar exudates from patients with laryngeal stenosis or with respiratory distress syndrome. LysoPAF, the direct precursor as well as initial metabolite of PAF, was also analyzed after being converted to PAF by acetylation. There was a wide variation in the amount of lysoPAF present in individual patients, suggesting that lysoPAF levels cannot be taken as an indicator for the presence of PAF.

Asthma↗
PubMed2002

Congenital airway abnormalities in neonates.

Airway malformations such as laryngeal atresia, tracheal agenesis and subglottic stenosis are rare and present at birth with significant respiratory distress with or without stridor. There may be an initial improvement on bag and mask ventilation. Repeated attempts at intubation are met with failure. The related embryology and clinical aspect of airway malformations have been discussed. The prognosis in tracheal agenesis is universally fatal but cases with laryngeal atresia and subglottic stenosis may be saved with prompt tracheostomy and later surgical reconstruction.

Cricoid Cartilage↗
PubMed1993

Diffuse idiopathic skeletal hyperostosis: an unusual cause of difficult intubation.

A case is reported in which anterior osteophytes on the cervical vertebra, in combination with a subglottic stenosis, resulted in distortion of the airway and led to unexpected difficulties during intubation. The osteophytes, associated with the syndrome of diffuse idiopathic skeletal hyperostosis (DISH) were centred at the midcervical level and resulted in anterior displacement of the larynx with an acute angulation of the trachea just below the larynx. This acute angulation, immediately above an unrecognized subglottic stenosis, rendered it impossible to pass all but the smallest endotracheal tube. Diffuse idiopathic skeletal hyperostosis is an ossifying diathesis leading to bone formation in spinal and extraspinal sites, paravertebral osteophyte formation and ligamentous calcification and ossification. Ossification of the anterior longitudinal ligament is common, may be discontinuous, and is often more marked in the thoracolumbar spine than elsewhere. However, isolated and predominant cervical spinal involvement may occur. Diffuse idiopathic skeletal hyperostosis occurs primarily in the elderly population and is often associated with the syndromes of osteoarthritis and ossification of the posterior longitudinal ligament (OPLL). Difficult intubation resulting from anatomical abnormalities of the cervical spine is rare. Although radiological evaluation may be useful in assessing the airway in patients deemed to be at risk for difficult intubation, it cannot be recommended for screening patient populations on a routine basis because of the cost and anticipated extremely low yield. Careful clinical evaluation of the airway before operation and having an approach to the unexpected difficult intubation are emphasized.

Aged↗
PubMed2004

Laryngo-tracheo-bronchial stenosis in a patient with primary pulmonary amyloidosis: a case report and brief review.

PURPOSE: To report a case of lower respiratory tract obstruction occurring in a patient with primary pulmonary amyloidosis and discuss anesthetic management. CLINICAL FEATURES: A 53-yr-old man was referred to our institution for microlaryngoscopy and laser treatment of the larynx. He presented with a five-year history of primary laryngo-tracheo-bronchial amyloidosis and symptoms consistent with narrowing of the conducting airways. General anesthesia was induced with iv propofol 150 mg and remifentanil 50 microg. Mivacurium 20 mg provided muscle relaxation for endotracheal intubation. Following endotracheal intubation, the airway became obstructed and patient ventilation impossible. The endotracheal tube was removed and a Dedo laryngoscope inserted. Gas exchange was maintained using supraglottic jet ventilation via a distal port of the laryngoscope. Rigid bronchoscopy showed tissue partially obstructing the lumen of the lower trachea. This was removed and the airway appeared patent. At the end of the case, a further episode of lower airway obstruction occurred requiring reinsertion of the laryngoscope and resumption of jet ventilation. Extensive debridement through the bronchoscope was required before adequate ventilation could be restored. Some days later when the patient's condition deteriorated again and he required further debridement of the trachea and insertion of a tracheostomy, guide wires were positioned in the femoral vessels in the event that cardiopulmonary bypass was required for gas exchange. CONCLUSIONS: Primary laryngo-tracheo-bronchial amyloidosis is a recurrent disease, requiring repetitive surgical procedures. Airway compromise can be a persistent problem. Awareness of this uncommon disease process and its presentation may serve to caution the anesthesiologist presented with this type of case.

Amyloidosis↗
PubMed1994

Percutaneous transtracheal jet ventilation for paediatric endoscopic laser treatment of laryngeal and subglottic lesions.

Percutaneous transtracheal high frequency jet ventilation (TTJV) in adults is frequently used during anaesthesia for laryngeal microsurgery. It provides excellent surgical operating conditions and safety for the patient. The technique has not been evaluated in infants and children. Accordingly, we studied 16 infants and children (mean age 5.5 +/- 3.8 yr, range 6 wk-12 yr) who underwent 28 consecutive endoscopic procedures with laser microsurgery of the glottic or subglottic space under general anaesthesia using a TTJV technique. All patients had a severe obstructive lesion of the larynx and/or upper trachea. The mean duration of the procedure was 70 +/- 27 min (range 30-140 min). Indications for TTJV were: subglottic stenosis: 5, haemangioma: 4, laryngeal papillomatosis: 5, pharyngeal cyst: 1, laryngomalacia: 1. Adequate control of the airway and satisfactory gas exchange were obtained in all cases. Surgery was performed without being impeded by anaesthetic equipment. Three complications occurred: one extensive surgical emphysema; one bilateral pneumothorax; one severe vagus-induced cardiovascular depression. Prompt and complete recovery without sequelae followed appropriate treatment. In 32% of the cases, the children were outpatients and in about half of the procedures (13/28) they left the hospital between the first and the third day. We conclude that percutaneous transtracheal jet ventilation is effective in paediatric endoscopic surgery. Procedures that might otherwise require a tracheostomy can be performed safely with this minimally invasive technique. Adequate indications and appropriate understanding of the technique and its potential problems are required for its correct application and successful use.

Airway Obstruction↗