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At least 271 records · Page 15Linked to original sources
PubMed2006

Preoperative assessment in patients with postintubation tracheal stenosis : Rigid and flexible bronchoscopy versus spiral CT scan with multiplanar reconstructions.

BACKGROUND: Postintubation stenosis remains the most frequent indication for tracheal surgery. Rigid bronchoscopy has traditionally been considered the technique of choice for the preoperative diagnostic assessment. However, this technique is not routinely available, and new techniques such as flexible videobronchoscopy and spiral computed tomography (CT) scan with multiplanar reconstructions have been proposed as alternatives to rigid bronchoscopy. The aim of this study was to compare these techniques in the diagnostic assessment of patients with tracheal stenosis submitted to surgical treatment. METHODS: Twelve patients who underwent airway resection and reconstruction for postintubation tracheal and laryngotracheal stenosis were preoperatively evaluated with rigid and flexible bronchoscopy and with spiral CT scan with multiplanar reconstructions. The following parameters were examined: involvement of subglottic larynx, length of the stenosis, and associated lesions. The results were compared with the intraoperative findings. RESULTS: The accuracy of rigid bronchoscopy, flexible bronchoscopy, and CT scan in the evaluation of the involvement of subglottic larynx was, respectively, 92%, 83%, and 83%. The evaluation of the length of the stenosis was correct in 83%, 92%, and 25% of the patients, respectively, with rigid bronchoscopy, flexible bronchoscopy, and CT scan. A significant correlation was observed between the length of the stenosis measured intraoperatively and preoperatively with rigid (p < 0.001) and flexible bronchoscopy (p < 0.05) but not with CT scan (p = 0.08). The three techniques correctly showed the presence of an associated tracheoesophageal fistula in two patients, but CT scan did not correctly show the exact location of the fistula in relation to the airway. Flexible bronchoscopy was the only effective technique in the assessment of laryngeal function. CONCLUSIONS: Rigid bronchoscopy remains the procedure of choice in the evaluation of candidates for tracheal resection and reconstruction for postintubation stenosis, and it should be available in centers that perform surgery of the airway. Flexible bronchoscopy and CT scan have to be considered complementary techniques in the evaluation of laryngeal function and during follow-up.

Adult↗
PubMed2001

Successful reconstruction of extensive laryngotracheal strictures after inhalation burn injury: report of a case.

We report a rare case of long segmental laryngotracheal stenosis following inhalation burn injury. The patient presented 2 months after his injury with progressive stridor and dyspnea necessitating tracheostomy. A computed tomographic scan of the neck revealed stenosis extending from the vocal cords to the top of the sternum. Repair was successfully carried out with multiple surgical procedures employing hinge-flap closure tented with autogenous tissue.

Adult↗
PubMed1991

Improved technique for inserting a T tube in patients with subglottic stenosis.

An improved method for inserting a silicone T tube through a tracheostomy stoma in patients with subglottic stenosis is presented. A silicone T tube is pulled into the trachea with a catheter that is inserted into the tracheostomy stoma, advanced through the stenotic subglottic space, and pulled out the mouth. A cone-shaped dilator is placed beforehand at the proximal end of the vertical limb of the T tube to facilitate the passage of that end through the stenotic subglottic space. This method was used in 4 patients with good results. We suggest this technique be tried when attempts to insert a T tube by the usual method fail, as it can be performed under local anesthesia without special instruments and is technically easy.

Catheterization, Peripheral↗
PubMed1992

Laryngotracheal resection and reconstruction for subglottic stenosis.

Eighty patients with inflammatory stenoses of the subglottic larynx and upper trachea were treated by single-stage laryngotracheal resection and reconstruction. Fifty stenoses originated from postintubation lesions (endotracheal tubes, tracheostomy, cricothyroidostomy), 7 originated from trauma, 19 were idiopathic, and 4 were miscellaneous. Repair consisted of resection of the anterolateral cricoid arch in all patients, plus resection of posterior laryngeal stenosis where present, with salvage of the posterior cricoid plate, appropriate resection and tailoring of the trachea, and primary anastomosis using a posterior membranous tracheal wall flap to resurface the bared cricoid cartilage in 31 patients. One postoperative death resulted from acute myocardial infarction. Long-term results were excellent in 18 patients, good in 48, satisfactory in 8, and failure in 2. Three additional patients had good results at discharge but were followed up for less than 6 months.

Adolescent↗
PubMed1993

Idiopathic laryngotracheal stenosis and its management.

We describe idiopathic laryngotracheal and upper tracheal stenosis in 49 patients with no other cause for their stenosis. Traumatic, iatrogenic, infectious, and specific inflammatory processes were excluded. Histopathologically dense fibrosis of keloidal type thickened the lamina propria and choked the ducts of mucous glands but did not destroy cartilage. Thirty-five patients were treated by single-stage resection and reconstruction: 29 by laryngotracheal resection with laryngotracheoplasty and 6 by cricotracheal segmental resection. Thirty-two patients achieved good or excellent results in respiration and voice, 2 needed annual dilations, and 1 required permanent tracheostomy.

Adolescent↗
PubMed1995

Surgical treatment of nontumoral stenoses of the upper airway.

BACKGROUND: After 1970, the widespread use of nasotracheal intubation, avoiding tracheostomy and its pitfalls, resulted in more frequent laryngeal or laryngotracheal stenoses, which required more complex and sometimes multistaged procedures. METHODS: A series of 217 nontumoral stenoses of the upper airway were treated following the same therapeutic principles in the period 1978 to 1992. Two hundred one of them were iatrogenic postintubation strictures (92%); the others were posttraumatic (7), idiopathic (5), and various (4). RESULTS: One hundred twenty (55%) were tracheal stenoses and treated by resection and primary end-to-end anastomosis with 117 excellent or good results and three deaths. Length of the stenosis, old age, neuropsychological sequelae, and overall poor respiratory status of the patients made up the remaining difficulties in the treatment. Ninety-seven (45%) were laryngotracheal stenoses with much more complex surgical indications: 57 patients underwent tracheal and subglottic resection and anastomosis with 56 successes and one death, 7 had laryngotracheal resection and anastomosis with total cricoidectomy and consequently laryngeal stenting for 3 to 6 months (six successes, one death), 3 had supraglottic resection and anastomosis (three successes), 12 patients with glottic opening difficulties and short laryngeal stenosis underwent a laryngeal enlargement over a T tube without resection (11 successes, one death), and 18 were subjected to a complex combination of resection and modeling with 16 successes, 2 failures, and 1 death. Final results were successful in 208 cases (96%) with seven deaths and two failures. Mild phonetic sequelae were observed after laryngeal modeling. A minimal follow-up of 1 year has shown long-term stability of most repairs. CONCLUSIONS: Despite acceptable results, the therapeutic approach remains difficult for laryngotracheal stenoses involving the glottic and the supraglottic level as well as for those that have not responded to previous attempts at repair. In a few cases, despite a meticulous preoperative assessment, the surgical strategy can only be adopted intraoperatively. The key to surgical success is undoubtedly a careful preoperative treatment of infection and inflammation as well as a meticulous muco-mucosal approximation of healthy margins at the anastomosis.

Adolescent↗
PubMed1991

Management of pediatric laryngotracheal stenosis.

In the past 6 years, 40 children underwent surgery for laryngotracheal stenosis; 32 by the external approach and 8 by endoscopic CO2 laser. Twenty-seven children (67%) were less than 5 years old at the time of treatment and 80% of the stenoses (n = 32) corresponded to an etiology that is secondary to endotracheal intubation and/or tracheotomy. By grading the stenoses according to the amount of narrowing of the lumen, the authors emphasize the interest of conservative treatment (endoscopic for grade I [less than 70%, n = 8], and treatment by external surgical methods for grade II [70% to 90%, n = 13], grade III [90% to 99%, n = 14], and grade IV [total obstruction, n = 5]). At this time, the most commonly used technique is laryngotracheoplasty with costal cartilage interposition. In this series, 88% of the patients were successfully decannulated. As for the treatment of stenosis in infants, the authors describe their recent experience of laryngotracheofissure in 7 patients as an alternative to either tracheotomy in cases of difficult extubation or laryngotracheoplasty when the child is underweight.

Adolescent↗
PubMed1991

Relief of subglottic stenosis by anterior cricoid resection: an operation for the difficult case.

Anterior cricoid resection is an effective procedure to relieve subglottic stenosis. This is well documented in adults, although reports of the procedure in growing airways are limited. Over an 11-year period, seven pediatric patients underwent anterior cricoid resection for recalcitrant subglottic stenosis. In four patients, the stricture was secondary to prolonged intubation, one developed subglottic stenosis following a high placement of tracheostomy for epiglottitis and another had congenital subglottic stenosis. One child had subglottic stenosis combined with laryngotracheoesophageal cleft and more distally located tracheoesophageal fistula. All patients had failed to respond to previous treatment: dilatations (3 to 20), steroid injection (3 patients), and Evan's tracheoplasty (2 patients). All patients had an excellent result from anterior cricoid resection. The median age of children undergoing anterior cricoid resection was 3 years. There was no mortality. Tracheostomy decannulation was accomplished within 12 weeks following operation in all patients. It was necessary to remove a tracheal granuloma in one patient. Anterior cricoid wedge resection leaving the posterior portion of the cricoid in place is done to avoid recurrent nerve injury. It is a relatively simple and effective procedure. There has been minimal morbidity and no mortality. Follow-up from 1 to 11 years shows no recurrence of stenosis. There has been normal laryngeal and airway growth.

Child, Preschool↗
PubMed1992

Innovations in pediatric laryngotracheal reconstruction.

Techniques for the reconstruction of pediatric subglottic and tracheal stenoses continue to undergo modification and refinement. The modified Réthi procedure of anterior laryngotracheal division and posterior cricoidotomy may be supplemented by unilateral or bilateral division of the cricoid cartilage for increased expansion of the subglottic lumen. The resulting four-quadrant division of the cricoid cartilage can be used in conjunction with the placement of cartilaginous grafts and stenting techniques common to laryngotracheal reconstruction (LTR). From October 1, 1986, to January 10, 1990, 31 four-quadrant division procedures were performed in 29 patients. Overall, decannulation has been achieved in 22 of 29 patients (76%). Another technique in LTR is the use of endotracheal tube stenting, resulting in single-stage LTR. The endotracheal tube supports the surgically expanded lumen for a period of intubation, followed by extubation. On extubation, the patient is effectively decannulated because the tracheostomy site is closed during the reconstructive procedure. From January 1, 1985, to July 31, 1990, 36 single-stage LTRs were performed in 35 patients. Overall successful results have been achieved in 30 of 35 (86%) of single-stage LTR patients.

Adolescent↗
PubMed1992

Aerocele, an unusual complication of anterior cricoid split.

Since its introduction, the anterior cricoid split has proven to be a safe and effective procedure for the management of infants with acquired subglottic stenosis. In this article we report an unusual complication--an aerocele, which occurred on the 14th day following an anterior cricoid split on a 9-month-old child. The possible etiology and successful management of the aerocele are reviewed.

Air↗
PubMed1993

Tracheostomy: acute and long-term mortality and morbidity in very low birth weight premature infants.

Thirty-six very low birth weight premature infants (VLBW-PT) born at 24 to 32 weeks gestation and with birth weights 635 to 1,360 g who had tracheostomies performed for acquired subglottic stenosis or for prolonged mechanical ventilation were followed in relation to acute and long-term mortality and morbidity. Mortality due to the tracheostomy occurred in 4 patients (11%); mortality from all other causes was 25%. Death after hospital discharge was associated with the nonuse of prescribed cardiorespiratory monitors. Complications < 1 week postsurgery occurred in 31% of infants and complications > or = 1 week postsurgery occurred in 64% of infants. Fifty percent of infants required tracheostomy for > 2 years and/or extensive reconstructive surgery of the airway. Parents should be counselled that VLBW-PT infants with a tracheostomy may require extended medical and home care. An effective home care program requires parental training in tracheostomy care, the use of ancillary equipment, and infant cardiopulmonary resuscitation.

Female↗
PubMed1980

Peroral endoscopy in neonates.

A study was made of 100 neonates examined by 171 procedures in a 5 year period. Thirty-six patients had vocal cord palsies: unilateral, bilateral, complete or incomplete. Twenty-four infants had laryngomalacia of which 5 had concomitant problems of multiple congenital anomalies or palsies of varying severity. Laryngeal stenosis was encountered in 13 patients. Four of these were congenital, and two required tracheotomy; 8 of the 9 patients with acquired stenosis required tracheotomy. Nine infants had cardiovascular anomalies. Three were seen following TEF repair. Esophageal foreign bodies (endotracheal tube) were removed from two infants. Of the 28 neonates who had tracheotomies, 13 had vocal cord palsies, 10 had laryngeal stenosis and 8 had congenital cardiovascular disease. In the 171 procedures, anesthesia was used 18 times for tracheotomy and 7 times for repeated procedures. There were 3 deaths in this series, all related to the underlying disease. This study indicates that endoscopic examinations of the neonate can be accomplished safely. It further indicates the diverse diseases for which endoscopy is indicated. General anesthesia is not mandatory for such examinations.

Age Factors↗
PubMed1980

Treatment of post-intubation laryngotracheal stenosis.

Post-intubation laryngotracheal stenosis in children is an important therapeutic problem in pediatric otolaryngology. The numbers of children treated by prolonged intubation and resuscitated children are increasing. In the Department of Pediatric Otolaryngology in Warsaw, 6 children were treated for post-intubation laryngotracheal stenosis. In the treatment the method of longitudinal intralaryngotracheal incisions was applied; in 3 cases with tracheotomy followed by cellophane separation and in 3 cases without the use of separator and without tracheotomy. There were no complications connected directly with the operation. Pneumonia was a frequent later complication making treatment difficult. Good therapeutic results were obtained.

Adolescent↗