Treatment of post intubation and cuffed tube tracheal stenosis with T-tube tracheal stent.
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Female↗
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Results for “TRACHEAL STENOSIS”
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[Laryngo-tracheal stenosis. Complications of tracheotomy and tracheal intubation in respiratory resuscitation].
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Adolescent↗
[The application of metal stent in the treatment of adult non neoplastic tracheal stenosis].
OBJECTIVE: To assess the feasibility and the curative effect of the metal stent inserted in non neoplastic tracheal stenosis. METHOD: In this study, 7 patients were treated with endotracheal metal ultraflex stent for non neoplastic tracheal stenosis, who had a contraindication or refuse to the surgery operation. There are six cases, their length of tracheal stenosis more than 4 cm. The other one, tracheal stenosis located at the tracheal fistula after total laryngectomy. Non-silica gel membrane metal stent were used in four cases, silica gel membrane metal stent were used in three cases. RESULT: These stents were well tolerated and produced immediate symptomatic and functional improvement. Granulation tissue without obstruction of the airway was observed in 6 patients; only one patient had a local recurrence that needed a re-tracheotomy. One patient had to pull out the stent after 10 months of operation. The reason is local discomfort. CONCLUSION: Metal stent has a good curative effect in the treatment of non neoplastic tracheal stenosis, especially for the nonresectable patient, and it is easy to operate. However, the results are not sufficient to assess the efficacy and tolerance of the device in the medium and the long term.
Adult↗
[Surgical treatment of tracheal stenosis].
In the Department of General and Thoracic Surgery between 1981 and 1992 497 patients with tracheal stenosis were treated surgically. In 19 (3.8%) cases the stenosis was after previous tracheostomy. In 469 patients (94.4%) the stenosis was caused as the result of compression by goitre and in 9 (1.8%) by neoplastic tumors of mediastinum. Most patients with tracheal stenosis were treated surgically. In 13 cases the stenosis was resected, in 3 cases T-tube was inserted and in 3 cases the stenosis was dilated. In patients with secondary stenosis due to compression by goitre subtotal thyroidectomy was performed. Early good immediate results in both groups of tracheal stenosis were obtained in 90% of cases. Late results obtained 12 months after treatment of primary tracheal stenosis and 4 to 48 months after treatment of secondary tracheal stenosis (due to goitre) revealed 90% of good results.
Aged↗
Tracheal stenosis in sarcoidosis.
A 58-year-old woman with sarcoidosis had dyspnea found to be caused by a rare manifestation of that disease--tracheal stenosis. Tracheal dilatation has been beneficial.
Female↗
Management of distal tracheal stenosis.
OBJECTIVE: To evaluate the treatment, perioperative management, and outcome of infants who underwent repair of congenital tracheal stenosis. We hypothesized that early resection and tracheoplasty with early weaning of ventilatory support results in less mucosal injury, and thus better outcome. DESIGN: Retrospective study from 1986 to 1996. SETTING: Tertiary care children's hospital. PATIENTS: Seventeen consecutive infants with congenital tracheal stenosis, aged from birth to 16 months. Fifteen patients had complete tracheal rings, 6 of whom also had a left pulmonary artery sling. Fourteen patients underwent either tracheoplasty or resection and reanastomosis of the trachea, both facilitated by cardiopulmonary bypass. RESULTS: Six patients underwent resection and reanastomosis; 4 patients were extubated within 2 to 5 days without sequelae. There was 1 unrelated perioperative death. Two patients required reintubation. Eight patients required tracheoplasty due to severe tracheal stenosis and had variable postoperative courses. Seven of 14 patients required 0 to 1 postoperative bronchoscopies. Seven of 14 patients required 2 to 7 bronchoscopies for granulation tissue formation, cicatrix, graft collapse, and tracheitis. One patient required numerous procedures and revision tracheoplasty for cicatrix and stenosis. CONCLUSIONS: Correction of short-segment (<5 rings) tracheal stenosis by resection and reanastomosis of the trachea with the aid of cardiopulmonary bypass and early weaning of ventilatory support is recommended. Tracheoplasty using either the castellation technique or slide tracheoplasty is recommended in the treatment of infants with severe (long segment) tracheal stenosis.
Bronchoscopy↗
[Nitinol alloy endotracheal stent used in treatment of tracheal stenosis: experimental and clinical applications].
A new method used in treatment of tracheal stenosis by means of nitinol alloy intraluminal tracheal stent (Ni-Ti ITS) is introduced. Altogether 7 stents were implanted into tracheas of 7 mongrels each with a model of tracheal stenosis. The observation periods ranged from 2 to 6 months. The experimental results showed: The Ni-Ti ITSs could maintain long term patency without severe infection or obstruction by granulations or secretion. No displacement was found. There were no signs of either generalized or localized corrosion on the surface of stents. The shape memory character remained unchanged. On the basis of animal experimental study, the stents were successfully used in treatment of 2 patients with tracheal stenosis. One was caused by advanced tracheal tumor, the other was due to recurrent anastomotic stricture.
Adult↗
Mitomycin: effects on laryngeal and tracheal stenosis, benefits, and complications.
The management of laryngeal and tracheal stenosis continues to challenge us, despite advances in surgical techniques and better understanding of the wound healing process. Injury to the airway mucosa is the inciting event, regardless of the cause of the stenosis. Mitomycin-C is an antineoplastic antibiotic that acts as an alkylating agent by inhibiting DNA and protein synthesis. It can inhibit cell division, protein synthesis, and fibroblast proliferation. Topical application of mitomycin-C (0.4 mg/mL) was used as an adjuvant treatment in the endoscopic laser management of laryngeal and tracheal stenosis in 15 patients. Fourteen patients (93%) have shown improvement of their airway and resolution of their preoperative symptoms. After a mean follow-up of 18 months, no complication was noted with regard to the application of mitomycin-C. This study gives promising findings on the efficacy and safety of mitomycin-C as an adjuvant treatment in the management of selected cases of laryngeal and tracheal stenosis.
Administration, Topical↗
[An adult case of asymptomatic congenital tracheal stenosis].
We report an adult case of asymptomatic congenital tracheal stenosis. A 42-year-old woman was admitted to our hospital, whose chief complaint was tongue pain. Clinical examination revealed a tumor 35 x 20 mm in diameter along the middle, right edge of the tongue, and histopathological examination determined a diagnosis of squamous cell carcinoma of the tongue. She had no history of dyspnea, stridor nor recurrent pneumonia, and enjoyed playing table tennis in her daily life. Physical examination, electrocardiogram, spirogram and laboratory data showed no abnormal signs although chest roentgenogram revealed a narrowed trachea 6 mm in diameter, however, the tracheal stenosis was not noted at the time. On the 10th hospital day, radical operation for cancer of the tongue including right hemiglossectomy and supraomohyoid neck dissection, were performed. Oral intubation was not successful, and a tracheostomy was conducted. The trachea was incised, and revealed that complete tracheal rings existed without posterior membraneous tissue. The operation time was limited because of high airway pressure for a narrow tracheal tube (5 mm in diameter). The main postoperative complication was one crust formation in the tracheal lumen that resulted in CO2 narcosis due to check valve obstruction of the trachea on the 4th postoperative day. A nebulizer provided continuous moisture and was effective in preventing recurrence of the crust attachment to the tracheal membrane thus, the tracheostoma was closed by the 17th postoperative day. This case indicates that among healthy people there are extremely rare patients with congenital tracheal stenosis who survive their postnatal and infantile periods, and who experience no trouble in their daily lives. As physicians, we must be aware of this disease in adult patients in our clinics.
Adult↗
Tracheal stenosis.
While still an uncommon cause of airway obstruction, the incidence of tracheal stenosis in adults has increased with the use of assisted ventilation. The etiology, diagnosis, and treatment of tracheal stenosis are discussed. Special attention is paid to post-intubation tracheal stenosis and to tracheal resection as its most successful treatment option.
Adult↗
Tracheal stenosis depends on the extent of cartilaginous injury in experimental canine model.
To test the hypothesis that the development of tracheal stenosis would depend on the extent of tracheal cartilaginous injury, either 90 degrees (n=6) or 180 degrees (n=6) of anterior wall of 4 tracheal rings were cauterized in 12 mongrel dogs using Nd-YAG laser. Beginning at 3 weeks after cauterization, 180 degrees tracheal injury resulted in life-threatening tracheal stenosis whereas 90 degrees injury did not. Gross and microscopic examinations showed that after 180 degrees injury, tracheal stenosis was accompanied by the loss of tracheal cartilage and dense fibrosis. These results indicate that tracheal stenosis depends on the extent of tracheal injury in experimental canine model.
Animals↗
Vascular-pedicled costal cartilage graft for the treatment of subglottic and upper tracheal stenosis.
BACKGROUND/PURPOSE: Free costal cartilage graft for the treatment of subglottic and tracheal stenosis is widely used, but postoperative granulation formation is a problem. To reduce the risk of granulation formation after free costal graft, a new operation of costal cartilage graft with vascular pedicle was introduced. METHODS: A vascular pedicled fifth costal cartilage graft is prepared using internal thoracic artery and vein and intercostal artery and vein as a vascular pedicle. The prepared graft is brought to the upper trachea. The anterior wall of cricoid is split, and the costal cartilage graft is implanted to the split part and tracheostomy. Extubation on the next day is possible if the general condition of the patient permits. RESULTS: In 3 cases of subglottic or upper tracheal stenosis, this operation was performed. All the patients had tracheostomy made during early infancy. The postoperative course was uneventful, and all the patients were extubated soon after the operation. No granulation tissue was observed by postoperative bronchoscopic examinations. CONCLUSIONS: Costal cartilage graft with vascular pedicle is a safe and useful new operation for the treatment of subglottic and upper tracheal stenosis. There also is a possibility of using this procedure for the treatment of long segment tracheal stenosis.
Cartilage↗
[An adult case of asymptomatic congenital tracheal stenosis].
A 42-year-old woman was admitted with abnormal chest radiographs. Though interstitial pneumonia associated with dermatomyositis was diagnosed, her chest radiograph also revealed a narrowed trachea about 6 mm in diameter. Bronchoscopy showed that her trachea lacked a membranous posterior segment and O-shaped complete tracheal rings were present throughout the trachea, indicating congenital tracheal stenosis. Congenital tracheal stenosis is a rare disorder and is usually recognized in the first few weeks of life, but the patient had no history of dyspnea or recurrent pneumonia. This case suggests that among healthy people there are a very few who have asymptomatic congenital tracheal stenosis.
Adult↗
Nd-YAG laser treatment of tracheal stenosis.
We administered Nd-YAG laser treatments in four patients aged 56 to 68 years for severe tracheal stenosis, the tracheal diameters varying between 2.5 and 5 mm. These patients were all dyspneic at rest with talking or dressing and their peak flows ranged from 8% to 36% of predicted. They were not felt to be candidates for surgical excision. Immediate palliative relief was achieved in all patients and lasted two to four months after a single treatment in three patients. One patient died three weeks after laser treatment due to respiratory failure from underlying emphysema. There were no complications of laser therapy. Postlaser therapy the tracheal diameter in each patient was at least 9 mm and peak flow improved to between 25% and 76% of predicted. The results suggest that laser treatment may be beneficial in cases of severe tracheal stenosis.
Aged↗
Is tracheal stenosis caused by percutaneous tracheostomy different from that by surgical tracheostomy?
STUDY OBJECTIVE: To compare the surgical findings of tracheal stenosis caused by percutaneous tracheostomy (PCT) and surgical tracheostomy (SGT). DESIGN AND SETTING: A combined prospective (from 2001 to 2003) and retrospective (from 1993 to 2001) observational study of the patients undergoing tracheal resection and reconstruction for treatment of tracheal stenosis following PCT or SGT in a national referral center for thoracic surgery in the United Kingdom. PATIENTS AND MEASUREMENTS: We studied 29 patients presenting with symptomatic tracheal stenosis requiring tracheal reconstruction. We recorded the demographic data, duration of mechanical ventilation, onset of tracheal stenosis after decannulation, and type of tracheostomy (PCT or SGT) from referral notes. Tracheal reconstruction was preceded by rigid bronchoscopy, through which the distance of the superior level of stenosis to the vocal cords, and the length and the diameter of stenosis were measured. The type of surgical technique for tracheal resection was also recorded. We then compared the stenosis caused by PCT (n = 15) and SGT (n = 14) using an unpaired t test, Mann-Whitney U test, or Fisher exact test as appropriate for statistical analysis. RESULTS: The mean distance from the superior level of stenosis in the PCT group was significantly closer to the vocal cords compared with the mean distance in the SGT group: 1.6 cm (95% confidence interval [CI], 1.1 to 2.1) vs 3.4 cm (95% CI, 2.3 to 4.5), respectively (p = 0.04). The mean onset of stenosis was significantly earlier in the PCT group compared to the SGT group: 5.0 weeks (95% CI, 5.0 to 6.0) vs 28.5 weeks (95% CI, 12 to 84), respectively (p = 0.009). Seven of 15 patients in the PCT group required partial cricoid resection and a mucosal flap, compared with 1 of 14 patients in the SGT group, although the difference did not reach statistic significance (p = 0.23). CONCLUSION: Stenosis caused by PCT occurred earlier and was subglottic in nature compared to that by SGT. Surgical correction of stenosis was more difficult in the PCT group due to its presentation in the subglottic area.
Adult↗
An unusual cause of tracheal stenosis.
PURPOSE: To report a large chronic tracheal foreign body, causing tracheal stenosis in an 11-yr-old girl. CLINICAL FEATURES: The history was suggestive of obstructive airways disease with secondary bronchiectasis. Physical findings were crepitations and rhonchi all over the chest. Blood gases were normal. Chest X-ray showed bronchiectasis and a ventilation perfusion scan identified a tracheo-esophageal fistula. During anesthesia to confirm this, intubation and ventilation were difficult because of tracheal stenosis. The hypoventilation resulted in severe hypercarbia and acidosis. A subsequent CT scan showed a stenosis of 2 mm diameter and 1 cm length in the middle third of trachea, bronchiectasis, and an air filled pocket between the trachea and esophagus. PFT showed a severe obstruction. Antitubercular treatment which was started on the presumptive diagnosis of tuberculous stenosis and tracheoesophageal fistula caused a delay with deterioration of patient from intermittent dyspnea to orthopnea with severe hypecarbia and acidosis. The anesthetic management of the tracheal reconstruction was difficult due to her moribund condition even after medical treatment, the short length of the trachea above the obstruction, its severity and lack of resources for alternative techniques. A large foreign body was found lying obliquely in the trachea dividing it into an anterior narrow airway mimicking a stenosed trachea, and a wider posterior blind passage. CONCLUSION: The anesthetic consequences were peculiar to the unexpected etiology of the stenosis and poor general condition of the patient. Minor details like the tracheal tube bevel and ventilatory pattern became vitally important.
Acidosis↗
Low frequency jet ventilation for stent insertion in a patient with tracheal stenosis.
PURPOSE: Evaluate oxygen jet ventilation in a patient with tracheal stenosis undergoing stent insertion. CLINICAL FEATURES: Manual intermittent low frequency oxygen jet ventilation was used during general anesthesia for fibreoptic bronchoscopy and stent insertion in a patient with tracheal stenosis. Oxygen jets were delivered via a Sander's injector adapted to the proximal end of the endotracheal tube on one side, and open to room air on the other side. Adequate oxygenation and carbon dioxide removal were ensured throughout the procedure. CONCLUSION: Low frequency jet ventilation in a patient with tracheal stenosis provided adequate ventilation as well as a non- obstructed field during fibreoptic bronchoscopy and stent insertion.
Adolescent↗
Simultaneous management of congenital tracheal stenosis and cardiac anomalies in infants.
OBJECTIVE: The present article aims to describe our experience with patients who underwent simultaneous repair of congenital tracheal stenosis and cardiac anomalies. METHODS: Between January 2000 and December 2003, 9 infants underwent simultaneous surgical repair of a congenital tracheal stenosis and congenital heart disease. The intraoperative findings revealed localized tracheal stenosis in 3 patients. The funnel-type tracheal stenosis was present in 6 patients. Associated cardiac anomalies included ostium secundum atrial septal defect in 5 patients and ventricular septal defect in 2 patients, pulmonary artery sling in 4 patients, patent ductus arteriosus in 6 patients, atrioventricular septal defect in 1 patient, aortic arch hypoplasia in 1 patient, coarctation of the aorta in 1 patient, and partial anomalous pulmonary venous connection in 2 patients, one of them with "scimitar syndrome." Tracheal origin of the right upper lobe was diagnosed in 2 of the patients. A right aberrant subclavian artery (lusoria) was found in one patient. All patients were operated on through a median sternotomy and with cardiopulmonary bypass. Tracheal resection with direct end-to-end anastomosis was performed in all cases. RESULTS: There was no operative mortality. One patient died 6 weeks postoperatively. Eight patients were extubated between the 14th and 30th postoperative days under bronchoscopic monitoring. The extubation was performed after a stepwise respirator-weaning program. Postoperative endoscopic examination showed adequate airway dimensions and patency in every case. The midterm results after a mean follow-up of 37 months (range, 16-58 months) of the entire group demonstrate a stabile and complication-free clinical outcome. CONCLUSIONS: We advocate our current strategy for infants with congenital tracheal stenosis: resection with end-to-end anastomosis and simultaneous repair of associated intracardiac anomalies.
Female↗