Complex adult laryngotracheal reconstruction with a prefabricated flap: A case series

Head & Neck ◽  
2013 ◽  
Vol 35 (12) ◽  
pp. E376-E380 ◽  
Author(s):  
Kara Y. Detwiller ◽  
Joshua S. Schindler ◽  
Daniel S. Schneider ◽  
Robert Lindau ◽  
Mark K. Wax
Keyword(s):  
Case Series ◽  
Laryngotracheal Reconstruction ◽  
Prefabricated Flap

Tracheocutaneous Fistula After Pediatric Open Airway Reconstruction

2021 ◽  
pp. 000348942098742
Author(s):  
Stephen R. Chorney ◽  
Joanne Stow ◽  
Luv R. Javia ◽  
Karen B. Zur ◽  
Ian N. Jacobs ◽  
...  
Keyword(s):  
Costal Cartilage ◽  
Case Series ◽  
Primary Objective ◽  
Multivariable Logistic Regression Analysis ◽  
Pediatric Airway ◽  
Surgical Closure ◽  
Laryngotracheal Reconstruction ◽  
Airway Reconstruction ◽  
Tracheocutaneous Fistula

Objectives: Tracheocutaneous fistula (TCF) is a common occurrence after pediatric tracheostomy decannulation. However, the persistence of TCF after staged reconstruction of the pediatric airway is not well-described. The primary objective was to determine the rate of persistent TCF after successful decannulation in children with staged open airway reconstruction. Methods: A case series with chart review of children who underwent decannulation after double-stage laryngotracheal reconstruction between 2017 and 2019. Results: A total of 26 children were included. The most common open airway procedure was anterior and posterior costal cartilage grafting (84.6%, 22/26). Median age at decannulation was 3.4 years (IQR: 2.8-4.3) and occurred 7.0 months (IQR: 4.3-10.4) after airway reconstruction. TCF persisted in 84.6% (22/26) of children while 15.4% (4/26) of stomas closed spontaneously. All closures were identified by the one-month follow-up visit. There was no difference in age at tracheostomy ( P = .86), age at decannulation ( P = .97), duration of tracheostomy ( P = .43), or gestational age ( P = .23) between stomas that persisted or closed. Median diameter of stent used at reconstruction was larger in TCFs that persisted (7.0 mm vs 6.5 mm, P = .03). Tracheostomy tube diameter ( P = .02) and stent size ( P < .01) correlated with persistence of TCF on multivariable logistic regression analysis. There were 16 surgical closure procedures, which occurred at a median of 14.4 months (IQR: 11.4-15.4) after decannulation. Techniques included 56.3% (9/16) by primary closure, 18.8% (3/16) by secondary intention and 25% (4/16) by cartilage tracheoplasty. The overall success of closure was 93.8% (15/16) at latest follow-up. Conclusions: Persistent TCF occurs in 85% of children who are successfully decannulated after staged open airway reconstruction. Spontaneous closure could be identified by 1 month after decannulation and was more likely when smaller stents and tracheostomy tubes were utilized. Surgeons should counsel families on the frequency of TCF and the potential for additional procedures needed for closure.

Laryngotracheal Reconstruction in Adults Aged 60 Years and Older

2019 ◽  
Vol 160 (6) ◽  
pp. 1065-1070 ◽  
Author(s):  
Saad C. Rehman ◽  
Deborah X. Xie ◽  
James R. Bekeny ◽  
Alexander Gelbard ◽  
Christopher T. Wootten
Keyword(s):  
Complete Blood Count ◽  
Tertiary Care ◽  
Case Series ◽  
Tracheal Resection ◽  
Distribution Width ◽  
Free Survival ◽  
Laryngotracheal Reconstruction ◽  
Airway Reconstruction

Objective The primary aim of this study is to evaluate the safety, efficacy, and execution of major open laryngotracheal operations for patients in the advanced decades. Study Design Case series with chart review. Setting Multidisciplinary clinic at a tertiary care academic hospital. Subjects and Methods Patient characteristics, operative course, and postoperative outcomes were retrospectively recorded for all airway reconstruction operations performed between 1999 and 2016 on patients aged ≥60 years Long-term success was defined as prosthesis-free survival at last follow-up. Descriptive statistics were performed. Results Twenty-nine patients met inclusion criteria, and the median age was 71 years (interquartile range, 63-74). Tracheal resection was the most common procedure (13 patients), followed by laryngotracheal reconstruction (7 patients). Fifteen patients began their operation with a tracheostomy, 6 of whom underwent decannulation prior to leaving the operating room. Three additional patients underwent decannulation at follow-up appointments and were prosthesis-free at most recent follow-up. The mean time to decannulation among these patients was 3 months. Of the 14 patients beginning their procedure without a tracheostomy, only 2 required permanent airway prosthesis. The overall long-term rate of prosthesis-free survival was 72.4% (21 of 29 patients). Factors suggestive of long-term success include lower McCaffrey grade and lack of pulmonary disease, hypertension, or diabetes, as well as decreased red blood cell distribution width on preoperative complete blood count. Conclusion Through careful patient selection, preoperative workup, and meticulous postoperative care, airway reconstruction procedures in patients aged ≥60 years are reasonably successful. Of 29 patients, 21 (72.4%) were successfully breathing long-term without airway prosthesis.

Short- versus Long-term Stenting in Children with Subglottic Stenosis Undergoing Laryngotracheal Reconstruction

2017 ◽  
Vol 158 (2) ◽  
pp. 375-380 ◽  
Author(s):  
David F. Smith ◽  
Alessandro de Alarcon ◽  
Niall D. Jefferson ◽  
Meredith E. Tabangin ◽  
Michael J. Rutter ◽  
...  
Keyword(s):  
Demographic Data ◽  
Tertiary Care ◽  
Case Series ◽  
Subglottic Stenosis ◽  
Short Term ◽  
Number Of Children ◽  
Laryngotracheal Reconstruction ◽  
Significant Difference ◽  
Outcomes For Children

Objectives Suprastomal stents are routinely used in laryngotracheal reconstruction (LTR) to stabilize grafts and provide framework to sites of repair. However, the duration of stenting varies according to patient history and physician preference. We examined outcomes of short- versus long-term stenting in children with subglottic stenosis (SGS) undergoing LTR. Study Design Case series with chart review. Setting Tertiary care pediatric hospital. Subjects and Methods Thirty-six children <18 years old who underwent double-stage LTR for SGS from January 2012 to January 2015 were included. Demographic data, stenosis grade, and decannulation rates were compared between children with short-term stenting (≤21 days; n = 14) and those with long-term stenting (>21 days; n = 22). Results No significant difference between groups was seen for sex, age, race, or previous repair. Children in the short-term group were stented for 10.9 ± 4.9 days, compared with 44.0 ± 10.6 for those long-term ( P < .0001). A similar number of children with short- versus long-term stents had grade 3/4 stenosis preoperatively (71.4% vs 77.2%). Although time to decannulation was not significantly different, 72.7% of children with long-term stents were decannulated, as opposed to 35.7% with short-term stents ( P = .03). After adjusting for grade at surgery and age, children with long-term stents had 4.3 greater odds (95% CI, 1.0-18.3) of decannulation than children with short-term stents. Conclusions Children with long-term stenting were more likely to be successfully decannulated. Although long-term stenting improved outcomes for children with SGS, additional research is needed to better define ideal candidates for short- versus long-term stenting.

scholarly journals Flexible CO2Laser Fiber in the Pediatric Airway

2011 ◽  
Vol 2011 ◽  
pp. 1-5 ◽  
Author(s):  
Kimberly K. Caperton ◽  
G. Paul Digoy
Keyword(s):  
Granulation Tissue ◽  
Carbon Dioxide Laser ◽  
Tissue Injury ◽  
Case Series ◽  
Laser Technique ◽  
Pediatric Airway ◽  
Laser Fiber ◽  
Tissue Removal ◽  
Laryngotracheal Reconstruction ◽  
Left Main Stem Bronchus

Objective. Our institution has been using a novel flexible laser fiber in pediatric surgical airway procedures, which has been quite successful. The purpose of this paper is to present our preliminary experience in the treatment of pediatric airway lesions using this laser technique.Methods.A case series reviewing 40 patients undergoing 95 laser procedures is reported. Indications included removal of suprastomal granulation tissue, removal of granulation after laryngotracheal reconstruction, subglottic and supraglottic stenoses, recurrent respiratory papillomas, subglottic hemangioma, laryngeal cleft, and left main stem bronchus stenosis. Procedures were performed via microdirect laryngoscopy and bronchoscopy.Results. No complications including postoperative glottic webs, concentric scar formation, or airway fires occurred in any of the patients (after the series was completed, we did experience an airway fire. It was a flash flame that was self-limited and caused no long-term tissue injury).Conclusions. The endoscopic application of a new flexible carbon dioxide laser fiber for management of pediatric airways lesions provides good outcomes in selected patients. Distal respiratory papillomas, subglottic stenosis, and granulation tissue are, in our experience, appropriate indications.

scholarly journals Advanced Laryngotracheal Stenosis in a Tertiary Provincial Government Hospital: A Prospective Case Series

2019 ◽  
Vol 34 (1) ◽  
pp. 30-33
Author(s):  
Jules Verne M. Villanueva ◽  
Ronaldo G. Soriano
Keyword(s):  
Tracheal Stenosis ◽  
Case Series ◽  
Provincial Government ◽  
Subglottic Stenosis ◽  
Laryngotracheal Stenosis ◽  
Government Hospital ◽  
Prolonged Intubation ◽  
Laryngotracheal Reconstruction ◽  
Prospective Case Series ◽  
Grade Iii

Objective: To describe the clinical profiles, interventions, and surgical outcomes of patients with advanced (grade III and IV) laryngotracheal stenosis prospectively seen over a 2-year period.   Methods:             Design:           Prospective Case Series             Setting:           Tertiary Provincial Government Hospital             Participants:  Five (5) patients with advanced laryngotracheal stenosis       confirmed by laryngoscopy and/or tracheoscopy. Results: Five (5) patients (4 males, 1 female), aged 23 to 31years (mean 27-years-old) diagnosed with advanced laryngotracheal stenosis between June 2016 to June 2018 were included in this series. Four resulted from prolonged intubation (14 - 60 days) while one had a prolonged tracheotomy (13 years). Presentations of stenosis included dyspnea on extubation attempt (n=3), failure to extubate (n=1) and failure to decannulate tracheotomy (n=1). Stenosis length was 3 cm in two, and 1.5 cm in three. Of the five (5) patients, three had grade IV stenosis while two had grade III stenosis based on the Cotton-Myer Classification System. Two of those with grade IV stenosis and both patients with grade III stenosis had undergone prolonged intubation. The stenosis involved the subglottis in three, and combined subglottic and tracheal stenosis in two. Prolonged intubation was present in all three with subglottic stenosis, and in one of the two with combined subglottic and tracheal stenosis. Two patients underwent open surgical approaches while three underwent endoscopic dilatation procedures. Four patients were successfully decannulated while one is still on tracheostomy. None of them had post-operative complications. Conclusion:  Advanced laryngotracheal stenosis is a challenging entity that results from heterogenous causes. Categorizing stenosis and measuring stenosis length may help in treatment planning and predicting surgical outcome.  Keywords: laryngotracheal stenosis; laryngotracheal reconstruction; tracheal resection anastomosis; subglottic stenosis; tracheal stenosis

scholarly journals Laryngotracheal Reconstruction with a Prefabricated Flap

2011 ◽  
Vol 145 (2_suppl) ◽  
pp. P139-P139
Author(s):  
Kara Y. Detwiller ◽  
Daniel S. Schneider ◽  
Joshua S. Schindler ◽  
Mark K. Wax
Keyword(s):  
Laryngotracheal Reconstruction ◽  
Prefabricated Flap

Abstract #856 A Case Series Review of Clinical and Biochemical Characteristics of Pituitary Abcess in Mexican Patients

2018 ◽  
Vol 24 ◽  
pp. 202-203
Author(s):  
Mireya Perez-Guzman ◽  
Alfredo Nava de la Vega ◽  
Arturo Pena Velarde ◽  
Tania Raisha Torres Victoria ◽  
Froylan Martinez-Sanchez ◽  
...  
Keyword(s):  
Case Series ◽  
Biochemical Characteristics ◽  
Mexican Patients

Abstract #316: Latent Auto-Immune Diabetes in Adults (LADA): Is it More Prevalent Than We Think? A Case Series

2016 ◽  
Vol 22 ◽  
pp. 95
Author(s):  
Chandni Merchant ◽  
Smita Kargutkar
Keyword(s):  
Case Series
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