Adult Laryngotracheal Stenosis

1995 ◽  
Vol 112 (5) ◽  
pp. P58-P58
Author(s):  
P.J. Gullane ◽  
J. Irish
Keyword(s):  
Subglottic Stenosis ◽  
Laryngotracheal Stenosis ◽  
Educational Objectives ◽  
Cricotracheal Resection

Educational objectives: To evaluate and treat patients with posterior glottic and subglottic stenosis and to understand the limitations and usefulness of cricotracheal resection combined with laryngeal tracheoplasty in patients with combined glottic and subglottic stenosis.

Cricotracheal Resection with Primary Thyrotracheal Anastomosis (CTR) as a Surgical Treatment for Subglottic Stenosis in Pediatric Cases

2001 ◽  
Vol 52 (6) ◽  
pp. 473-480 ◽  
Author(s):  
Masaaki Kashiwamura ◽  
Yoshitaka Nakamura ◽  
Shigeki Hiyama ◽  
Yasushi Mesuda ◽  
Noriko Nishizawa ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Subglottic Stenosis ◽  
Cricotracheal Resection

scholarly journals Multimodality Surgical Approach in Management of Laryngotracheal Stenosis

2018 ◽  
Vol 2018 ◽  
pp. 1-11
Author(s):  
Ashfaque Ansari ◽  
Annju Thomas
Keyword(s):  
Primary Anastomosis ◽  
Delayed Diagnosis ◽  
Subglottic Stenosis ◽  
Long Term Results ◽  
Laryngotracheal Stenosis ◽  
Surgical Anastomosis ◽  
Suture Tension ◽  
Multiple Treatments ◽  
Almost All

Introduction. Postintubation laryngotracheal stenosis requires a precise diagnosis and an experienced operator in both endoscopic and surgical treatment. This report presents surgically treated cases of laryngotracheal stenosis secondary to long-term intubation/tracheostomy with review of the literature. Materials and Methods. In this retrospective study, we present 5 cases (a 23-year-old male, 13-year-old male, 22-year-old male, 19-year-old male, and 33-year-old female) of postintubation/tracheostomy laryngotracheal (glottic/subglottic) stenosis in the years 2016 and 2017. Each patient was managed differently. Intubation characteristics, localization of stenosis, surgical technique and material, postoperative complications, and survival of patients were recorded. Results. The site of stenosis was in the subglottis in 4 patients and glottis in 1 patient. The mean length of the stenosis was greater in the postintubation group. Postintubation stenosis had a mean duration of intubation of 6.8 days, compared to 206.25 days of cannulation following tracheostomies. Each patient underwent an average of 2 procedures during their treatment course. One patient underwent open surgical anastomosis because of recurrent subglottic stenosis after multiple treatments. Phonation improved immediately in almost all except in the patient who underwent only endoscopic dilatation. Discussion. The reasons for laryngeal stenosis and its delayed diagnosis have been reviewed from the literature. Suture tension should be appropriate, and placement of the suture knot outside the trachea minimizes formation of granulation tissue. The published reports suggest that resection by endoscopy with laser and open technique resection and primary anastomosis are the best treatment modality so far as the long-term results are concerned. Conclusion. Resection of stenotic segment by open surgical anastomosis and laser-assisted resection is a safe option for the treatment of subglottic stenosis following intubation without the need for repeated dilation. Endoscopic dilation can be reserved for unfit patients.

scholarly journals Tracheal and cricotracheal resection for laryngotracheal stenosis: experience in 54 consecutive cases

2006 ◽  
Vol 29 (1) ◽  
pp. 35-39 ◽  
Author(s):  
Juan Moya Amorós ◽  
Ricard Ramos ◽  
Rosa Villalonga ◽  
Ricard Morera ◽  
Gerardo Ferrer ◽  
...  
Keyword(s):  
Laryngotracheal Stenosis ◽  
Cricotracheal Resection

Idiopathic Subglottic Stenosis: Long-Term Outcomes of Open Surgical Techniques

2017 ◽  
Vol 156 (5) ◽  
pp. 906-911 ◽  
Author(s):  
Deanna C. Menapace ◽  
Mara C. Modest ◽  
Dale C. Ekbom ◽  
Eric J. Moore ◽  
Eric S. Edell ◽  
...  
Keyword(s):  
Median Time ◽  
Open Surgery ◽  
Voice Quality ◽  
Subglottic Stenosis ◽  
Tracheal Resection ◽  
Open Approach ◽  
Cricotracheal Resection ◽  
Day Range

Objectives Idiopathic subglottic stenosis (iSGS) is rare, and its cause remains elusive. Treatment options include empiric medical therapy and endoscopic or open surgery. We present our results for open surgical technique. Study Design Case series with chart review (1978-2015). Setting Tertiary academic center. Subjects/Methods Thirty-three patients (32 female; median age, 51 years) met inclusion criteria and underwent cricotracheal resection with thyrotracheal anastomosis, tracheal resection with primary anastomosis, or laryngotracheoplasty with rib grafting. Continuous variables were summarized using medians and ranges while categorical features are presented using frequency counts and percentages. Results Sixteen patients (48%) underwent a single-stage approach with immediate extubation or temporary intubation following surgery (median, 1 day; range, 1-3 days). Seventeen patients (52%) underwent a double-staged approach with a median time to decannulation of 35 days (range, 13-100 days). Twenty-four (73%) patients underwent a previous intervention. Median stay in the intensive care unit was 1 day (range, 0-3 days), with a median hospital stay of 4 days (range, 2-7 days). Recurrence requiring further surgical intervention was observed in 12 patients (36%). The median time to recurrence was 8 years over an average follow-up of 9.7 years. The most common complaint following surgery was change in voice quality (fair to poor; n = 10; 30%). Conclusions Open surgery should be reserved for refractory cases of iSGS; cricotracheal resection with thyrotracheal anastomosis is the preferred open technique. Recurrence may occur after open treatment, highlighting the importance of long-term follow-up. Patients should be counseled about the potential for worsening voice quality with the open approach.

Arytenoid Prolapse as a Consequence of Cricotracheal Resection in Children

2001 ◽  
Vol 110 (3) ◽  
pp. 210-214 ◽  
Author(s):  
Michael J. Rutter ◽  
Benjamin E. J. Hartley ◽  
Dana Thompson Link ◽  
Robin T. Cotton
Keyword(s):  
Positive Airway Pressure ◽  
Incidental Finding ◽  
Anastomotic Dehiscence ◽  
Poor Sleep ◽  
Arytenoid Cartilage ◽  
Laryngotracheal Stenosis ◽  
Shortness Of Breath ◽  
Rigid Endoscopy ◽  
Cricotracheal Resection ◽  
Endoscopic Laser

Cricotracheal resection (CTR) is a technique introduced comparatively recently for treating severe laryngotracheal stenosis in children. The recognized complications of CTR include recurrent laryngeal nerve damage, anastomotic dehiscence, and restenosis. We describe a further complication of CTR, namely, prolapse of the arytenoid cartilage. The presentation may be late, with symptoms of shortness of breath on exertion and nocturnal stertor with a poor sleep pattern, or the prolapse may be an asymptomatic incidental finding. The diagnosis is performed with flexible nasopharyngoscopy with the patient unanesthetized, or with rigid endoscopy with the patient lightly anesthetized and spontaneously ventilating. The affected arytenoid cartilage is noted to prolapse anteriorly and medially with inspiration, partly obstructing the airway. If treatment is required, endoscopic laser partial arytenoidectomy is effective. In a series of 44 children who underwent CTR, 20 were noted to develop arytenoid prolapse after operation. Twelve were asymptomatic, and 8 required laser arytenoidectomy, 2 of whom now require continuous positive airway pressure for moderate supraglottic collapse.

Lathyrogenic Agents as Therapy for Subglottic Stenosis—A Pilot Study

1987 ◽  
Vol 97 (5) ◽  
pp. 446-451 ◽  
Author(s):  
Gary L. Livingston ◽  
Joyce A. Schild
Keyword(s):  
Pilot Study ◽  
Surgical Repair ◽  
Canine Model ◽  
Subglottic Stenosis ◽  
Laryngotracheal Stenosis ◽  
Human Beings ◽  
Scar Contracture ◽  
The Past ◽  
Human Use ◽  
Collagen Cross Linking

The surgical repair of subglottic stenosis (SGS) is often unsuccessful because of recurrence of the scar contracture. Over the past few years, two lathyrogenic agents (compounds that inhibit collagen cross-linking) have been shown effective in prevention of stenosis in animal models that have deep caustic esophageal burns. Since the principles of induced lathyrism have not been applied to the treatment of laryngotracheal stenosis, a pilot study using a canine model was conducted to test the efficacy of penicillamine and N-acetyl-L-cysteine in reduction of the rate of reformation of SGS. In all six animals used, a complete, 10 to 15 mm thick, mature SGS was induced experimentally, then opened with a Co2 laser. The dogs that were treated with lathyrogenic agents exhibited a lower rate of re-stenosis (one maintained patency throughout the 5 weeks of treatment) when compared to the two control dogs. Histologic sections of the subglottis in each dog revealed severe cricoid collapse, necrosis, and scarring, and thus demonstrated similarities to SGS in human beings. The two lathyrogenic agents used in this study are already approved for human use and may represent a valuable form of adjunctive therapy in the surgical management of SGS.

scholarly journals Image-Based 3-Dimensional Characterization of Laryngotracheal Stenosis in Children

OTO Open ◽  
2018 ◽  
Vol 2 (1) ◽  
pp. 2473974X1775358 ◽  
Author(s):  
Lee S. McDaniel ◽  
William J. Poynot ◽  
Keith A. Gonthier ◽  
Michael E. Dunham ◽  
and Tyler W. Crosby
Keyword(s):  
Tertiary Care ◽  
Airway Disease ◽  
Subglottic Stenosis ◽  
Ct Scans ◽  
Patient Specific ◽  
Laryngotracheal Stenosis ◽  
Cross Sectional ◽  
3 Dimensional ◽  
Airway Lumen ◽  
Staging Systems

Objectives Describe a technique for the description and classification of laryngotracheal stenosis in children using 3-dimensional reconstructions of the airway from computed tomography (CT) scans. Study Design Cross-sectional. Setting Academic tertiary care children’s hospital. Subjects and Methods Three-dimensional models of the subglottic airway lumen were created using CT scans from 54 children undergoing imaging for indications other than airway disease. The base lumen models were deformed in software to simulate subglottic airway segments with 0%, 25%, 50%, and 75% stenoses for each subject. Statistical analysis of the airway geometry was performed using metrics extracted from the lumen centerlines. The centerline analysis was used to develop a system for subglottic stenosis assessment and classification from patient-specific airway imaging. Results The scaled hydraulic diameter gradient metric derived from intersectional changes in the lumen can be used to accurately classify and quantitate subglottic stenosis in the airway based on CT scan imaging. Classification is most accurate in the clinically relevant 25% to 75% range of stenosis. Conclusions Laryngotracheal stenosis is a complex diagnosis requiring an understanding of the airway lumen configuration, anatomical distortions of the airway framework, and alterations of respiratory aerodynamics. Using image-based airway models, we have developed a metric that accurately captures subglottis patency. While not intended to replace endoscopic evaluation and existing staging systems for laryngotracheal stenosis, further development of these techniques will facilitate future studies of upper airway computational fluid dynamics and the clinical evaluation of airway disease.

scholarly journals A Modified Laryngeal Stent for Glotto-Subglottic Stenosis: A Novel Stent for Better Outcomes

2019 ◽  
pp. 014556131988307
Author(s):  
Jeffrey D. Wilcox ◽  
Michel Nassar
Keyword(s):  
Reconstructive Surgery ◽  
Subglottic Stenosis ◽  
Laryngotracheal Stenosis ◽  
Excellent Outcome ◽  
Laryngotracheal Reconstruction ◽  
And Function ◽  
Dependent Patient

Management of laryngotracheal stenosis is challenging and laryngotracheal stenosis is generally managed with laryngotracheal reconstruction. Stents are often used as part of the reconstructive surgery. Although most stents adequately stabilize the reconstruction during healing, they often do a poor job of mimicking glottic anatomy, particularly the anterior glottis. Here, we present a modified suprastomal stent designed to stabilize reconstruction after laryngotracheal reconstruction while also improving postoperative glottic anatomy and function. The case of a 15-year-old tracheostomy-dependent patient with glotto-subglottic stenosis who underwent laryngotracheal reconstruction using this modified stent is described. The patient had an excellent outcome with decannulation of her tracheostomy and significant improvement in voice.

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