Airway Management of the Deformed Trachea Using T-Tube Stents in Patients with Mucopolysaccharidosis Type IVA

2021 ◽  
pp. 000348942110327
Author(s):  
Yi-Hao Lee ◽  
Li-Chun Hsieh ◽  
Chin-Hui Su ◽  
Hsiang-Yu Lin ◽  
Shuan-Pei Lin ◽  
...  
Keyword(s):  
Three Dimensional ◽  
Fiberoptic Bronchoscopy ◽  
Innominate Artery ◽  
Thoracic Cage ◽  
Laryngeal Function ◽  
Airway Patency ◽  
T Tube ◽  
Airway Stenting ◽  
Anatomical Relationship ◽  
Mucopolysaccharidosis Type Iva

Introduction: Mucopolysaccharidosis (MPS) type IVA usually results in airway obstruction due to thoracic cage deformity and crowding of intrathoracic structures, causing tracheal compression by the tortuous innominate artery. Objectives: To offer an alternative and effective method in dealing with the challenged deformity of the airway in patients with MPS type IVA. Methods: We present 3 patients with MPS type IVA who underwent airway stenting using Montgomery® T-tube stents. Three-dimensional reconstructed computed tomography was essential to design the T-tube and evaluate the anatomical relationship between the innominate artery and the trachea. The Y-shaped Montgomery® Pediatric Safe-T-Tube™ is more suitable for MPS type IVA. Regular follow-ups using fiberoptic bronchoscopy are necessary to evaluate the complications. Results: All 3 patients had good outcomes during the follow-ups until present, despite the complication of granulation formation, which was resolved by revising the limbs of the T-tube. Conclusions: T-tube stents placed below the vocal cord may restore airway patency and preserve laryngeal function, including respiration, phonation, and swallowing, in patients with MPS type IVA.

scholarly journals Effect of inhaled carbon dioxide on laryngeal abduction

2015 ◽  
Vol 118 (4) ◽  
pp. 489-494 ◽  
Author(s):  
Jonathan Cheetham ◽  
Amanda Jones ◽  
Manuel Martin-Flores
Keyword(s):  
Laryngeal Mask Airway ◽  
High Speed ◽  
Upper Airway ◽  
Laryngeal Mask ◽  
Maximal Response ◽  
High Temporal Resolution ◽  
Respiratory Drive ◽  
Laryngeal Function ◽  
Airway Patency ◽  
End Tidal

Hypercapnia produces a profound effect on respiratory drive and upper airway function to maintain airway patency. Previous work has evaluated the effects of hypercapnia on the sole arytenoid abductor, the posterior cricoarytenoid (PCA), using indirect measures of function, such as electromyography and direct nerve recording. Here we describe a novel method to evaluate PCA function in anesthetized animals and use this method to determine the effects of hypercapnia on PCA function. Eight dogs were anesthetized, and a laryngeal mask airway was used, in combination with high-speed videoendoscopy, to evaluate laryngeal function. A stepwise increase in inspired partial pressure of CO2 produced marked arytenoid abduction above 70-mmHg end-tidal CO2 (ETCO2) ( P < 0.001). Glottic length increased above 80-mmHg ETCO2 ( P < 0.02), and this lead to underrepresentation of changes in glottic area, if standard measures of glottic area (normalized glottic gap area) were used. Use of a known scale to determine absolute glottic area demonstrated no plateau with increasing ETCO2 up to 120 mmHg. Ventilatory parameters also continued to increase with no evidence of a maximal response. In a second anesthetic episode, repeated bursts of transient hypercapnia for 60 s with an ETCO2 of 90 mmHg produced a 43–55% increase in glottic area ( P < 0.001) at or shortly after the end of the hypercapnic burst. A laryngeal mask airway can be used in combination with videoendoscopy to precisely determine changes in laryngeal dimensions with high temporal resolution. Absolute glottic area more precisely represents PCA function than normalized glottic gap area at moderate levels of hypercapnia.

Extra-long Montgomery T tube in major airway stenosis

2008 ◽  
Vol 123 (7) ◽  
pp. 772-777 ◽  
Author(s):  
Y-H Liu ◽  
Y-C Wu ◽  
M-J Hsieh ◽  
Y-K Chao ◽  
C-J Wang ◽  
...  
Keyword(s):  
Airway Obstruction ◽  
Tertiary Care ◽  
Three Dimensional ◽  
Vocal Folds ◽  
Rigid Bronchoscopy ◽  
Tube Placement ◽  
Nasogastric Feeding ◽  
Airway Stenosis ◽  
T Tube ◽  
Airway Reconstruction

AbstractBackground:We evaluated the efficacy and safety of the extra-long Montgomery T tube for the management of major airway obstruction in tertiary care patients in Taiwan.Method:Eleven patients with major airway stenosis treated with an extra-long Montgomery T tube between April 2004 and December 2006 were retrospectively reviewed. Five patients had tracheostomy stenosis, two had intubation stenosis, one had traumatic stenosis, one had corrosive stenosis, one had laser burn stenosis and one had tubercular stenosis. All patients underwent three-dimensional airway reconstruction and endoscopic evaluation of airway stenosis. After determining the severity and location of airway stenosis, rigid bronchotherapy and Montgomery T tube placement were performed by rigid bronchoscopy.Results:The overall procedural success rate was 100 per cent. Three (27 per cent) patients were weaned from artificial ventilation, and all patients exhibited improved respiratory and functional status. No major post-operative complications or mortality were observed. At follow up (mean, 21.5 months), the decannulation rate was 27 per cent, and eight (73 per cent) patients had stable T tube ventilation. In four patients, granulation over the end of the T tube was controlled by endoscopic procedures. Three patients with stents above the vocal folds showed aspiration and required further intervention (i.e. one nasogastric feeding tube for nutrient supplement, one feeding jejunostomy and one stent shortening to decrease aspiration).Conclusion:The extra-long Montgomery T tube is an effective and safe method for treating major airway obstruction in the supra-glottic to lower tracheal region.

scholarly journals Novel Three-Dimensional Imaging of the Anatomical Relationship Between the Pulmonary Vein and Left Atrium

2009 ◽  
Vol 73 (3) ◽  
pp. 573-574 ◽  
Author(s):  
Minoru Yamada ◽  
Masahiro Jinzaki ◽  
Kozo Sato ◽  
Yutaka Tanami ◽  
Kotaro Fukumoto ◽  
...  
Keyword(s):  
Left Atrium ◽  
Pulmonary Vein ◽  
Three Dimensional ◽  
Three Dimensional Imaging ◽  
Anatomical Relationship

scholarly journals Three-Dimensional Analysis of the Human Pancreas

Endocrinology ◽  
2018 ◽  
Vol 159 (3) ◽  
pp. 1393-1400 ◽  
Author(s):  
Jonas L Fowler ◽  
Steve Seung-Young Lee ◽  
Zachary C Wesner ◽  
Scott K Olehnik ◽  
Stephen J Kron ◽  
...  
Keyword(s):  
Three Dimensional ◽  
Capillary Density ◽  
Pancreatic Tissue ◽  
Specimen Preparation ◽  
Human Pancreas ◽  
Surface Rendering ◽  
Tissue Slices ◽  
Sufficient Power ◽  
Anatomical Relationship ◽  
Volumetric Quantification

Abstract Pancreatic islets are endocrine micro-organs scattered throughout the exocrine pancreas. Islets are surrounded by a network of vasculature, ducts, neurons, and extracellular matrix. Three-dimensional imaging is critical for such structural analyses. We have adapted transparent tissue tomography to develop a method to image thick pancreatic tissue slices (1 mm) with multifluorescent channels. This method takes only 2 to 3 days from specimen preparation and immunohistochemical staining to clearing tissues and imaging. Reconstruction of the intact pancreas visualizes islets with β, α, and δ cells together with their surrounding networks. Capturing several hundred islets at once ensures sufficient power for statistical analyses. Further surface rendering provides clear views of the anatomical relationship between islets and their microenvironment as well as the basis for volumetric quantification. As a proof-of-principle demonstration, we show an islet size–dependent increase of intraislet capillary density and an inverse decrease in sphericity.

scholarly journals Self-expanding covered metallic stents as a transition to silicone stent implantation in management of severe post-tuberculosis bronchial stenosis

2021 ◽  
Vol 15 ◽  
pp. 175346662110195
Author(s):  
Zi-Qing Zhou ◽  
Jia-Xin Feng ◽  
Yu Chen ◽  
Zhu-Quan Su ◽  
Chang-Hao Zhong ◽  
...  
Keyword(s):  
Stent Implantation ◽  
Metallic Stents ◽  
Bronchial Stenosis ◽  
Related Complication ◽  
Airway Patency ◽  
Airway Stenting ◽  
Silicone Stent ◽  
Major Treatment ◽  
Medical University ◽  
Covered Metallic Stents

Background and aims: Post-tuberculosis bronchial stenosis (PTBS) is one of the most common complications of tracheobronchial tuberculosis. Silicone stent serves as a major treatment for maintaining airway patency. However, silicone stent placement remains a large challenge in patients with severe cicatricial PTBS. Our objective was to evaluate the efficacy and safety of covered, self-expanding, metallic stents (SEMSs) as a transition to silicone stent implantation for treating severe PTBS. Methods: We retrospectively reviewed the data of patients with severe PTBS who received airway stenting in the First Affiliated Hospital of Guangdong Medical University between September 2015 and May 2019. The types of the stent, intervention procedures, bronchoscopic findings, clinical outcomes and related complications were collected and analyzed. Results: Fifty-eight cases with severe PTBS were included in this study. Thirteen (22.4%) of the patients received bronchial silicone stent implantation immediately after dilations. For the remaining 45 (77.6%) patients, silicone stents could not be deployed after dilations and SEMSs implantation was implemented as a bridge to silicone stenting. The SEMSs were placed for an interval of 28.4 ± 11.1 days. All of the silicone stents were inserted successfully following the removal of SEMSs. No SEMS-related complication occurred. The subgroup analysis showed that patients who received transitional SEMSs had less luminal caliber but fewer transbronchial dilations before silicone stent implantation ( p < 0.05). Conclusion: Covered SEMS placement as a transition to silicone stenting could serve as a feasible procedure to reduce complications and improve the success rate of silicone stent implantation in patients with severe PTBS. The reviews of this paper are available via the supplemental material section.

scholarly journals Three-Dimensional Sheath Inked Rapid Acquisition with Refocused Echoes Imaging (SHINKEI) MRI for Delineating the Intraparotid Facial Nerve Branches and Their Anatomical Relationship with Parotid Tumors

2021 ◽  
Vol 18 (3) ◽  
Author(s):  
Yanwei Jiang ◽  
Cheng Sun ◽  
Wei Zhou ◽  
Lianpin Yu ◽  
Weidong Zhang ◽  
...  
Keyword(s):  
Parotid Gland ◽  
Facial Nerve ◽  
Three Dimensional ◽  
Parotid Tumor ◽  
Main Trunk ◽  
Rapid Acquisition ◽  
Parotid Tumors ◽  
Facial Nerves ◽  
Anatomical Relationship ◽  
The Relationship

Background: Accurate imaging of the anatomical relationship between the intraparotid facial nerve branches and parotid tumor can be helpful for surgical planning and effective protection of the facial nerve during surgery. Three-dimensional sheath inked rapid acquisition with refocused echoes imaging (3D-SHINKEI) is a new MRI sequence with a high tissue contrast resolution, which has been used for imaging the peripheral nerves in several organs. Objectives: To evaluate the value of 3D-SHINKEI sequence in representing the intraparotid facial nerve branches and their anatomical relationship with neoplasms of the parotid gland. Patients and Methods: Thirty-six patients with parotid tumors underwent MRI with 3D-SHINKEI and 3D-T2-fast field echo (3D-T2-FFE) sequences in the coronal plane. The contrast-to-noise ratios (CNRs) and signal intensity ratios (SIRs) of the facial nerves in the two sequences were compared. The relationship between the intraparotid facial nerve branches and parotid tumor was also analyzed in 36 patients, and the results were compared with the intraoperative anatomy and postoperative pathological findings. Results: The image quality score of the 3D-SHINKEI sequence for anatomical representation of the intraparotid facial nerve branches was significantly higher than that of the 3D-T2-FFE sequence (Z = −6.197, P < 0.01). The SIRs and CNRs of the facial nerves were significantly higher in the SHINKEI images as compared to the 3D-T2-FFE images (t = 10.772, P < 0.01 and t = 11.586, P < 0.01, respectively). The delineation accuracy of the anatomy of the main trunk of the facial nerve and its first-level branches and their relationship with tumors was significantly higher with the 3D-SHINKEI sequence than with the 3D-T2-FFE sequence (P < 0.01). Besides, the relationship between parotid tumors and the main trunk of the facial nerve and its first-level branches was classified into six types. Conclusion: A high-resolution 3D-SHINKEI sequence could accurately represent the relationship between the intraparotid facial nerve branches and parotid gland neoplasms. It was also found to be more accurate than the 3D-T2-FFE sequence.

Interventional Pulmonology—Airway Stenting Simulated with a Three-dimensional Printed Airway Model—

2015 ◽  
Vol 66 (5) ◽  
pp. 341-350
Author(s):  
Naoya Yamasaki ◽  
Tomoshi Tsuchiya ◽  
Keitaro Matsumoto ◽  
Takuro Miyazaki ◽  
Koichiro Shimoyama ◽  
...  
Keyword(s):  
Three Dimensional ◽  
Interventional Pulmonology ◽  
Airway Stenting ◽  
Airway Model

Montgomery T-tube for Management of Tracheal Stenosis: A Retrospective Analysis in a Government Hospital of South India

2016 ◽  
Vol 6 (2) ◽  
pp. 73-77
Author(s):  
Myle Mahesh Babu
Keyword(s):  
Retrospective Analysis ◽  
Tracheal Stenosis ◽  
South India ◽  
Good Alternative ◽  
Tracheal Resection ◽  
Laryngotracheal Stenosis ◽  
Government Hospital ◽  
Airway Patency ◽  
T Tube ◽  
Male Preponderance

ABSTRACT This study investigated the outcome of patients who developed tracheal stenosis after tracheostomy or intubation using Montgomery T-tube. We reviewed 21 patients who had experienced tracheal stenosis at a single institution, over 7 years from January 2008 to January 2015. Majority were in the age group of 20 to 30 years and a male preponderance was noted. The duration between extubation and appearance of respiratory symptoms ranged from 32 to 96 days. Location of stenosis was more common in subglottic region (61.9%), followed by tracheal (33.33%) and laryngotracheal stenosis (4.7%). At the end of 6 months, 18 of 21 patients were decannulated successfully and 3 were decannulated at the end of 9 months. Our study showed that use of Montgomery T-tube for laryngotracheal stenosis gave complete improvement in all the patients. Tracheal resection and anastomosis is the definitive surgical treatment of choice in tracheal stenosis but when surgical management is not feasible T-tube is a good alternative and T-tube as front line of management has produced complete improvement in airway patency and restoration of voice in our study. How to cite this article Babu MM, Kumar RA, Thirugnanamani R. Montgomery T-tube for Management of Tracheal Stenosis: A Retrospective Analysis in a Government Hospital of South India. Int J Phonosurg Laryngol 2016;6(2):73-77.

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