Laryngotracheal Reconstruction in Adults with the Sternocleidomastoid Myoperiosteal Flap

1992 ◽  
Vol 101 (11) ◽  
pp. 897-908 ◽  
Author(s):  
Michael Friedman ◽  
Amy D. Mayer
Keyword(s):  
Thyroid Carcinoma ◽  
Tracheal Stenosis ◽  
Patient Management ◽  
Subglottic Stenosis ◽  
Single Stage ◽  
Clinical Use ◽  
First Line ◽  
Tracheal Reconstruction ◽  
Laryngotracheal Reconstruction

Subglottic or tracheal reconstruction may be required in cases of subglottic stenosis, invasive thyroid carcinoma, or trauma. The sternocleidomastoid myoperiosteal flap uses clavicular periosteum on a muscle pedicle to provide vascularity. Clavicular periosteum is fibrous and durable and will conform to the shape of the trachea, forming bone to provide stability to the airway. The procedure is relatively simple and involves single-stage reconstruction. Success has been achieved in reconstruction of long-standing subglottic and/or tracheal stenosis and in cases of extreme tracheal defects. On the basis of 8 years' experience with this flap, we present the results from a series of 26 patients who underwent subglottic or tracheal reconstruction with the sternocleidomastoid myoperiosteal flap. Twenty-five of the 26 patients were successfully decannulated. Complications have been expanded to include one case of osteomyelitis of the sternum with mediastinitis, and 1 patient required revision. Subsequently, modifications of technique and patient management have been adopted. The complications compare favorably in frequency and in seriousness with those of other techniques for laryngotracheal reconstruction. We describe additional experience with this procedure and longer follow-up to establish its position as a first-line reconstructive approach for widespread clinical use.

scholarly journals Single-stage laryngotracheal reconstruction for the treatment of subglottic stenosis in children

2012 ◽  
Vol 16 (02) ◽  
pp. 217-221 ◽  
Author(s):  
Mariana Smith ◽  
Denise Manica ◽  
Camila Meotti ◽  
Larissa Eneas ◽  
Gabriel Kuhl ◽  
...  
Keyword(s):  
Retrospective Study ◽  
Success Rate ◽  
Tracheal Stenosis ◽  
Postoperative Period ◽  
Subglottic Stenosis ◽  
Single Stage ◽  
Laryngotracheal Reconstruction ◽  
Airway Reconstruction ◽  
Grade 3 ◽  
Multiple Stages

Summary Introduction: In recent decades, airway reconstruction has become the treatment of choice for subglottic stenosis (SGS) in children, which is performed in either single or multiple stages. However, there is evidence in the literature that single-stage surgery is more effective. Objective: To evaluate the success rate of single-stage laryngotracheoplasty (LTP) and cricotracheal resection (CTR) in patients that were treated in our hospital. Materials and Method: We performed a retrospective study of children undergoing laryngotracheal reconstruction. Results: Twenty-four children were included. The etiology of SGS was postintubation in 91.6% and congenital in 8.3%. One patient (4.2%) had grade 4 SGS, 17 (70.8%) presented with grade 3 SGS, 4 (16.6%) had grade 2 SGS, 1 (4.2%) had grade 3 SGS associated with glottic stenosis, and 1 (4.2%) had grade 3 SGS with tracheal stenosis. We performed 26 LTPs and 3 CTRs. Decannulation rates were 66% in the CTR procedures and 85.7% in the LTP procedures; the overall decannulation rate was 83.3%. All children presented with fever in the postoperative period, but were afebrile after the tube was removed. Conclusion: Our series showed a decannulation rate of 83.3%.

scholarly journals P503 Changes in clinical use of vedolizumab are driven by lower drug costs and are associated with better outcomes: a real-life single-centre Spanish experience

2020 ◽  
Vol 14 (Supplement_1) ◽  
pp. S437-S438
Author(s):  
Y Gonzalez Lama ◽  
M Calvo ◽  
V Matallana ◽  
I Gonzalez-Partida ◽  
I Omella ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Real Life ◽  
Clinical Use ◽  
First Line ◽  
Tertiary Centre ◽  
Health Authorities ◽  
Before And After ◽  
Lower Drug ◽  
Inflammatory Bowel

Abstract Background Vedolizumab (VDZ) has shown efficacy in the treatment of inflammatory bowel disease (IBD). Available data show better outcomes in naïve patients than in AntiTNFa experienced patients, and current ECCO guidelines support first-line use of VDZ since 2017. Nevertheless, reimbursement of VDZ was initially approved in Spain only in patients failing to at least one AntiTNFa agent (except contraindication) until January 2018 when, following a significative decrease in costs of VDZ, reimbursement was approved also in naïve patients. Our aim was to elucidate if our clinical use of vedolizumab have evolved after costs decrease, and if was associated with better clinical outcomes. Methods Retrospective review of all VDZ treated patients with at least 6 months of follow-up in a referral IBD Unit of a tertiary centre in Madrid (Spain) since December 2014. Demographics, clinical data and information regarding VDZ treatment were collected. Results 118 IBD patients included (61(52%) Crohn’s disease, 57(48%) ulcerative colitis): 62(53%) female; median age 48(IQR 32–63) years. 64 patients started VDZ before 2018, 54 since January 2018. Among patients who started VDZ treatment before and after January 2018: 9(14%) and 22(41%) respectively were naïve to antiTNFa (p = 0.001); 38(60%) and 10(18.5%) respectively had previously received at least 2 anti-TNFa agents (p = 0.0001). Among patients who started VDZ treatment before and after January 2018, 25(39%) and 6 (11%), respectively, had VDZ intensified along the follow-up (p = 0.001); 36(56%) and 12(22%) respectively withdrawn VDZ (p = 0.0001); 40(73%) and 15(27%) respectively withdrawn or intensified VDZ along the follow-up (p = 0.0001). Conclusion Lower costs have facilitated earlier use of VDZ in our clinical practice, towards increase use in patients who have failed to one single AntiTNFa agent or even naïve to AntiTNFa. This evolved a pattern of VDZ use is associated with better clinical outcomes in terms of VDZ intensification and/or withdrawn. Price policies facilitating appropriate access to drugs, such as VDZ, should be more easily and quickly acceptable by national health authorities. Patient-centred care demand best use of all available drugs, including VDZ.

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

Posterior Cartilage Graft in Single-Stage Laryngotracheal Reconstruction

2003 ◽  
Vol 129 (3) ◽  
pp. 168-175 ◽  
Author(s):  
Ramzi T. Younis ◽  
Rande H. Lazar ◽  
Frank Astor
Keyword(s):  
Medical Center ◽  
Subglottic Stenosis ◽  
Single Stage ◽  
Extensive Experience ◽  
Laryngotracheal Reconstruction ◽  
Mississippi Medical ◽  
Experience Good ◽  
The University ◽  
Age Range ◽  
Graft Reconstruction

PURPOSE: Single-stage laryngotracheal reconstruction (LTR) has gained popularity during the past decade, but few reports discuss posterior grafting. We assessed the indications, treatment, complications, and outcomes for patients who underwent this procedure. METHODS: We reviewed the charts of 120 pediatric patients who underwent LTR at LeBonheur Children's Medical Center or the University of Mississippi Medical Center between January 1992 and September 2000. We identified and evaluated those who had undergone single-stage anterior plus posterior cartilage rib graft reconstruction during this period. RESULTS: Of 120 patients, 56 had anterior graft procedures, and 46 had anterior plus posterior cartilage rib graft reconstruction. The 46 patients included 26 boys and 20 girls (age range, 18 months to 9 years; follow-up periods, 3 months to 6 years). Twenty-one of 46 had circumferential grade III stenosis, 14 had grade IV stenosis, 4 had bilateral vocal cord paralysis, 4 had posterior glottic and subglottic stenosis, and 3 had laryngeal cleft. Eleven of 46 patients had previous procedures and required revision LTR. All 46 patients underwent single-stage reconstruction with temporary stenting using an endotracheal tube for 10 to 24 days; 4 failed required replacement of the tracheotomy tube, and 8 required reintubation after the first extubation. The overall decannulation success rate was 83% (38 of 46). CONCLUSIONS: LTR is the procedure of choice for the surgical management of subglottic stenosis. Although use of a posterior rib graft is technically demanding and requires extensive experience, good results can be obtained when the guidelines are followed.

scholarly journals Diagnosis and treatment of pediatric subglottic stenosis: evaluation of our treatment protocol

2020 ◽  
Vol 6 (3) ◽  
pp. 489
Author(s):  
Sanajeet Kumar Singh ◽  
Roohie Singh ◽  
Sunil Goyal ◽  
Ravi Roy ◽  
D. K. Gupta ◽  
...  
Keyword(s):  
Balloon Dilatation ◽  
Surgical Intervention ◽  
Treatment Protocol ◽  
Subglottic Stenosis ◽  
Management Scheme ◽  
Laryngotracheal Reconstruction ◽  
Grade Ii ◽  
A Prospective Study ◽  
Partial Cricotracheal Resection

<p class="abstract"><strong>Background:</strong> The aim was to describe our experience in management of pediatric subglottic stenosis and formulate a management scheme based on our experience.</p><p class="abstract"><strong>Methods:</strong> A prospective study and follow-up was conducted in children diagnosed with subglottic stenosis (SGS) (both congenital and acquired) from January 2016 to January 2019 (36 months). We have proposed further subcategorization of each grade of SGS into mild and severe depending on absence or presence of the described “hard signs” respectively.  </p><p class="abstract"><strong>Results:</strong> A total of 28 patients with SGS were identified. 8 had congenital while 20 had acquired SGS. There were 16 cases of grade II, 7 cases of grade III and 5 cases of grade I stenosis. None had grade 4 stenosis. Most common surgical intervention was microlaryngoscopy and bronchoscopy which had both diagnostic and therapeutic role (in conjunction with other intervention). Other interventions were balloon dilatation, combined laser and balloon dilatation, anterior cricoid split, laryngotracheal reconstruction and Partial cricotracheal resection. As of July 2019, overall recovery rate was 89.2% and decannulation rate was 81.2%. One patient succumbed to death due to because unrelated to SGS. Two patients are still under follow-up.</p><p class="abstract"><strong>Conclusions:</strong> Number of procedures increases with increasing severity of stenosis. Further subcategorization of SGS as mild or severe guides in selecting endoscopic or open surgical management scheme. The type of procedure for each patient needs to be tailored according to requirement.</p>

131J-speichernde pulmonale und ossäre Metastasen differenzierter Schilddrüsenkarzinome bei niedrigem Serum-Thyreoglobulinspiegel – Ausnahme in der Tumornachsorge?

1987 ◽  
Vol 26 (03) ◽  
pp. 139-142 ◽  
Author(s):  
G. Arning ◽  
O. Schober ◽  
H. Hundeshagen ◽  
Ch. Ehrenheim
Keyword(s):  
Serum Level ◽  
Thyroid Carcinoma ◽  
Bone Metastases ◽  
Differentiated Thyroid Carcinoma ◽  
Serum Thyroglobulin ◽  
Thyroglobulin Level ◽  
Low Serum

In the follow-up of differentiated thyroid carcinoma it is discussed whether the tumormarker thyroglobulin can replace the1311 scan, especially when the thyroglobulin serum level is normal. A positive1311 scan of metastases in the follow-up of patients with differentiated thyroid carcinoma combined with a low serum thyroglobulin level is extremely rare. The literature shows a frequency of about 4%. Recently we found 3 cases with a positive1311 scan demonstrating pulmonary and bone metastases whereas the serum thyroglobulin level was low.

The Renal Outer Medullary Potassium Channel (ROMK): An Intriguing Pharmacological Target for an Innovative Class of Diuretic Drugs

2018 ◽  
Vol 25 (23) ◽  
pp. 2627-2636 ◽  
Author(s):  
Vincenzo Calderone ◽  
Alma Martelli ◽  
Eugenia Piragine ◽  
Valentina Citi ◽  
Lara Testai ◽  
...  
Keyword(s):  
Physiological Role ◽  
Clinical Use ◽  
Diuretic Activity ◽  
First Line ◽  
Potassium Homeostasis ◽  
Diuretic Drugs ◽  
Pharmacological Target ◽  
Diuretic Agents ◽  
Effective Drugs

In the last four decades, the several classes of diuretics, currently available for clinical use, have been the first line option for the therapy of widespread cardiovascular and non-cardiovascular diseases. Diuretic drugs generally exhibit an overall favourable risk/benefit balance. However, they are not devoid of side effects. In particular, all the classes of diuretics cause alteration of potassium homeostasis. <p> In recent years, understanding of the physiological role of the renal outer medullary potassium (ROMK) channels, has shown an intriguing pharmacological target for developing an innovative class of diuretic agents: the ROMK inhibitors. This novel class is expected to promote diuretic activity comparable to (or even higher than) that provided by the most effective drugs used in clinics (such as furosemide), with limited effects on potassium homeostasis. <p> In this review, the physio-pharmacological roles of ROMK channels in the renal function are reported, along with the most representative molecules which have been currently developed as ROMK inhibitors.

Sign in / Sign up

Export Citation Format

Share Document