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.

Adjunctive Measures for Successful Laryngotracheal Reconstruction

1987 ◽  
Vol 96 (5) ◽  
pp. 509-513 ◽  
Author(s):  
Steven Gray ◽  
Charles M. Myer ◽  
Robert Miller ◽  
Robin T. Cotton
Keyword(s):  
Granulation Tissue ◽  
Reconstructive Surgery ◽  
Surgical Techniques ◽  
Laryngotracheal Stenosis ◽  
Surgical Tools ◽  
Diagnostic Skills ◽  
Laryngotracheal Reconstruction

The field of reconstructive surgery of the laryngotracheal complex has been the object of considerable enthusiasm in recent years. New surgical techniques, better surgical tools, and improved diagnostic skills all have contributed to a more confident approach to severe laryngotracheal stenosis. Just as the surgeon's judgment is crucial for a successful primary laryngotracheal reconstruction, so are his or her skill and judgment vitally important in managing the various problems that frequently are found following reconstructive surgery of the larynx and trachea. These problems, although seemingly minor, may prevent successful decannulation if not managed appropriately. This paper discusses the various problems that have been encountered while achieving decannulation following laryngotracheal reconstruction. An approach to such frustrating problems as suprastomal collapse, granulation tissue, and the inability to decannulate are presented.

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

Laryngotracheal Reconstruction for Subglottic Stenosis in Children

1987 ◽  
Vol 96 (6) ◽  
pp. 665-669 ◽  
Author(s):  
John Maddalozzo ◽  
Lauren D. Holinger
Keyword(s):  
Cricoid Cartilage ◽  
Costal Cartilage ◽  
Subglottic Stenosis ◽  
Endoscopic Management ◽  
Stent Insertion ◽  
Laryngotracheal Stenosis ◽  
High Likelihood ◽  
Cartilage Grafts ◽  
Laryngotracheal Reconstruction ◽  
Tracheal Disease

The experience with laryngotracheal reconstruction in 20 children in Chicago is reviewed. Nine of the 20 children (45%) operated upon had congenital subglottic stenosis. Ten (50%) had acquired stenosis. One child was classified as having combined types. All patients underwent laryngotracheal reconstruction with autogenous costal cartilage grafts. Eight patients had both anterior and posterior costal cartilage grafts with stent insertion. One had a posterior costal cartilage graft only. Sixteen of the 20 children (80%) have been decannulated. Midtracheal or lower tracheal disease concomitant with laryngotracheal stenosis is an indication that endoscopic management of severe subglottic stenosis is likely to fail. Early laryngotracheal reconstruction is indicated for patients with a high likelihood of failure of endoscopic management and for those with severe cricoid cartilage deformities. Our results support the use of laryngotracheal reconstruction as an alternative to conservative (endoscopic) management of severe subglottic stenosis in carefully selected patients.

scholarly journals Adolescent and adult laryngotracheal stenosis: a review

2021 ◽  
Vol 37 (1) ◽  
Author(s):  
Gerhard Johan Klopper ◽  
Oladele Vincent Adeniyi ◽  
Kate Stephenson
Keyword(s):  
Intensive Care ◽  
Past Century ◽  
Main Body ◽  
Laryngotracheal Stenosis ◽  
Airway Protection ◽  
Interventional Pulmonology ◽  
The Past ◽  
Airway Emergency ◽  
The Individual ◽  
And Function

Abstract Background The larynx has multiple composite functions which include phonation, airway protection, and sensory control of respiration. Stenosis of the larynx and trachea were first recorded by O’Dwyer in 1885 and by Colles in 1886, respectively. Initially, the aetiology of laryngotracheal stenosis was predominantly infective. Currently, the leading cause is iatrogenic injury to the laryngotracheal complex secondary to prolonged ventilation in an intensive care unit. Main body Laryngotracheal stenosis is a complex and diverse disease. It poses a major challenge to the surgeon and can present as an airway emergency. Management typically demands the combined involvement of various disciplines including otorhinolaryngology, cardiothoracic surgery, anaesthesiology, interventional pulmonology, and radiology. Both the disease and its management can impact upon respiration, voice, and swallowing. The incidence of iatrogenic laryngotracheal stenosis has reflected the evolution of airway and intensive care whilst airway surgery has advanced concurrently over the past century. Correction of laryngotracheal stenosis requires expansion of the airway lumen; this is achieved by either endoscopic or open surgery. We review the relevant basic science, aetiopathogenesis, diagnosis, management, and treatment outcomes of LTS. Conclusion The choice of surgical procedure in the management of laryngotracheal stenosis is often dictated by the individual anatomy and function of the larynx and trachea, together with patient factors and available facilities. Regardless of how the surgeon chooses to approach these lesions, prevention of iatrogenic laryngotracheal damage remains of primary importance.

scholarly journals Utility of Two-Stage Laryngotracheal Reconstruction in the Management of Subglottic Stenosis in Adults

2009 ◽  
Vol 119 (S3) ◽  
pp. S263-S263
Author(s):  
Nathan A. Deckard ◽  
Justin Yeh ◽  
Michael Criddle ◽  
Robert Stachler ◽  
James Coticchia
Keyword(s):  
Subglottic Stenosis ◽  
Two Stage ◽  
Laryngotracheal Reconstruction

Laryngotracheal Reconstruction Using Microplates in a Porcine Model With Subglottic Stenosis

1996 ◽  
Vol 106 (3) ◽  
pp. 301-305 ◽  
Author(s):  
Mary T. Mitskavich ◽  
Frank L. Rimell ◽  
Andrew M. Shapiro ◽  
J. Christopher Post ◽  
Silloo B. Kapadia
Keyword(s):  
Porcine Model ◽  
Subglottic Stenosis ◽  
Laryngotracheal Reconstruction

scholarly journals Fasciotomy through Multiple Small Skin Incisions for the treatment of early acute osteofascial compartment syndrome in children

2020 ◽  
Author(s):  
Xiaowei Yuan ◽  
Jun Wu ◽  
Xiangyang Qu ◽  
Ming Li ◽  
Linjun Jiang ◽  
...  
Keyword(s):  
Compartment Syndrome ◽  
Nerve Conduction Velocity ◽  
Pediatric Patients ◽  
Early Stage ◽  
Healing Time ◽  
Compartment Pressure ◽  
Excellent Outcome ◽  
And Function ◽  
Average Procedure Time

Abstract Background The purpose of the present study is to investigate the therapeutic effect of fasciotomy through multiple small skin incisions for the treatment of early osteofascial compartment syndrome in children.Methods From January 2009 to May 2017, 56 pediatric patients with early osteofascial compartment syndrome in their limbs were admitted into our department and treated with multiple small skin incisions for decompression at the early stage. The skin incisions, function and sensation of the limbs were followed up.Results The osteofascial compartment syndrome was diagnosed at 7.4±2.1 hours after injury, and then fasciotomy was performed at 1.4±0.4 hours later. The average procedure time of fasciotomy was 12.7±4.8 minutes. No postoperative incision infections or neurovascular injuries were observed in all the patients. The incisions completely healed in 7-10 days with an average healing time of 8 days without secondary suture. The patients were followed up for an average of 5.1 years. No Volkmann’s contractures in the injured climbs were found. The appearance, electromyography and nerve conduction velocity of the affected limbs were not significantly different from that of the contralateral limbs. All the patients were free of symptoms, were full recovery of sensation and function, being an “excellent” outcome at the latest follow-up. Conclusion Fasciotomy through multiple small skin incisions, which can be useful to decompress the compartment pressure with fewer complications, is a simple and effective strategy for the treatment of early osteofascial compartment syndrome in children.

Development of a high fidelity subglottic stenosis simulator for laryngotracheal reconstruction rehearsal using 3D printing

2019 ◽  
Vol 124 ◽  
pp. 134-138 ◽  
Author(s):  
Chelsea L. Reighard ◽  
Kevin Green ◽  
Allison R. Powell ◽  
Deborah M. Rooney ◽  
David A. Zopf
Keyword(s):  
3D Printing ◽  
Subglottic Stenosis ◽  
High Fidelity ◽  
Laryngotracheal Reconstruction

scholarly journals Cannulated Cancellous Screw Fixation for Capitellum Fractures in Adolescents

2011 ◽  
Vol 19 (3) ◽  
pp. 346-349 ◽  
Author(s):  
Kee Leong Ong ◽  
Arjandas Mahadev
Keyword(s):  
Performance Index ◽  
Kirschner Wire ◽  
Excellent Outcome ◽  
Excellent Functional Outcome ◽  
Cancellous Screws ◽  
The Mean ◽  
And Function ◽  
Anterior Direction

Purpose. To review the outcome of 9 adolescents treated with 2 to 3 cannulated cancellous screws for type-1 capitellum fractures. Methods. Records of 8 boys and one girl aged 12 to 14 (mean, 14) years with type-1 capitellum fractures were reviewed. The mechanism of injury was a fall on the flexed elbow. No patient had associated injuries or neurovascular compromise. In 2 patients, the fracture was minimally displaced and treated with a cast. The remaining 7 patients with displaced fractures underwent open reduction and internal fixation using 4.0-mm cannulated partially threaded cancellous screws inserted in a posterior-to-anterior direction. In one patient, a Kirschner wire was added to fix a small comminuted fragment. Elbow pain, range of motion, stability, and function were evaluated using the Mayo Elbow Performance Index. Results. The mean follow-up period was 7 (range, 2–18) months. The mean Mayo Elbow Performance Index score was 100, indicating excellent outcome. No patient developed avascular necrosis or heterotrophic ossification. All patients achieved anatomic bone union. All implants were removed after a mean of 4.7 (range, 2–7) months. Conclusion. The fixation of type-1 capitellum fractures with 2 to 3 cannulated cancellous screws inserted posteroanteriorly achieved excellent functional outcome.

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