scholarly journals Outcome of surgery for laryngotracheal stenosis in grade III and IV subglottic stenosis

2013 ◽  
Vol 8 (S1) ◽  
Author(s):  
HR Davari
Keyword(s):  
Subglottic Stenosis ◽  
Laryngotracheal Stenosis ◽  
Outcome Of Surgery ◽  
Grade Iii

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 The Impact of Tracheotomy on the Eventual Outcome of Surgery for Benign Laryngotracheal Stenosis in a Tertiary Health Care Setup

2015 ◽  
Vol 7 (2) ◽  
pp. 51-56
Keyword(s):  
Health Care ◽  
Vital Role ◽  
Definitive Treatment ◽  
Laryngotracheal Stenosis ◽  
Key Factors ◽  
Tertiary Healthcare ◽  
History Of ◽  
The Impact ◽  
Eventual Outcome ◽  
Outcome Of Surgery

ABSTRACT Introduction Acquired benign laryngotracheal stenosis is often preventable. A majority of such patients have a history of some airway intervention, ranging from a planned endotracheal intubation for the purpose of anesthesia, to an emergency tracheotomy in the setting of stridor. The primary aim of the first treating clinician is to secure the airway, and often these patients already have a tracheotomy at the time of initial presentation. Materials and methods We analyzed 80 patients that have been managed for varying grades and locations of acquired benign laryngotracheal stenosis presenting to a tertiary healthcare centre, and analyzed the impact of tracheotomy on the eventual outcome. Summary and conclusion Tracheotomies performed in patients suffering from stenosis in the airway pose technical challenges. If planned even in the most urgent situations, they can play a vital role in determining the eventual outcome of the definitive treatment. The site, technique and care of the tracheotomy are key factors in determining the eventual outcome. How to cite this article Hathiram BT, Khattar VS. The Impact of Tracheotomy on the Eventual Outcome of Surgery for Benign Laryngotracheal Stenosis in a Tertiary Health Care Setup. Int J Otorhinolaryngol Clin 2015;7(2):51-56.

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.

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.

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.

End-to-end anastomosis in the management of laryngotracheal defects

2017 ◽  
Vol 131 (5) ◽  
pp. 447-454 ◽  
Author(s):  
E D Gozen ◽  
M Yener ◽  
Z B Erdur ◽  
E Karaman
Keyword(s):  
Surgical Procedures ◽  
Granulation Tissue ◽  
Vocal Fold ◽  
Laryngotracheal Stenosis ◽  
Thyroid Malignancy ◽  
Operative Complications ◽  
Vocal Fold Palsy ◽  
Grade Ii ◽  
End To End ◽  
Grade Iii

AbstractObjective:To present clinical experience and surgical outcomes of end-to-end anastomosis in the management of laryngotracheal stenosis and tracheal defects following invasive thyroid malignancy resection.Methods:A retrospective analysis was performed of 14 patients with laryngotracheal stenosis and tracheal invasive thyroid malignancy. All patients underwent tracheal or cricotracheal resection and primary end-to-end anastomosis.Results:Length of stenosis was 1.7–4 cm. Stenosis was classified as Myer and Cotton grade II in 4 patients, grade III in 6 and grade IV in 2. Surgical procedures included tracheotracheal end-to-end anastomosis (n= 4), cricotracheal anastomosis (n= 2) and thyrotracheal anastomosis (n= 6). Patients with invasive thyroid malignancy underwent segmental resection of the involved segment with tumour-free margins, and tracheal or cricotracheal end-to-end anastomosis. Successful decannulation was achieved in 13 patients (93 per cent). Post-operative complications were: wound infection (n= 1), subcutaneous emphysema (n= 1), temporary unilateral vocal fold palsy (n= 1), granulation tissue development (n= 1), and restenosis (n= 2).Conclusion:End-to-end anastomosis can be used safely and successfully in the management of advanced laryngotracheal stenosis and wide laryngotracheal defects. Greater success can be achieved using previously described surgical rules and laryngotracheal release manoeuvres.

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