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 Clinical Profile of Patients with Laryngotracheal Stenosis in a Tertiary Government Hospital

2016 ◽  
Vol 31 (1) ◽  
pp. 26-30
Author(s):  
Anna Carlissa P. Arriola ◽  
Antonio H. Chua
Keyword(s):  
Tracheal Stenosis ◽  
Case Series ◽  
Clinical Profile ◽  
Laryngotracheal Stenosis ◽  
Government Hospital ◽  
Retrospective Case ◽  
Presenting Symptoms ◽  
Pediatric Age Group ◽  
Neck Masses ◽  
History Of

Objective:  To describe the clinical profile of patients with laryngotracheal stenosis over a 7-year period and discuss strategies for its prevention. Methods:       Study Design: Retrospective Case Series Setting: Tertiary Government Hospital Participants: Patients with laryngotracheal stenosis confirmed by laryngoscopy and/or bronchoscopy Results: Twenty-one patients were evaluated for laryngotracheal stenosis from January 2008 to June 2015, but only 13 with complete data were included in this study. Of the 13 patients, nine (69.2%) belonged to the pediatric age group. Ten (77%) were males and three (23%) were females. Laryngotracheal stenosis following endotracheal tube (ET) intubation was seen in 11 (84.6%) while 2 had thyroid masses and no history of prior ET intubation. Presenting symptoms or reasons for referral were wheezing (n=4), stridor (n=4), failure to decannulate the tracheostomy tube (n=3), and dyspnea (n=2). Duration of ET intubation was four to 60 days. The highest frequency of ET re-intubation was 5 times.  Among those intubated, stenosis was glottic in one, subglottic in five and tracheal in five patients. Three had Cotton-Myer grade I stenosis, two had grade II, three had grade III and three had grade IV stenosis. Those with thyroid masses had tracheal stenosis. Conclusion: Strategies for prevention of laryngotracheal stenosis should include routine airway endoscopy for patients with longstanding neck masses and for those with prolonged ET intubation, for whom the option of early prophylactic tracheostomy is worth considering. Otherwise, immediate post-extubation endoscopy may facilitate documentation and appropriate intervention. Keywords:  acquired laryngeal stenosis; tracheal stenosis; endoscopy; intubation, intratracheal; tracheostomy    

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.

Short- versus Long-term Stenting in Children with Subglottic Stenosis Undergoing Laryngotracheal Reconstruction

2017 ◽  
Vol 158 (2) ◽  
pp. 375-380 ◽  
Author(s):  
David F. Smith ◽  
Alessandro de Alarcon ◽  
Niall D. Jefferson ◽  
Meredith E. Tabangin ◽  
Michael J. Rutter ◽  
...  
Keyword(s):  
Demographic Data ◽  
Tertiary Care ◽  
Case Series ◽  
Subglottic Stenosis ◽  
Short Term ◽  
Number Of Children ◽  
Laryngotracheal Reconstruction ◽  
Significant Difference ◽  
Outcomes For Children

Objectives Suprastomal stents are routinely used in laryngotracheal reconstruction (LTR) to stabilize grafts and provide framework to sites of repair. However, the duration of stenting varies according to patient history and physician preference. We examined outcomes of short- versus long-term stenting in children with subglottic stenosis (SGS) undergoing LTR. Study Design Case series with chart review. Setting Tertiary care pediatric hospital. Subjects and Methods Thirty-six children <18 years old who underwent double-stage LTR for SGS from January 2012 to January 2015 were included. Demographic data, stenosis grade, and decannulation rates were compared between children with short-term stenting (≤21 days; n = 14) and those with long-term stenting (>21 days; n = 22). Results No significant difference between groups was seen for sex, age, race, or previous repair. Children in the short-term group were stented for 10.9 ± 4.9 days, compared with 44.0 ± 10.6 for those long-term ( P < .0001). A similar number of children with short- versus long-term stents had grade 3/4 stenosis preoperatively (71.4% vs 77.2%). Although time to decannulation was not significantly different, 72.7% of children with long-term stents were decannulated, as opposed to 35.7% with short-term stents ( P = .03). After adjusting for grade at surgery and age, children with long-term stents had 4.3 greater odds (95% CI, 1.0-18.3) of decannulation than children with short-term stents. Conclusions Children with long-term stenting were more likely to be successfully decannulated. Although long-term stenting improved outcomes for children with SGS, additional research is needed to better define ideal candidates for short- versus long-term stenting.

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%.

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.

Orally Inhaled Drug Particle Transport in Computerized Models of Laryngotracheal Stenosis

2020 ◽  
pp. 019459982095967
Author(s):  
Dennis Onyeka Frank-Ito ◽  
Seth Morris Cohen
Keyword(s):  
Tracheal Stenosis ◽  
Particle Transport ◽  
Particle Deposition ◽  
Inhaled Corticosteroids ◽  
Academic Medical Center ◽  
Subglottic Stenosis ◽  
Laryngotracheal Stenosis ◽  
Drug Particle ◽  
Computed Tomography Images ◽  
Stenotic Segment

Objective Adjuvant management for laryngotracheal stenosis (LTS) may involve inhaled corticosteroids, but metered dose inhalers are designed for pulmonary drug delivery. Comprehensive analyses of drug particle deposition efficiency for orally inhaled corticosteroids in the stenosis of LTS subjects are lacking. Study Design Descriptive research. Setting Academic medical center. Methods Anatomically realistic 3-dimensional reconstructions of the upper airway were created from computed tomography images of 4 LTS subjects—2 subglottic stenosis and 2 tracheal stenosis subjects. Computational fluid dynamics modeling was used to simulate airflow and drug particle transport in each airway. Three inhalation pressures were simulated, 10 Pa, 25 Pa, and 40 Pa. Drug particle transport was simulated for 100 to 950 nanoparticles and 1 to 50 micron-particles. Particles were released into the airway to mimic varying inhaler conditions with and without a spacer chamber. Results Based on smallest to largest cross-sectional area ratio, the laryngotracheal stenotic segment shrunk by 57% and 47%, respectively, for subglottic stenosis models and by 53% for both tracheal stenosis models. Airflow resistance at the stenotic segment was lower in subglottic stenosis models than in tracheal stenosis models: 0.001 to 0.011 Pa.s/mL vs 0.024 to 0.082 Pa.s/mL. Drug depositions for micron-particles and nanoparticles at stenosis were 0.06% to 2.48% and 0.10% to 2.60% for subglottic stenosis and tracheal stenosis models, respectively. Particle sizes with highest stenotic deposition were 6 to 20 µm for subglottic stenosis models and 1 to 10 µm for tracheal stenosis models. Conclusion This study suggests that at most, 2.60% of inhaled drug particles deposit at the stenosis. Particle size ranges with highest stenotic deposition may not represent typical sizes emitted by inhalers.

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.

Partial Cricotracheal Resection in Children

2009 ◽  
Vol 141 (2) ◽  
pp. 225-231 ◽  
Author(s):  
Mercy George ◽  
Christos Ikonomidis ◽  
Yves Jaquet ◽  
Philippe Monnier
Keyword(s):  
Medical Center ◽  
Preoperative Evaluation ◽  
Case Series ◽  
Anastomotic Dehiscence ◽  
Subglottic Stenosis ◽  
Retrospective Case ◽  
Cricotracheal Resection ◽  
Grade Ii ◽  
Partial Cricotracheal Resection ◽  
Grade Iii

OBJECTIVES: To delineate the various factors contributing to failure or delay in decannulation after partial cricotracheal resection (PCTR) in children. STUDY DESIGN: Case series. SETTING: Academic tertiary medical center. SUBJECTS AND METHODS: A retrospective case review of 100 children who underwent PCTR between 1978 and 2008 for severe subglottic stenosis using an ongoing database. RESULTS: Ninety of 100 (90%) patients were decannulated. Six patients needed secondary tracheostomy. The results of the preoperative evaluation showed grade II stenosis in four patients, grade III in 64 patients, and grade IV in 32 patients. The overall decannulation rate was 100 percent in grade II, 95 percent in grade III, and 78 percent in grade IV stenosis. Fourteen (14%) patients required revision open surgery. The most common cause of revision surgery was posterior glottic stenosis. Partial anastomotic dehiscence was seen in four patients. Delayed decannulation (>1 year) occurred in nine patients. Overall mortality rate in the whole series was 6 percent. No deaths were directly related to the surgery. No iatrogenic recurrent laryngeal nerve injury was present in the entire series. CONCLUSION: Comorbidities and associated syndromes should be addressed before PCTR is planned to improve the final postoperative outcome in terms of decannulation. Perioperative morbidity due to anastomotic dehiscence, to a certain extent, can be avoided by intraoperative judgment in the selection of double-stage surgery when more than five tracheal rings need to be resected. Subglottic stenosis with glottic involvement continues to pose a difficult challenge to pediatric otolaryngologists, often necessitating revision procedures.

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.

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