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%.

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.

Surgical Treatment of Prolapse of the Third Eyelid Gland in Dogs using Modified Morgan Pocket Technique

2019 ◽  
Author(s):  
R. Yaygingul ◽  
Z. Bozkan ◽  
Z. Bilgen ªen ◽  
B. Kibar Kurt ◽  
O. Bulut ◽  
...  
Keyword(s):  
Retrospective Study ◽  
Surgical Treatment ◽  
Clinical Outcome ◽  
Success Rate ◽  
Postoperative Period ◽  
Clinical Problem ◽  
The Third ◽  
Unilateral Disease ◽  
Percent Success ◽  
The Right

The aim of this retrospective study was to evaluate the clinical outcome, complications, recurrence rate, and results of the pocket technique in the treatment of prolapse of the third eyelid gland, cherry eye namely. Thirty eyes of 26 dogs diagnosed with prolapse of the third eyelid gland were included the study. Conjunctivitis and ocular discharges were noticed in the affected eyes. The four cases were (15%) bilateral and twenty-two (85%) were unilateral. Of the dogs with unilateral disease, the affected eye was on the left side in 10 (45%) dogs and the right side in 12 (55%). Eighteen dogs were male and eight were female. Twenty-six dogs, 30 eyes with protrusion of the third eyelid gland were treated using Modified Morgan’s pocket technique. In the postoperative period, the dogs were controlled 3 times with 7 day intervals and no clinical problem was detected. Modified Morgan pocket technique was used with 96.1 percent success rate for the re-positioning of prolapsed gland of the third eyelid in dogs.

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.

Tracheocutaneous Fistula After Pediatric Open Airway Reconstruction

2021 ◽  
pp. 000348942098742
Author(s):  
Stephen R. Chorney ◽  
Joanne Stow ◽  
Luv R. Javia ◽  
Karen B. Zur ◽  
Ian N. Jacobs ◽  
...  
Keyword(s):  
Costal Cartilage ◽  
Case Series ◽  
Primary Objective ◽  
Multivariable Logistic Regression Analysis ◽  
Pediatric Airway ◽  
Surgical Closure ◽  
Laryngotracheal Reconstruction ◽  
Airway Reconstruction ◽  
Tracheocutaneous Fistula

Objectives: Tracheocutaneous fistula (TCF) is a common occurrence after pediatric tracheostomy decannulation. However, the persistence of TCF after staged reconstruction of the pediatric airway is not well-described. The primary objective was to determine the rate of persistent TCF after successful decannulation in children with staged open airway reconstruction. Methods: A case series with chart review of children who underwent decannulation after double-stage laryngotracheal reconstruction between 2017 and 2019. Results: A total of 26 children were included. The most common open airway procedure was anterior and posterior costal cartilage grafting (84.6%, 22/26). Median age at decannulation was 3.4 years (IQR: 2.8-4.3) and occurred 7.0 months (IQR: 4.3-10.4) after airway reconstruction. TCF persisted in 84.6% (22/26) of children while 15.4% (4/26) of stomas closed spontaneously. All closures were identified by the one-month follow-up visit. There was no difference in age at tracheostomy ( P = .86), age at decannulation ( P = .97), duration of tracheostomy ( P = .43), or gestational age ( P = .23) between stomas that persisted or closed. Median diameter of stent used at reconstruction was larger in TCFs that persisted (7.0 mm vs 6.5 mm, P = .03). Tracheostomy tube diameter ( P = .02) and stent size ( P < .01) correlated with persistence of TCF on multivariable logistic regression analysis. There were 16 surgical closure procedures, which occurred at a median of 14.4 months (IQR: 11.4-15.4) after decannulation. Techniques included 56.3% (9/16) by primary closure, 18.8% (3/16) by secondary intention and 25% (4/16) by cartilage tracheoplasty. The overall success of closure was 93.8% (15/16) at latest follow-up. Conclusions: Persistent TCF occurs in 85% of children who are successfully decannulated after staged open airway reconstruction. Spontaneous closure could be identified by 1 month after decannulation and was more likely when smaller stents and tracheostomy tubes were utilized. Surgeons should counsel families on the frequency of TCF and the potential for additional procedures needed for closure.

scholarly journals Pyelonephritis in Pediatric Uropathic Patients: Differences from Community-Acquired Ones and Therapeutic Protocol Considerations. A 10-Year Single-Center Retrospective Study

Children ◽  
2021 ◽  
Vol 8 (6) ◽  
pp. 436
Author(s):  
Giovanni Parente ◽  
Tommaso Gargano ◽  
Stefania Pavia ◽  
Chiara Cordola ◽  
Marzia Vastano ◽  
...  
Keyword(s):  
Escherichia Coli ◽  
Retrospective Study ◽  
Success Rate ◽  
Pediatric Population ◽  
Gram Negative Bacteria ◽  
Gram Positive ◽  
Gram Negative ◽  
Gram Positive Bacteria ◽  
Significant Difference ◽  
Klebsiella Spp

Pyelonephritis (PN) represents an important cause of morbidity in the pediatric population, especially in uropathic patients. The aim of the study is to demonstrate differences between PNs of uropathic patients and PNs acquired in community in terms of uropathogens involved and antibiotic sensitivity; moreover, to identify a proper empiric therapeutic strategy. A retrospective study was conducted on antibiograms on urine cultures from PNs in vesicoureteral reflux (VUR) patients admitted to pediatric surgery department and from PNs in not VUR patients admitted to Pediatric Emergency Unit between 2010 and 2020. We recorded 58 PNs in 33 patients affected by VUR and 112 PNs in the not VUR group. The mean age of not VUR patients at the PN episode was 1.3 ± 2.6 years (range: 20 days of life–3 years), and almost all the urine cultures, 111 (99.1%), isolated Gram-negative bacteria and rarely, 1 (0.9%), Gram-positive bacteria. The Gram-negative uropathogens isolated were Escherichia coli (97%), Proteus mirabilis (2%), and Klebsiella spp. (1%). The only Gram-positive bacteria isolated was an Enterococcus faecalis. As regards the antibiograms, 96% of not VUR PNs responded to beta-lactams, 99% to aminoglycosides, and 80% to sulfonamides. For the VUR group, mean age was 3.0 years ± 3.0 years (range: 9 days of life–11 years) and mean number of episodes per patient was 2.0 ± 1.0 (range: 1–5); 83% of PNs were by Gram-negatives bacteria vs. 17% by Gram-positive: the most important Gram-negative bacteria were Pseudomonas aeruginosa (44%), Escherichia coli (27%), and Klebsiella spp. (12%), while Enterococcus spp. determined 90% of Gram-positive UTIs. Regimen ampicillin/ceftazidime (success rate: 72.0%) was compared to ampicillin/amikacin (success rate of 83.0%): no statistically significant difference was found (p = 0.09). The pathogens of PNs in uropathic patients are different from those of community-acquired PNs, and clinicians should be aware of their peculiar antibiotic susceptibility. An empiric therapy based on the association ampicillin + ceftazidime is therefore suggested.

scholarly journals ALTERNATIVE TO THE INVERTED “Y” INCISION IN SCOLIOSIS SECONDARY TO MYELOMENINGOCELE

2019 ◽  
Vol 18 (1) ◽  
pp. 14-16
Author(s):  
Diego Veiga Bezerra ◽  
Luis Eduardo Munhoz da Rocha ◽  
Dulce Helena Grimm ◽  
Carlos Abreu de Aguiar ◽  
Luiz Müller Ávila ◽  
...  
Keyword(s):  
Retrospective Study ◽  
Spina Bifida ◽  
Postoperative Period ◽  
Medical Records ◽  
Surgical Intervention ◽  
Case Series ◽  
Material Failure ◽  
Spinal Deformities ◽  
Level Of Evidence ◽  
Skin Conditions

ABSTRACT Objective: To evaluate the healing of the modified inverted “Y” incision in patients with scoliosis due to myelomeningocele. Methods: Retrospective study through medical records review of patients with myelomeningocele surgically treated with a modified inverted “Y” approach between January 2013 and December 2015. Results: We analyzed the medical records of six patients. Two patients progressed with skin complications in the immediate postoperative period and only one of them required surgical intervention for debridement and suturing. In another patient, it was necessary to perform two surgical reviews due to material failure without skin complications in these interventions. Conclusions: The modified inverted “Y” technique is a great alternative to traditional incision and inverted “Y” because it has good results in patients with spina bifida associated with poor skin conditions treated surgically for correction of spinal deformities. Level of Evidence IV; Case series.

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
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