Fetoscopic balloon dilation and stent placement of congenital high airway obstruction syndrome leading to successful Caesarian delivery

Introduction: Without fetal or perinatal intervention, congenital high airway obstruction syndrome (CHAOS) is a fatal anomaly. The ex utero intrapartum treatment (EXIT) procedure has been used to secure the fetal airway and minimize neonatal hypoxia, but is associated with increased maternal morbidity. Case Presentation: A 16-year-old woman (gravida 1, para 0) was referred to our hospital at 31 weeks gestation with fetal anomalies, including echogenic lungs, tracheobronchial dilation and flattened diaphragms. At 32 weeks, fetoscopic evaluation identified laryngeal stenosis, which was subsequently treated with balloon dilation and stent placement. The patient developed symptomatic and regular preterm contractions at post-operative day 7 with persistent sonographic signs of CHAOS, which prompted a repeat fetoscopy with confirmation of a patent fetal airway followed by Cesarean delivery under neuraxial anesthesia. Attempts to intubate through the tracheal stent were limited and resulted in removal of the stent. A neonatal airway was successfully established with rigid bronchoscopy. Direct laryngoscopy and bronchoscopy confirmed laryngeal stenosis with a small tracheoesophageal fistula immediately inferior to the laryngeal stenosis and significant tracheomalacia. A tracheostomy was then immediately performed for anticipated long term airway and pulmonary management. The procedures were well tolerated by both mom and baby. The baby demonstrated spontaneous healing of the tracheoesophageal fistula by day of life 7 with discharge home with ventilator support at three months of life. Conclusion: Use of repeated fetoscopy in order to relieve fetal upper airway obstruction offers the potential to minimize neonatal hypoxia, while concurrently decreasing maternal morbidity by avoiding an EXIT procedure. Use of the tracheal stent in CHAOS requires further investigation. The long-term reconstruction and respiratory support of children with CHAOS remain challenging

A laser management in cases of laryngeal stenosis due to corrosive poisoning

Background: Post corrosive poisoning result in serious chemical injuries and complications to the gastrointestinal tract and a high mortality rate. Post corrosive Complications that include respiratory injuries are especially significant for determining the severity of acute corrosive poisonings. Mortality is most often caused by tracheal necrosis, perforation of esophagus or stomach, followed by Mediastinitis or peritonitis. Results: Herewith presenting nine cases of laryngotracheal stenosis following corrosive poisoning ingestion. The purpose of this study is to upper aerodigestive tract complications and its Management. Stricture can be managed by endoscopic dilatation, oesophageal Stents, surgery. In our experience we planned for laser release of cricopharyngeal stricture with oesophageal dilatation. Diode laser isused for release of cricopharyngeal. Conclusions: Good postoperative outcome can be achieved and patient can be without tracheostomy for life long living near normal life. Pre and post operative psychological analysis and counselling is also very important for better functional outcome.Giving general anaesthesia is challenging in these cases hence experienced Team of anaesthetist is required to prevent mortality.

Variants of surgical treatment of chronic post-intubation laryngeal stenosis in children

Objective. To evaluate the effectiveness of a surgical tactics used for the treatment of children with chronic post-intubation laryngeal stenosis depending on the condition of their laryngeal cartilages. Patients and methods. We treated 47 children with chronic post-intubation laryngeal stenosis. Preoperative examination included endoscopy and computed tomography (CT) of the larynx and trachea. We evaluated the condition of their laryngeal cartilages in order to choose an optimal surgical tactics. Children with intact laryngeal cartilages (n = 20) have undergone endolaryngeal microsurgery using a CO2 laser. This method caused minimal injury due to submucosal excision of scar tissue, which enabled wound coverage with mucous microflaps to prevent recurrent stenosis. Surgery for extensive stenosis in the middle portion of the larynx was associated with a risk of recurrent scarring. In our study, we prevented it by using endografts during 21 days. However, patients with lesions in the subglottic larynx still had a high risk of recurrent stenosis (5 out of 12 patients) even if there was no evidence of damage to the laryngeal cartilages. Results. Twenty-seven patients with laryngeal post-intubation stenosis with lesions to the laryngeal cartilages detected before surgery have undergone extralaryngeal laryngotracheoplasty. Eighteen children have undergone laryngofissure with subsequent stenting between 6 and 18 months with a T-shaped silicone stent. Nine patients have undergone single-stage laryngotracheoplasty with autologous grafts. Conclusion. The methods used in this study have demonstrated high effectiveness, while the use of grafts reduced the number of stages of surgery and its duration. Key words: laryngotracheoplasty in children, laryngeal microsurgery, complications of tracheal intubation in children, chronic laryngeal stenosis, cartilage autologous grafts, CO2 laser

Congenital tracheal stenosis: case report

The rate of congenital malformations of the larynx is challenging to assess. This is probably accounted for by the fact that these diseases occur more commonly than they are diagnosed. This paper describes a case report of congenital laryngeal stenosis, which was a diagnosis of exclusion since this congenital malformation is very rare in neonatal and pediatric practice. After a preliminary diagnosis in the maternity hospital, a newborn was transferred to Krasnoyarsk’s large pediatric hospital for examinations and treatment. Clinical diagnosis was verified by laryngotracheoscopy and CT scan of the larynx and trachea. The newborn’s condition was severe for 28 days. He stayed in the intensive care unit and was on a ventilator and oxygen. Tracheal intubation followed by extubation (performed three times) has no effect due to the increase in respiratory failure. Newborn’s condition improved only after palliative tracheostomy. The child was discharged in satisfactory condition with recommendations on tracheostoma care. Management decision on the surgical technique to address this malformation will be taken later. KEYWORDS: primary congenital tracheal stenosis, children, clinical presentations, diagnosis. FOR CITATION: Gol’tsman E.V., Kuchma O.A., Bondarenko E.N., Maiseenko D.A. Congenital tracheal stenosis: case report. Russian Journal of Woman and Child Health. 2021;4(3):298–301 (in Russ.). DOI: 10.32364/2618-8430-2021-4-3-298-301.