Management of a Patient With Tracheal Stenosis After Previous Tracheotomy

Tracheal stenosis after tracheotomy can cause difficult airway management and respiratory complications. It is difficult to predict tracheal stenosis after tracheotomy based on a patient's symptoms as the symptoms of tracheal stenosis appear only after they become severe. In patients with a history of previous tracheotomy, it is important to consider the risk factors for tracheal stenosis. Detailed preoperative evaluation of patients with a history of previous tracheotomy is essential and should include 3-dimensional assessment of the airway. We report the preoperative assessment and perioperative management of an 83-year-old woman at high risk for tracheal stenosis due to a previous emergency tracheotomy who was scheduled to undergo general anesthesia for a right maxillectomy for squamous cell carcinoma. Preoperative anteroposterior chest radiograph revealed findings indicative of tracheal stenosis. Additional detailed examinations of the stenotic area were conducted with computed tomography imaging and bronchofiberscopy. General anesthesia with nasotracheal intubation was performed, and although there were no adverse intraoperative events, stridor after extubation was observed. Nebulized epinephrine was administered via an ultrasound nebulizer and effectively improved the patient's postoperative transient dyspnea.

Acute Epiglottitis Due to COVID-19 Infection

A 53-year-old man presented acutely to the Accident and Emergency department with a 2-day history of progressive odynophagia and shortness of breath. The patient had stridor at rest and acute epiglottitis was suspected. The patient was transferred urgently to theatre for intubation but due to a severely oedematous airway, this was unsuccessful and emergency tracheotomy was performed by the ENT team. Throughout admission the only positive microbiological sample was a nasopharyngeal swab for SARS-CoV-2 infection. In the absence of other positive microbiology, it is highly likely that COVID-19 was the aetiological cause of acute epiglottitis in this instance.

Successfully managed bilateral pneumothorax and subcutaneous emphysema after emergency open surgical tracheotomy

Background The most common complications we encountered in tracheotomies are hemorrhage, pneumothorax, and tube displacement. In this case report, we describe bilateral pneumothorax following an emergency tracheotomy. Case presentation A 57-year-old woman, who was diagnosed with laryngeal carcinoma, was developed sudden respiratory distress in the ear nose throat (ENT) ward before surgery. The patient was taken to the operating room for emergency tracheotomy. After surgery, at the 5th minute of the mechanical ventilator follow-up in ICU, she developed subcutaneous emphysema on her eyes, face, neck, and chest. She was taken to re-operation. On the postoperative follow-up, bilateral pneumothorax was detected on chest X-ray and bilateral thorax tube was applied by thoracic surgeon. She was externed to ENT ward on the 3rd postoperative day. The left thorax tube was removed on the 2nd and right thorax tube was removed on the 6th postoperative day. Conclusion Here, we presented a successfully managed bilateral pneumothorax and subcutaneous emphysema after emergency open surgical tracheotomy. If persistence reduction of SPO2 levels after tracheotomy, pneumothorax should be kept in the mind.

LARYNGEAL SYNOVIAL SARCOMA – A CASE REPORT

Laryngeal synovial sarcoma is an extremely rare mesenchymal tumor. During the past four decades, literature findings revealed under 40 cases with this localization. We are bringing forward the case of a 70-year-old male patient who was referred to the ENT Clinic as a respiratory emergency – a tumor obstructing the laryngeal glottis, for which an emergency tracheotomy was initially performed, followed by a CT scan and a biopsy under general anesthesia through suspension videolaringoscopy. The histopathological report was suggestive of a biphasic synovial sarcoma. A multidisciplinary team set the surgical indication for total laryngectomy followed by chemo-radiotherapy. Long-term follow-up is mandatory for recurrence prevention. Patient has checked in for follow-up every 3 months over the past 2 years, with no macroscopic signs of tumoral relapse.

Laryngeal chondritis in two Dorper sheep

Laryngeal chondritis is an acute obstructive upper respiratory condition characterised by severe dyspnoea and laryngeal stridor, considered an uncommon disease in sheep. In this study, we describe detailed clinical evolution, imaging and pathological findings of the first cases of laryngeal chondritis in Dorper sheep. Two Dorper sheep from different flocks were referred to clinical care with respiratory distress and fatigue. Due to dyspnoea, both sheep were submitted to emergency tracheotomy. Both sheep did not show recovery after treatment with antimicrobials and anti-inflammatories and died. Main gross findings observed in sheep 1 were purulent foci affecting cricoid cartilage and surrounding tissues. Sheep 2 presented with marked swelling of the laryngeal mucosa, reduced airway lumen and a pus-draining fistula in the arytenoid cartilage. Histologically, both cases revealed necrosis of the laryngeal cartilage, suppurative inflammation and abscedation within myriads of intralesional bacteria.

Progressive dysphagia and dysphonia secondary to DISH-related anterior cervical osteophytes: A case report

Background: Dysphagia due to diffuse idiopathic skeletal hyperostosis (DISH)-related anterior cervical osteophytes is not uncommon. However, this rarely leads to dysphonia and/or dysphagia along with life- threatening airway obstruction requiring emergency tracheotomy. Case Description: A 56-year-old male presented with progressive dysphagia and dysphonia secondary to DISH-related anterior osteophytes at the C3–C4 and C4–C5 levels. The barium swallow, X-ray, magnetic resonance imaging, and computed tomography scans confirmed the presence of DISH. Utilizing an anterior cervical approach, a large beak-like osteophyte was successfully removed, while preserving the anterior annulus. After clinic-radiological improvement, the patient was discharged with a soft cervical collar and nonsteroidal anti-inflammatory drug (NSAID). Conclusion: Large anterior osteophytes in Forestier disease/DISH may cause dysphagia and dysphonia. Direct anterior resection of these lesions yields excellent results as long as other etiologies for such symptoms have been ruled out.

Conicotomy and emergency tracheotomy in general hospital

The article presents 6 clinical cases of emergency conicotomy and / or tracheotomy in an in-patient department of a general emergency hospital. A variety of tactics for the management of the preoperative period and surgical aid is described in conditions of extreme shortage of time for the adoption and implementation of a decision due to the severity of the patient’s condition and the rate of increase in the disorders of the vital functions. The causes of unfavourable outcomes of operations are analyzed. Proposals have been made to improve the training of personnel for action in an emergency situation and to provide material and technical support for this type of assistance in health facilities.