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.

Efficacy of Corticosteroids Treatment on Reducing the Risk of Post-Extubation Stridor: Study Protocol for a Randomized Controlled Trial

Background: Laryngotracheal injury is one of common complications of airway intubation, with severe cases leading to stridor or even extubation failure (need for reintubation within 48 hours after extubation). As corticosteroids have anti-inflammatory effects, they may play an important role in reducing the risk of post-extubation stridor and extubation failure among adult patients.Aim: To investigate the efficacy of corticosteroids on reducing the risk of post-extubation stridor. Methods: A multicenter, randomized, placebo-controlled trial will be performed. The trial will enroll 232 patients undergoing extubation from mechanical ventilation. The patients will be randomly assigned to treatment four hours prior to extubation either with intravenous methylprednisolone 40mg or placebo. The primary endpoint is the occurrence of laryngeal stridor within 48 hours, and the secondary endpoints are the need for respiratory support or reintubation secondary to post-extubation stridor within 48 hours after extubation, side effects or corticosteroids, hospital length of stay, and 30-day mortality.Discussion: The trial will examine if corticosteroid therapy before extubation is effective at reducing the risk of post-extubation stridor-related complications among adult patients. Trial registration: Chictr.org.cn, ChiCTR2000030349. Registered on 29 Feb 2020.

DOZ047.44: Coblation supraglottoplasty for symptomatic laryngomalacia

Background Laryngomalacia is the commonest cause of congenital laryngeal stridor and supraglottoplasty is the mainstay of surgical treatment for symptomatic laryngomalacia. A variety of techniques used for ablating redundant tissue in the supraglottis. Novel supraglottoplasty surgical technique is needed to achieve better safety and efficacy. The purpose of this study is to evaluate the outcome and effectiveness of supraglottoplasty. Methods A total of 71 patients with laryngomalacia were studied retrospectively. Of 20 patients with symptomatic laryngomalacia underwent supraglottoplasty and 48 patients were treated conservatively. Two patients refused surgical management. Of 80% underwent successive apnea technique, rest under ETGA. The number of patients who underwent supraglottoplasty technique 14 was of coblation, 3 were of cold steel, 1 was of coagulation, 1 was of laser, and 1 was of microdebrider. The patients were kept under observation in intensive care unit (ICU) from 1 to 3 days then in step downward for 3 to 5 days. No child was intubated in the postoperative period. The patient's demographic information, symptoms, comorbidities, type of laryngomalacia, synchronous airway lesions, and final outcomes were examined. Results The common indications for surgery were feeding problems and failure to thrive along with inspiratory stridor. Most common type of laryngomalacia was type 2 (71%). Good weight gain happened for 18 patients, one patient had to be continued on gastrostomy feeding, one patient did not gain weight. Majority of the patients continued to have some amount of noisy breathing and eventually settled in 3 months postoperatively. No perioperative deaths and no long-term complications occurred, 2 patients were readmitted for increasing stridor and treated with nebulizations and improved. Conclusions Supraglottoplasty is an effective and safe treatment for symptomatic laryngomalacia and has the potential to provide better breathing and feeding outcomes. Among all the techniques, in our retrospective study, we found that successive apnea technique and coblator ablation is safe and effective methods in supraglottoplasty because it gives good exposure of supraglottis, no concern of airway fire, less collateral damage. The advantage is easy instrumentation with single wand for ablation, coagulation, and aspiration. Multicenter cooperative studies of comparison between coblator and conventional approaches would lend further evidence-based support for this surgical method.

Unusual Presentation of Prostate Cancer Metastatic to the Cricoid Cartilage and Oral Cavity

In Mexico, prostate cancer is the second leading cause of death in men. Prostate cancer usually presents metastasis to the regional lymph nodes and bone. Hereby, we present an unusual case of metastatic prostate cancer, with affectation to the cricoid cartilage and oral cavity, being the first case to have ever been reported in Mexico. A 68-year-old Mexican man was diagnosed with prostate cancer and cribriform architecture histology with low serum level of prostate-specific antigen, debuting with laryngeal stridor. The biopsy came back positive for metastatic prostate carcinoma. During treatment with radiotherapy, metastasis developed to the oral cavity.