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subglottis stenosis

Kevin Motz, Idris Samad, Linda X Yin, Michael K Murphy, Madhavi Duvvuri, Dacheng Ding, Alexander T Hillel
Importance: Laryngotracheal stenosis (LTS) is a fibroproliferative disorder of the glottis, subglottis, and trachea. In models of fibrosis from other organ systems, the CD4+ T-cell response has been shown to regulate extracellular matrix deposition. Specifically, helper T cell 2 (TH2) promotes fibrosis, whereas TH1 and associated cytokines have been shown to be antifibrotic. However, this antifibrotic effect of the TH1 response has not been demonstrated in LTS. Objective: To determine whether the TH1 cytokine interferon-γ inhibits the function of LTS-derived fibroblasts in vitro...
July 13, 2017: JAMA Otolaryngology—Head & Neck Surgery
Tuhina Raman, Kshitij Chatterjee, Bashar N Alzghoul, Ayoub A Innabi, Ozlem Tulunay, Thaddeus Bartter, Nikhil K Meena
OBJECTIVES: Subglottic stenosis is an abnormal narrowing of the tracheal lumen at the level of subglottis (the area in between the vocal cords and the cricoid cartilage). It can cause significant symptoms due to severe attenuation of airflow. We describe our experience in alleviating symptoms by addressing the stenosis using fibreoptic bronchoscopic methods. METHODS: We report all concurrent cases performed between September 2015 and July 2016. We use a combination of balloon dilation, electro-surgery knife to dilate and incise stenotic segments followed by steroid injection to modulate healing...
2017: SAGE open medical case reports
Hang Yang, Zhe Chen, Shui-Hong Zhou, Qin-Yin Wang, Li-Xia Weng, Fang Wang, Ting-Ting Wu, Min-Li Zhou, Yang-Yang Bao
Objective The treatment of laryngotracheal stenosis is a major therapeutic challenge. Various treatments include observation, medical management, and surgical management. The most effective surgical management is resection and reconstruction. To the authors' knowledge, no reports have described the use of xenogenic acellular dermal matrix (ADM) for laryngotracheal stenosis. Methods A 27-year-old man presented with hemoptysis of the neck due to a traffic accident. Emergency orotracheal intubation was performed...
January 1, 2017: Journal of International Medical Research
Kimberly A Russell, Christopher D Brook, Michael P Platt, Gregory A Grillone, Avner Aliphas, J Pieter Noordzij
Importance: Targeted laryngoscopy training can be used successfully in de novo learners. Objective: To determine the value of targeted laryngoscopy education in interns. Design, Setting, and Participants: This prospective study of fiberoptic laryngoscopy interpretations enrolled 13 participants in an academic hospital setting from August 1 to December 31, 2015. Participants included 10 postgraduate year 1 emergency and otolaryngology interns and 3 board-certified otolaryngology attending physicians...
July 1, 2017: JAMA Otolaryngology—Head & Neck Surgery
S D Sharma, S L Gupta, M Wyatt, D Albert, B Hartley
OBJECTIVES: To describe our experience and provide guidelines for maximum safe balloon sizes according to age in children undergoing balloon dilatation. METHOD: A retrospective review was conducted of children undergoing balloon dilatation for subglottic stenosis in a paediatric tertiary unit between May 2006 and February 2016. RESULTS: A total of 166 patients underwent balloon dilatation. Mean ( ± standard deviation) patient age was 4.5 ± 3...
March 2017: Journal of Laryngology and Otology
Olubunmi Ajose-Popoola, Erica Su, Ashley Hamamoto, Alex Wang, Joseph C Jing, Tony D Nguyen, Jason J Chen, Kathryn E Osann, Zhongping Chen, Gurpreet S Ahuja, Brian J F Wong
OBJECTIVES/HYPOTHESIS: Current imaging modalities lack the necessary resolution to diagnose subglottic stenosis. The aim of this study was to use optical coherence tomography (OCT) to evaluate nascent subglottic mucosal injury and characterize mucosal thickness and structural changes using texture analysis in a simulated intubation rabbit model. STUDY DESIGN: Prospective animal study in rabbits. METHODS: Three-centimeter-long sections of endotracheal tubes (ETT) were endoscopically placed in the subglottis and proximal trachea of New Zealand White rabbits (n = 10) and secured via suture...
January 2017: Laryngoscope
Liuba Soldatova, Candace Hrelec, Laura Matrka
OBJECTIVE: To determine if the results of routine spirometry and flow volume loops (Pulmonary Function Tests (PFTs)) can be used to distinguish Paradoxic Vocal Fold Movement Disorder (PVFMD) from Subglottic Stenosis (SGS). METHODS: PFT records and medical history of 49 patients with diagnosis of PVFMD and 39 patients with SGS were compared. Groups were then subdivided to compare PFTs in patients with and without smoking history or lung disease. RESULTS: Peak expiratory flow rate (PEFR) and Expiratory Disproportion Index (ratio of forced expiratory volume in 1 second (FEV1) over PEFR (FEV1/PEFR)) were both significantly different between patients with SGS and those with PVFMD (p<0...
December 2016: Annals of Otology, Rhinology, and Laryngology
Satish Nair, Ajith Nilakantan, Amit Sood, Atul Gupta, Abhishek Gupta
Laryngeal stenosis is one of the most complex and challenging problems in the field of head and neck surgery. The management involves a multidisciplinary approach with multiple complex procedures. In this study we discuss our experience of laryngeal stenosis with regards to patient characteristics, cause and management. A retrospective analysis of 35 patients of laryngeal stenosis treated at a tertiary care centre was evaluated. Inclusion criteria were all patients with laryngeal stenosis who required surgical intervention...
September 2016: Indian Journal of Otolaryngology and Head and Neck Surgery
Giriraj K Sharma, Anthony Chin Loy, Erica Su, Joe Jing, Zhongping Chen, Brian J-F Wong, Sunil Verma
OBJECTIVES: To determine the feasibility of long-range optical coherence tomography (LR-OCT) as a tool to intraoperatively image and measure the subglottis and trachea during suspension microlaryngoscopy before and after endoscopic treatment of subglottic stenosis (SGS). METHODS: Long-range optical coherence tomography of the adult subglottis and trachea was performed during suspension microlaryngoscopy before and after endoscopic treatment for SGS. The anteroposterior and transverse diameters, cross-sectional area (CSA), distance from the vocal cords, and length of the SGS were measured using a MATLAB software...
October 2016: Annals of Otology, Rhinology, and Laryngology
Niall D Jefferson, Aliza P Cohen, Michael J Rutter
Subglottic stenosis (SGS) is a congenital or acquired condition characterized by a narrowing of the upper airway extending from just below the vocal folds to the lower border of the cricoid cartilage. With the introduction of prolonged intubation in neonates (mid 1960s), acquired SGS became the most frequent cause of laryngeal stenosis; unlike congenital SGS, it does not improve with time. Laryngeal reconstruction surgery evolved as a consequence of the need to manage these otherwise healthy but tracheotomized children...
June 2016: Seminars in Pediatric Surgery
Kate A Stephenson, Michelle E Wyatt
Glottic stenosis is a fixed, focal narrowing at the level of the laryngeal inlet, the true vocal cords. It may be either congenital or acquired and be related to a wide range of etiologies. The stenosis may be either anterior, posterior, or in rare cases, complete. Isolated glottic stenosis is rare; lesions often involve adjacent regions, namely the subglottis. A diagnosis is made from careful history and examination, including evaluation by microlaryngoscopy and bronchoscopy. The management of glottic stenosis is challenging and should be tailored to each individual case...
June 2016: Seminars in Pediatric Surgery
Kazuo Adachi, Toshiro Umezaki, Shizuo Komune
Tracheobronchomegaly (TBM) is a rare enlargement of the tracheal cartilage, also known as Mounier-Kuhn syndrome (MKS). Here, we describe an unusual case of acquired TBM in an adult, caused by amyloid regeneration and associated tracheal weakening, rather than by MKS. CT scan and fiberscopic examination of a 55-year-old woman suffering from severe dyspnea revealed TBM and subglottic stenosis, which was caused by deposition of amyloid tissue. We performed a tracheostomy and vaporized the subglottic stenosis with a CO2 laser, after which we installed a silicone T-tube...
August 2016: Auris, Nasus, Larynx
Owain R Hughes, Sarah M Ayling, Martin A Birchall
OBJECTIVE: The aim of this study was to measure the effects of endotracheal intubation on innate immune response within the pig laryngeal mucosa. STUDY DESIGN: Prospective controlled basic science study. SETTING: The animal experiments and analyses were conducted at the University of Bristol. SAMPLES AND METHODS: Eighteen pigs, matched at the major histocompatibility complex (MHC), were used in the study. The pigs were divided into 9 pairs...
January 2016: Otolaryngology—Head and Neck Surgery
Keiichi Morita, Akiko Yokoi, Yuko Bitoh, Hiroaki Fukuzawa, Yuichi Okata, Tamaki Iwade, Kosuke Endo, Junkichi Takemoto, Akihiko Tamaki, Kosaku Maeda
PURPOSE: The present study analyzed the clinical features and surgical outcomes of laryngotracheal reconstruction (LTR) in pediatric patients with severe acquired subglottic stenosis (SGS) based on the range of stenosis. The aim was to clarify the indications for LTR in severe acquired SGS. METHODS: The medical records of 33 pediatric patients with severe acquired SGS (Myer-Cotton grade III or IV) at our institution between January 1994 and December 2013 were retrospectively reviewed...
October 2015: Pediatric Surgery International
Christopher M Johnson, John T Howell, Donald J Mettenburg, Frederick A Rueggeberg, Rebecca J Howell, Gregory N Postma, Paul M Weinberger
OBJECTIVES: Balloon dilation is generally considered first-line treatment for airway stenosis. Some dilation systems utilize a compliant balloon that can conform around rigid structures. Others use a noncompliant balloon that does not conform, allowing for dilation of more rigid stenoses. We hypothesized that subglottic dilation with a noncompliant balloon increases the likelihood of fracture of the cricoid when compared to a compliant balloon. METHODS: Three fresh human cricoid cartilages were placed in a universal testing system to determine the expansile force necessary for cricoid fracture...
January 2016: Annals of Otology, Rhinology, and Laryngology
Christopher D Brook, Michael P Platt, Kimberly Russell, Gregory A Grillone, Avner Aliphas, J Pieter Noordzij
OBJECTIVE: To determine the progression of flexible transnasal laryngoscopy reliability and competency in otolaryngology residency training. STUDY DESIGN: Prospective case control study. SETTING: Academic otolaryngology department. SUBJECTS: Medical students, otolaryngology residents, and otolaryngology attending physicians. METHODS: Fourteen otolaryngology residents from PGY-1 to PGY-5 and 3 attending otolaryngologists viewed 25 selected and digitally recorded flexible transnasal laryngoscopies...
May 2015: Otolaryngology—Head and Neck Surgery
Veronika Volgger, Giriraj K Sharma, Joseph C Jing, Ya-Sin A Peaks, Anthony Chin Loy, Frances Lazarow, Alex Wang, Yueqiao Qu, Erica Su, Zhongping Chen, Gurpreet S Ahuja, Brian J-F Wong
BACKGROUND: Acquired subglottic stenosis (SGS) most commonly results from prolonged endotracheal intubation and is a diagnostic challenge in the intubated child. At present, no imaging modality allows for in vivo characterization of subglottic microanatomy to identify early signs of acquired SGS while the child remains intubated. Fourier domain optical coherence tomography (FD-OCT) is a minimally invasive, light-based imaging modality which provides high resolution, three dimensional (3D) cross-sectional images of biological tissue...
February 2015: International Journal of Pediatric Otorhinolaryngology
Dhave Setabutr, Myrza R Perez, Mai Thy Truong, Craig W Senders, Brian K Rubinstein
BACKGROUND: Neurofibromatosis type 1 can rarely present in the larynx. Patients typically do not present with complete obstructive symptoms, but partial obstruction and stridor. We review our health centers' case series of two patients, the first of whom presented with persistent sleep apnea post tonsillectomy and adenoidectomy, and the second who presented with noisy breathing. Additionally, we will review the literature on the management and treatment options for children with this rare clinical entity...
September 2014: American Journal of Otolaryngology
Jie Chen, Yong Yin, Lei Zhang, Jun Yang
OBJECTIVE: To summarize clinical experience of application of argon knife under electronic bronchoscope in the management of pediatric glottic and subglottic diseases. METHOD: Reports in the literature were reviewed. Outcome and prognosis of 4 cases with pediatric glottic and subglottic diseases managed with argon beam coagulator technique in Shanghai children's Medical Center since 2011 were retrospectively analyzed. RESULT: Granulation tissue hyperplasia in 3 cases with subglottic lesions did not recur after surgery...
November 2013: Journal of Clinical Otorhinolaryngology, Head, and Neck Surgery
S Pookamala, Rakesh Kumar, Alok Thakar, C Venkata Karthikeyan, Ashu Seith Bhalla, R C Deka
Despite the availability of various surgical options, management of laryngotracheal stenosis (LTS) still remains an enigma. Proper selection of surgical technique in each clinical setting is the key for successful outcome. The purpose of this article is to guide one in selection of appropriate surgical procedures depending upon various stenosis parameters. Aim To record the clinical profile of cases with LTS. To assess the outcome following various surgical interventions based on site, severity, cause of stenosis and to derive conclusions regarding treatment options in various stenosis...
January 2014: Indian Journal of Otolaryngology and Head and Neck Surgery
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