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Laryngotracheal reconstruction

Patrick Zardo, Tom Kreft, Thomas Hachenberg
We present a case of impassable subglottic stenosis scheduled for tracheal resection and reconstruction managed by establishing a supraglottic airway. Despite careful preoperative evaluation, the stenosis was localized higher than anticipated, rendering conventional intubation impossible. Laryngeal mask bridging to cross-field ventilation was feasible and jet ventilation and cardiopulmonary bypass were available as emergency strategies. Surgery and emergence went uneventful. Perioperative considerations are discussed in this report...
December 2016: Thoracic and Cardiovascular Surgeon Reports
Santosh Kumar Swain, Neha Singh, Rankanidhi Samal, Santosh Kumar Pani, Mahesh Chandra Sahu
To describe the experience of anterior cricotracheal split with insertion of conchal cartilage graft in the treatment of subglottic and tracheal stenosis at a tertiary care hospital of eastern India. Six patients were included in the study, in the age group of 20-48 years. Out of which five patients were successfully decannulated after 3 months of laryngotracheal reconstruction with help of conchal cartilage. One case was undergone resection anastomosis after failure of the above technique. Successful restoration of the airway with decannulation in five cases and failure in one case...
December 2016: Indian Journal of Otolaryngology and Head and Neck Surgery
Anna M Ciccone, Camilla Vanni, Giulio Maurizi, Antonio D'Andrilli, Stylianos Korasidis, Mohsen Ibrahim, Claudio Andreetti, Federico Venuta, Erino A Rendina
Idiopathic subglottic stenosis is the most challenging condition in the field of upper airway reconstruction. We describe a successful novel technique for enlarging the airway space at the site of the laryngotracheal anastomosis in very high-level reconstructions.
November 2016: Annals of Thoracic Surgery
Sean Lewis, Marisa Earley, Richard Rosenfeld, Joshua Silverman
OBJECTIVES/HYPOTHESIS: To determine if open surgical treatment options for adult and adolescent laryngotracheal stenosis are more successful than endoscopic procedures. STUDY DESIGN: Systematic review. METHODS: Embase and MEDLINE were searched for publications on adult and adolescent patients (>13 years old) with laryngotracheal stenosis. Cause of stenosis (intubation, idiopathic, or trauma) and treatments (open laryngotracheal resection with anastomosis, open laryngotracheal reconstruction with expansion grafting, or endoscopic procedures) were included...
January 2017: Laryngoscope
Konrad Hoetzenecker, Thomas Schweiger, Imme Roesner, Matthias Leonhard, Gabriel Marta, Doris M Denk-Linnert, Berit Schneider-Stickler, Wolfgang Bigenzahn, Walter Klepetko
OBJECTIVES: Repair of laryngotracheal stenosis with pronounced side-to-side narrowing and involvement of the glottis is challenging and usually requires laryngotracheal reconstruction with rib cartilage interpositions. This technique, as first described by Couraud, needs prolonged postoperative stabilization with Montgomery T-tubes, imposing significant morbidity and discomfort on patients. We describe our initial experience with a modified laryngotracheal reconstruction technique that avoids the need for prolonged postoperative stenting...
October 2016: Journal of Thoracic and Cardiovascular Surgery
Olivia T Cheng, Akina Tamaki, Rod P Rezaee, Chad A Zender
BACKGROUND: Prefabricated composite free flaps have been described as a technique for reconstruction of laryngotracheal defects. METHODS: We present a 74-year-old woman with recurrent papillary thyroid carcinoma (PTC) who was initially treated with thyroidectomy, tracheal resection, and subsequent vocal cord medialization. The patient's recurrent disease was treated with partial laryngectomy and reconstruction using a prefabricated composite free flap. A 2-stage procedure was performed using conchal cartilage to create a prefabricated radial forearm free flap...
July 4, 2016: Head & Neck
Benoit Jacques Bibas, Paulo Francisco Guerreiro Cardoso, Helio Minamoto, Leandro Picheth Eloy-Pereira, Mauro Federico L Tamagno, Ricardo Mingarini Terra, Paulo Manoel Pêgo-Fernandes
BACKGROUND: Benign tracheoesophageal fistulas (TEFs) are rare, and surgical correction is the ideal method of treatment. The objective of this study was to evaluate the results of operative treatment of benign TEFs in patients from a tertiary referral center. METHODS: Retrospective study of patients with benign TEFs who were treated between January 2005 and December 2014. Preoperative evaluation included computed tomography of the chest, bronchoscopy, and upper endoscopy...
October 2016: Annals of Thoracic Surgery
Farzad Izadi, Reza Vaghardoost, Vita Derakhshandeh, Behnam Sobouti, Yaser Ghavami
INTRODUCTION: Laryngotracheal stenosis can be caused after traumatic injuries to the neck from the subglottic larynx to the trachea. Patients with laryngotracheal stenosis often need a tracheotomy and occasionally may become tracheotomy dependent. Different procedures have been described for the management of these lesions. Management options include techniques of endoscopic dilation, laser resection, laryngo-fissure, and an innovative array of plastic reconstructions with or without the use of stents...
March 2016: Iranian Journal of Otorhinolaryngology
L A de Trey, K Lambercy, P Monnier, K Sandu
OBJECTIVE: The aim of this study was to investigate respiratory and voice outcomes after open surgery for severe congenital laryngeal web. METHODS: Included were all patients treated for severe congenital glottic web (Cohen type 3 and 4) between 2002 and 2014. Demographic data, symptoms, endoscopic findings, type of operation, outcome and complications were analyzed. Open surgery was performed with division of the web and enlargement of the subglottis by a laryngotracheal reconstruction or an extended partial cricotracheal resection...
July 2016: International Journal of Pediatric Otorhinolaryngology
Mohamad Ahmad Bitar, Randa Al Barazi, Rana Barakeh
INTRODUCTION: The management of laryngotracheal stenosis is complex and is influenced by multiple factors that can affect the ultimate outcome. Advanced lesions represent a special challenge to the treating surgeon to find the best remedying technique. OBJECTIVE: To review the efficacy of our surgical reconstructive approach in managing advanced-stage laryngotracheal stenosis treated at a tertiary medical center. METHODS: A retrospective review of all patients that underwent open laryngotracheal repair/reconstruction by the senior author between 2002 and 2014...
April 27, 2016: Brazilian Journal of Otorhinolaryngology
Wenxian Chen, Pengfei Gao, Pengcheng Cui, Yanyan Ruan, Zhi Liu, Yongzhu Sun, Ka Bian
OBJECTIVE: To systematically study various surgical approaches for treating complex hypopharyngeal and/or laryngotracheal stenoses at a variety of sites and levels. PATIENTS AND METHODS: We retrospectively analyzed the treatment of 17 patients with severe and complex hypopharyngeal and/or laryngotracheal stenosis at various sites and levels of severity. All of the 17 patients initially had a tracheostomy. Thirteen had failed the previous laser lysis and/or dilation treatment...
2016: ORL; Journal for Oto-rhino-laryngology and its related Specialties
Christina L Costantino, Douglas J Mathisen
Idiopathic laryngotracheal stenosis (ILTS) is a rare inflammatory disease of unknown etiology. Infectious, traumatic and immunologic processes must first be excluded. The majority of patients affected are female who present with progressive symptoms of upper airway obstruction, which can extend over a number of years. ILTS is characterized by short segment, circumferential stenotic lesions, located particularly at the level of the cricoid. Bronchoscopic evaluation is essential for establishing the diagnosis and operative planning...
March 2016: Journal of Thoracic Disease
Hugh G Auchincloss, Cameron D Wright
Tracheal resection and reconstruction (TRR) and laryngotracheal resection and reconstruction (LTRR) is commonly performed for post-intubation tracheal stenosis, tracheal tumor, idiopathic laryngotracheal stenosis (ILTS), and tracheoesophageal fistula (TEF). Ninety-five percent of patients have a good result from surgery. Complications occur in ~20% of patients, of which half are anastomotic complications. Complications include granulation tissue formation, restenosis of the trachea, anastomotic separation, TEF and tracheoinnominate fistula (TIF), wound infection, laryngeal edema, and glottic dysfunction...
March 2016: Journal of Thoracic Disease
Ashok Muniappan, Douglas J Mathisen
Acquired non-malignant tracheo-oesophageal fistula (TOF) most commonly develops after prolonged intubation or tracheostomy. It may also develop after trauma, oesophagectomy, laryngectomy and other disparate conditions. TOF leads to respiratory compromise secondary to chronic aspiration and pulmonary sepsis. Difficulty with oral intake usually leads to nutritional compromise. After diagnosis, the goals are to eliminate or reduce ongoing pulmonary contamination and to restore proper nutrition. Operative repair of benign TOF is generally performed through a cervical approach...
2016: Multimedia Manual of Cardiothoracic Surgery: MMCTS
Bianca Siegel, Prasad Thottam, Deepak Mehta
OBJECTIVES: To determine the role of laryngotracheal reconstruction for recurrent croup and evaluate surgical outcomes in this cohort of patients. METHODS: Retrospective chart review at a tertiary care pediatric hospital. RESULTS: Six patients who underwent laryngotracheal reconstruction (LTR) for recurrent croup with underlying subglottic stenosis were identified through a search of our IRB-approved airway database. At the time of diagnostic bronchoscopy, all 6 patients had grade 2 subglottic stenosis...
March 2016: International Journal of Pediatric Otorhinolaryngology
Yuehuang Wu, Dezhi Li, Zhengjiang Li, Wensheng Liu, Xiaolei Wang, Zhenggang Xu
OBJECTIVE: To explore a new method for the reconstruction of defect after resection of hypopharyngeal and cervical esophageal cancer using pulled-up stomach combined with free jejunal flap or lanryngotracheal flap if pulled-up stomach can not reach the level of oral pharynx for ananstamosis. METHODS: From June 2010 to June 2014, 56 cases of hypopharyngeal or cervical esophageal cancer were treated with pharyngogastric anastamosis, in 5 cases of them, because the length of pulled-up stomach was limited and could not reach oral pharynx, free jejunal flap was used in 2 cases with laryngeal invasion and laryngotracheal flap was used in 3 cases without laryngeal invasion to reconstruct the defect between oral pharynx and stomach...
September 2015: Zhonghua Er Bi Yan Hou Tou Jing Wai Ke za Zhi, Chinese Journal of Otorhinolaryngology Head and Neck Surgery
Christen J Lennon, Alexander Gelbard, Carmin Bartow, C Gaelyn Garrett, James L Netterville, Christopher T Wootten
IMPORTANCE: Patients who undergo open airway reconstruction procedures are likely to experience some degree of postoperative dysphagia symptoms and delayed return to oral intake. OBJECTIVE: To review the duration of postoperative dysphagia symptoms and outcomes in a group of adult patients. DESIGN, SETTING, AND PARTICIPANTS: Retrospective review of the medical records of adult patients undergoing laryngotracheoplasty, posterior cricoid split laryngoplasty, tracheal resection, and cricotracheal resection in a tertiary hospital between July 2009 and September 2014...
January 2016: JAMA Otolaryngology—Head & Neck Surgery
Ian N Jacobs, Robert A Redden, Rachel Goldberg, Michael Hast, Rebecca Salowe, Robert L Mauck, Edward J Doolin
OBJECTIVES/HYPOTHESIS: To develop an effective rabbit model of in vitro- and in vivo-derived tissue-engineered cartilage for laryngotracheal reconstruction (LTR). STUDY DESIGN: 1) Determination of the optimal scaffold 1% hyaluronic acid (HA), 2% HA, and polyglycolic acid (PGA) and in vitro culture time course using a pilot study of 4 by 4-mm in vitro-derived constructs analyzed on a static culture versus zero-gravity bioreactor for 4, 8, and 12 weeks, with determination of compressive modulus and histology as outcome measures...
January 2016: Laryngoscope
Todd A Goldstein, Benjamin D Smith, David Zeltsman, Daniel Grande, Lee P Smith
OBJECTIVE: To use 3-dimensional (3D) printing and tissue engineering to create a graft for laryngotracheal reconstruction (LTR). STUDY DESIGN: In vitro and in vivo pilot animal study. SETTING: Large tertiary care academic medical center. SUBJECTS AND METHODS: A 3D computer model of an anterior LTR graft was designed. That design was printed with polylactic acid on a commercially available 3D printer. The scaffolds were seeded with mature chondrocytes and collagen gel and cultured in vitro for up to 3 weeks...
December 2015: Otolaryngology—Head and Neck Surgery
Rishi Talwar, Jagdeep Singh Virk, Yogesh Bajaj
BACKGROUND: Paediatric airway disorders are common, particularly in the context of improved ventilation methods for neonates in intensive care units. Management is not standardised. OBJECTIVES: To assess the number, severity, management and outcomes of all patients diagnosed with subglottic stenosis at a developing tertiary referral centre. STUDY DESIGN: 19 month prospective longitudinal study. STUDY POPULATION: All patients who underwent microlaryngobronchoscopy (MLB) were included...
December 2015: International Journal of Pediatric Otorhinolaryngology
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