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At least 415 records · Page 23Linked to original sources
PubMed1989

Stridor and airway compromise.

A graduated approach to the diagnosis of airway lesion will rarely fail. The availability of state-of-the-art optical equipment, excellent anesthesia, and high-quality medical care have remarkably reduced the morbidity and mortality of airway diseases. Electrodiagnosis of vocal cord paralysis will differentiate fixed arytenoids from neurogenic paralysis in candidates for laryngeal repair and will help define the prognosis of neurogenic paralysis. The excellent results from epiglottoplasty in treating laryngomalacia and laryngotracheal reconstruction for stenosis make obsolete any management with tracheotomy and watchful waiting. Close cooperation and good communication between the pediatrician and the otolaryngologist remain the key points for successful management.

Airway Obstruction↗
PubMed1985

Obstructive airway disease in infants and children.

Airway obstruction in infants and children can produce rapidly progressive life-threatening emergencies. An understanding of the common symptom complexes associated with regional obstructive abnormalities allows rapid evaluation and appropriate therapy. This article discusses the most common types of obstructive congenital and acquired airway anomalies, describes their symptomatology, and reviews the available diagnostic and treatment options.

Acute Disease↗
PubMed2000

Subglottic stenosis associated with transesophageal echocardiography.

Transesophageal echocardiography (TEE) is used extensively to assess cardiac function and anatomical relationships in both adults and children. Although considered a noninvasive procedure, TEE in infants and small children may result in airway complications. A patient who developed subglottic stenosis after the use of TEE during a cardiac procedure is reported.

Echocardiography, Transesophageal↗
PubMed2000

Cricotracheal resection as a primary procedure for laryngotracheal stenosis in children.

OBJECTIVE: Cricotracheal resection (CTR) is being increasingly used in the treatment of children with severe laryngotracheal stenosis. In this institution the majority of children are treated with CTR as a salvage procedure having undergone previous unsuccessful laryngotracheal reconstruction (LTR). Selected children have undergone CTR as a primary procedure (without previous LTR). The objective of this study is to examine the outcome for children undergoing cricotracheal resection as a primary procedure for severe laryngotracheal stenosis. METHOD: analysis from prospectively collected database. RESULTS: 17 patients underwent CTR without previous LTR or anterior cricoid split between October 1994 and September 1998. All the patients had grade 3 or 4 stenosis. After a minimum of 1 year follow up 15 children are decannulated. Five children required further surgery to achieve this. Two children still have tracheostomies. Both had extended procedures. One included bilateral arytenoid abduction for bilateral vocal cord paralysis in a patient with quadraparesis following transverse myelitis. The other child, who suffered from multiple congenital anomalies, underwent a concurrent posterior cricoid cartilage graft. Nine patients had good voice post-operatively, five had acceptable voice and three had weak or no voice. CONCLUSION: the early experience for CTR in children as a primary procedure achieved an overall decannulation rate of 88% after 1 year follow up in children with severe laryngotracheal stenosis. Five children required further surgery to achieve this. The voice outcome was variable. CTR is an alternative primary procedure to LTR for severe laryngotracheal stenosis in children. The relative indications for these procedures are discussed.

Child↗
PubMed2000

Langerhans cell histiocytosis of the larynx.

A pediatric case of Langerhans cell histiocytosis leading to severe and recurrent subglottic stenosis, ultimately necessitating partial cricotracheal resection, is presented and the literature on this very rare disorder is briefly reviewed.

Biopsy, Needle↗
PubMed2001

Laryngotracheoplasty for subglottic stenosis in Down Syndrome children: the Cincinnati experience.

Previous studies from our institution have noted difficulties in the surgical repair of subglottic stenosis (SGS) in children with Down Syndrome. The objectives of this paper were to update our 15 year experience in the Down Syndrome patient population, compare our results with our overall series of laryngotracheoplasty for SGS, and to report on the increased incidence of posterior glottic stenosis (PGS) within this group of patients. Medical records of all children with SGS and Down Syndrome evaluated between 1982 and 1997 were reviewed for history of prior intubation, tracheotomy, gastroesophageal reflux disease (GERD), pre-operative SGS grade, and decannulation. From this review several conclusions have been drawn. First, the risk factors for SGS appear to be the same in the Down Syndrome group as the general population. Second, SGS continues to be more prevalent among children with Down Syndrome than among children in the general population. Third, we have now found a higher rate of PGS within these patients when compared to our overall series. Finally, it now seems that our decannulation rates in Down Syndrome children are approaching our overall series results.

Down Syndrome↗
PubMed2001

Primary cricotracheal resection in children: indications, technique and outcome.

OBJECTIVE: Treatment of subglottic stenosis has benefited greatly from development of grafting techniques such as larygontracheoplasty. Meanwhile, cricotracheal resection of the stenotic area and a major part of the cricoid cartilage have been shown to give excellent results in adults. PATIENTS AND METHODS: From June 1993 to June 2000, we performed cricotracheal resection, as the primary surgical procedure, for acquired (n=13), congenital (n=2) or mixed (n=l) subglottic stenosis in 16 pediatric patients comprising seven boys and nine girls. At the time of surgery, the mean weight was 16 kg and the mean age was 5 years. Degree of stenosis was classified as grade II in one case, grade III in 12, and grade IV in three. Eight patients underwent two-stage procedures with postoperative tracheostomy. A rolled reinforced silastic stent was placed for a mean period of 20 days and the tracheostomy tube was removed within a mean period of 44 days after stent removal. Eight patients underwent single-stage procedures. The Portex endotracheal tube was used for a mean period of 4 days. RESULTS: All patients underwent regular clinical and endoscopic postoperative examination. Mean follow-up was 38 months. No interference with laryngotracheal growth has been noted in any case, including the five with follow-ups longer than 5 years. CONCLUSIONS: The indications for laryngotracheoplasty and cricotracheal resection in children with subglottic stenosis are still unclear. Decisions must be made on a case-by-case basis. In this article the authors discuss decisional factors in terms of clinical findings, surgical techniques, potential complications, and outcome.

Adolescent↗
PubMed2001

Thyroid ala cartilage reconstruction in neonatal subglottic stenosis as a replacement for the anterior cricoid split.

Cricoid split is the procedure of choice in neonatal subglottic stenosis in many paediatric institutions. However, the post-operative care of these patients is a concern given the potentially lethal complications which can occur, in particular, self-extubation. We have been using the thyroid ala cartilage (TAC) reconstruction, a proven technique, as an alternative treatment for this disorder to avoid these complications. The purpose of this study was to compare the results of the TAC reconstruction for this patient population with the results of the cricoid split procedure previously reviewed at our own institution. Between January 1995 and December 1999, 17 patients that underwent the TAC reconstruction for neonatal subglottic stenosis were retrospectively reviewed. Of the 17 patients, two patients required tracheotomy prior to discharge from hospital. Fifteen patients were discharged from hospital with a safe airway without tracheotomy. There were only two minor complications. Compared with the cricoid split study, the success rate with TAC reconstruction was higher (88 vs 83%) and the major complication rate was lower (0 vs 9%). Factors associated with failed procedures may include prematurity, low birth and surgical weight and presence of severe GER. Those that failed required much greater resources in terms of post-operative care and length of hospital stay. The TAC reconstruction has replaced cricoid split in treatment of neonates with subglottic stenosis at our institution.

Cricoid Cartilage↗
PubMed2001

Fire during the use of Nd-Yag laser.

Fire during the use of Nd-Yag laser is a very rare complication. A case report of laser fire during the use of Nd-Yag laser for congenital subglottic stenosis is reported. The probable causes for the fire, management and short review of literature are dealt with. This case report highlights the importance of following the safety protocol during laser surgery.

Child, Preschool↗
PubMed2002

Subglottic stenosis after endolaryngeal intubation in infants and children: result of wound healing processes.

OBJECTIVE: To study the histopathology of subglottic stenosis in children of different ages after treatment during different periods of time, with or without laser application. Partial resection of the anterior cricoid with adhering stenotic subglottic area in the live young patient provides unique material for studying wound healing and scarring processes. METHODS: 25 specimens obtained from partial cricotracheal resection (PCTR) in children, were histologically processed and stained with Haematoxylin and Eosin, Resorcin and Fuchsin (for elastic fibers), and immunohistochemical staining (for the presence of macrophages). RESULTS: All specimens were found to have severe and sclerotic scarring with squamous metaplasia of the epithelium, loss of glands and elastic mantle fibers (tunica elastica), and dilation of the remaining glands with formation of cysts. Also, the cricoid cartilage was affected on the internal and external side, with irreversible loss of perichondrium on the inside and resorption by macrophages of cartilage on both sides. Detrimental effects of laser therapy were demonstrated in four cases. The normal intercellular matrix was completely destroyed and the number of chondrocytes in the cartilage structure diminished. CONCLUSION: Wound healing after laryngeal injury is a process of intense restoration and reorganization of the various tissues involved. This process, however, does not guarantee complete repair. In the severe cases irreversible scarring has replaced normal tissues. There seems to be no direct relationship between the length of the post-lesional period, the age of the patient and the severity of the stenosis. When subglottic stenosis has developed and the majority of the tissues is replaced by dense fibrous tissue, PCTR is strongly indicated to achieve renewed patency of the airway.

Adolescent↗