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At least 433 records · Page 24Linked to original sources
PubMed2002

Pitfalls in preoperative management of acquired laryngeal stenosis. The problem of the hidden obstruction in the airway.

Most acquired laryngeal stenoses in infants and children can be treated surgically with successful outcome. We describe two patient cases in which removal of such a stenosis did not result in decanulation, because another, hidden obstruction was present. This demonstrates the importance of preoperative assessment to indicate factors that influence the outcome of surgery, especially in infants with a syndrome. Guidelines for preoperative management and an extensive list of syndromes in which a hidden obstruction can be suspected, are presented.

Airway Obstruction↗
PubMed2002

Thyroid alar cartilage graft in laryngoplasty: anatomical study in premature and newborn babies.

The aim of this prospective anatomical study was to determine the place of the thyroid alar cartilage graft (TAC) in the laryngotracheoplasty in a population of premature and newborn babies. Ninety-eight fresh larynges, collected from autopsies, were included in the study. After measurement of cartilage dimensions and thickness, the potential dimensions of TAC and its widening capacity were calculated for each specimen. The results showed that TAC thickness was similar to the anterior cricoid arch but was significantly less than the posterior cricoid arch. The maximal degree of stenosis which could be normalized by TAC ranged between 47.8 and 74.3%. The height of the TAC allowed a widening, from the level of the glottis to the inferior part of the second tracheal ring in 100% of cases and to the inferior part of the third tracheal ring in more than 70% of cases. In conclusion, the TAC could be used for anterior grafting in laryngotracheoplasty. Its indications should be limited to grade II and a few grade III of the Myer subglottic stenosis classification without glottic or tracheal extension. Moreover, variability of TAC dimensions leads to peroperatively reassess its indication.

Autopsy↗
PubMed2002

Upper airway abnormalities in Canavan disease.

OBJECTIVE: To describe upper airway anatomical abnormalities associated with Canavan disease. METHODS: Retrospective case report. RESULTS: Physical examination and laryngoscopy demonstrated oropharyngeal narrowing, macroglossia, and bronchial asymmetry in a child with Canavan disease. Tracheostomy decreased problems with chronic aspiration and obstructive sleep apnea. CONCLUSIONS: Oropharyngeal obstruction and bronchial asymmetry are previously undescribed upper airway abnormalities found in an individual with Canavan disease. Tracheostomy is an effective method of managing chronic aspiration and obstruction in these patients.

Airway Obstruction↗
PubMed2003

Postinflammatorial stenoses of the pharynx in a child with Barth-syndrome.

We report about a boy with Barth-syndrome (X-chromosomal cardioskeletal myopathy, neutropenia and abnormal mitochondria) and postinflammatorial pharyngeal stenosis. After a pseudomembranous pharyngitis he developed a dyspnea and an inability to swallow with a resultant aspiration pneumonia. After endoscopic diagnosis of scarred pharyngeal stenoses the child required a tracheostomy and a percutaneous endoscopic gastrostomy tube. Then the boy underwent transoral pharyngoplastic surgery. Thirty five months after pharyngoplasty transoral nutrition was feasible. The tracheostomy was closed and the gastrostomy tube was removed. Throughout a 40 month period of observation the child had no more complaints relating to the minor residual pharyngeal stenoses.

Cardiomyopathies↗
PubMed2003

Chlamydia infection in children with acquired subglottic stenosis.

The purpose of the study was to find out the frequency of occurrence and the role of Chlamydia infection in the pathogenesis of acquired subglottic stenosis in children. Forty-nine patients of the age from 1 year 10 months to 15 years with acquired cicatricial laryngotracheal stenosis were examined. The immunofluorescent method was used to detect serum antibodies to the antigens of Chlamydia trachomatis and Chlamydia pneumoniae. Dilutions of 1:32 for C. trachomatis and 1:64 for C. pneumoniae were considered positive. The results of the study suggested both a high frequency (26.5%) of Chlamydia infection (C. pneumoniae) of the children with acquired subglottic stenosis, as well as 92% of infected children were either with tracheotomies or had been decannulated earlier. It reasonable to test children with a tracheostomy for the presence of Chlamydia infection to perform timely and specific antibiotic therapy.

Adolescent↗
PubMed2003

Subglottic cysts: the Great Ormond Street experience.

OBJECTIVE: Subglottic cysts are a relatively rare, non-malignant cause of airway obstruction. In this study we reviewed the details of the patients who were treated for subglottic cysts in our department in order to evaluate the presentation and treatment of patients with this condition. METHODS: We performed a retrospective case note analysis of 55 patients with subglottic cysts. Case notes were examined to determine the following details for each patient: date of birth, gestational age at birth, history and length of intubation, age at presentation, presenting symptoms, findings on endoscopy, treatment given for subglottic cysts, recurrence(s) of cysts after initial treatment, and follow up for a minimum of 6 months post diagnosis. RESULTS: Fifty five patients were identified, 35 male, 20 female. Ninety four percent were born prematurely at 24-31 weeks gestation. All patients were intubated in the neonatal period. The median duration of intubation for all patients was 10 days (range 1-126). Fifty one patients underwent intervention for their subglottic cysts at their initial, diagnostic microlaryngoscopy and bronchoscopy (MLB), and recurrent cysts occurred in 22 cases. A total of 82 procedures for cyst removal were performed, using either the carbon dioxide laser or microinstruments. Subglottic stenosis was a commonly associated feature in our series of patients, being present in 38 patients. Eleven of the 14 patients who presented to our department with tracheostomies in situ were decannulated after removal of their subglottic cysts. CONCLUSIONS: This review of the largest series of patients with subglottic cysts reported to date, reinforces our view that such cysts are rare but potentially reversible causes of upper airway obstruction, and that they result from injury to the larynx as a result of endotracheal intubation. Treatment of the cysts will often be sufficient to correct the obstructed airway allowing successful extubation or decannulation of a tracheostomy. Patients who have had subglottic cysts treated should have access to long-term follow up as there is a tendency for these cysts to recur.

Bronchoscopy↗
PubMed2003

The endoscopic treatment of postintubation laryngeal stenosis in children, using argon plasma coagulation.

Laryngeal stenosis of the larynx in children is becoming a more frequent problem. Endoscopic dilation of the lumen of the larynx is one of the many methods of treatment. The authors present their own method for the treatment of postintubation laryngeal stenosis by argon plasma coagulation (APC). The investigation was based on ten children with postintubation laryngeal stenosis from I to IV degrees according to the Myer-Cotton grading system. The method of treatment, and the advantages and disadvantages of the new method of endoscopic treatment of postintubation laryngeal stenosis, are discussed in the article.

Child↗
PubMed2003

Prevention of laryngotracheal stenosis with carnitine after tracheotomy: an experimental study on rats.

OBJECTIVE: We investigated the effect of carnitine on wound healing of trachea in tracheotomyzed rats. This study was undertaken to test the hypothesis that treatment with carnitine would protect the wound tissue, which was evaluated by measuring nitrite and nitrate, thus nitric oxide, malondialdehyde and cholinesterase in blood, and examining the histopathological changes. METHODS: Standard vertical tracheotomy was performed on 24 Wistar-Albino type rats. Then the animals were randomly divided into two groups; group A (the study group) was administered intraperitoneal carnitine 100 mg/kg for 10 days; group B (the control group) was administered intraperitoneal saline for 10 days. On the 10th day, all animals were decanulated. Three weeks later, cardiac blood samples were taken for biochemical assays and trachea specimens were harvested for histopathologic examination. RESULTS: In the carnitine-administered group, granulation tissue thickness resulting from the wound healing in the level of tracheotomy incision was lower compared to the control group (P < 0.01). When serum malondialdehyde levels were considered, a lower malondialdehyde level was found in the carnitine-administered group (P < 0.01). However, serum nitric oxide levels were close to each other in both groups (P > 0.05), while serum cholinesterase level was higher in the carnitine-administered group than in the control group (P < 0.01). CONCLUSION: Carnitine treatment partially prevents and significantly reduces the severity of tracheotomy induced laryngotracheal stenosis.

Animals↗
PubMed2003

Laryngomalacia induced by exercise in a pediatric patient.

Exercise-induced laryngomalacia (EIL) is characterized by inspiratory stridor that is brought on by exercise (i.e. competitive sports) and fails to respond to treatment with bronchodilators (Smith et al., Ann Otol Rhinol Laryngol 1995;104:537-541). During exercise, (1) spirometric flow volume loops show evidence of variable extrathoracic obstruction, and (2) laryngoscopy shows inspiratory prolapse of supraglottic structures with partial glottic obstruction. Only five cases of probable EIL have been reported in the literature (Smith et al., Ann Otol Rhinol Laryngol 1995;104:537-541; Lakin et al., Chest 1984;86:499-501; Bittleman et al., Chest 1994;106:615-616; Bent et al., Ann Otol Rhinol Laryngol 1996;105:169-175; Chemery et al., Rev Mal Respir 2002;19:641-643). Here, a case of laryngomalacia induced by exercise in a previously asymptomatic 10-year-old athlete with a remote history of laryngomalacia in infancy is presented, and a review of previously reported cases is provided.

Airway Obstruction↗
PubMed1983

Serial dilation compared to elective laryngo-tracheoplasty in the treatment of acquired subglottic stenosis in children.

Acquired incomplete subglottic stenosis in children has historically been managed by serial bouginage of the strictured region sometimes accompanied by injection or systemic administration of corticosteroid medications. The forceful stretching of the scar whilst awaiting growth of the region to compensate for scar contracture, however, dooms that child to a prolonged period of waiting for an unpredictable result with a tracheotomy in place. Recently, laryngo-tracheoplasty has been undertaken in younger age groups and in a review of 30 children, with very similar types of stenosis, it was noted that the 19 children managed only by bouginage (with or without steroids) (1) had a much less predictable result, (2) were only able to be ultimately decannulated 52.6% of the time, and (3) had a mean time from the initiation of treatment to decannulation of 620.1 days. This contrasted very sharply with 11 children who underwent an elective laryngo-tracheoplasty of whom 81.8% were able to be decannulated with a mean time from the initiation of treatment of 82.33 days. It was noteworthy that of those managed by dilation alone 9 children (47.4%) were tracheotomy-dependent following treatment and 7 of these were aphonic (36.8% of the total group), whereas in the surgically managed group, 2 were tracheotomy-dependent (18.2% of the total), and all could talk around their tracheotomy tube. The methods and mechanics of such therapeutic approaches are examined and discussed.

Adolescent↗
PubMed1983

Laryngeal stenosis following papillomatosis--a report of three severe cases.

Three cases of severe laryngeal papillomatosis beginning in early childhood are presented. Several methods of treatment were tried, but lasting results were achieved by suction diathermy. The laryngeal lumen was totally obliterated in all cases during the course of the disease. The patients were successfully operated on by making a laryngofissure in the front part of the larynx, excising the scar and enlarging the lumen by a median incision in th back wall of the larynx. An indwelling prosthesis was placed in the larynx for several months. After removing the prosthesis, the laryngeal lumen was dilated several times by oesophageal sounds. All patients were successfully decannulated. The results of treatment are evaluated both clinically and by ventilatory function studies. Central airway obstruction persisted in two cases.

Child, Preschool↗
PubMed1984

Epidermolysis bullosa letalis in the larynx causing acute respiratory failure: a case presentation and review of the literature.

The case history is presented of a 29-month-old boy with the characteristic skin lesions of epidermolysis bullosa letalis, requiring steroid therapy. After an episode of gastrointestinal haemorrhage, probably caused by the steroids, the child experienced progressive stridor and respiratory failure and died 10 days later. The postmortem findings in the larynx were of marked mucosal inflammation and cystic swelling of the serumucinous glands producing severe narrowing of the supraglottic airway. The laryngeal cysts were thus entirely different in nature to the cutaneous bullae.

Child, Preschool↗
PubMed1985

Long-term results after surgical treatment of laryngeal stenosis in small children.

Thirteen severe cases of laryngeal stenosis were operated on at the ages of 1-3 years. The operations were performed by making a laryngofissure in the front part of the larynx and excising the stenosing scar. The back wall of the larynx was incised in the midline and the two halves of the cricoid lamina were separated from each other. An indwelling prosthesis was placed in the larynx for 4 months. All patients but one were decannulated. The positive clinical result of the operation proved to be permanent through the rapid growth phase of puberty in 7 patients out of the 10 who had reached puberty. Three patients developed a gradually worsening laryngeal stenosis during the rapid growth phase of puberty. One of them was successfully re-operated. The mean follow-up time was 12 years. Ventilatory function tests were performed on 9 patients, 4 of which proved to have normal ventilatory function or only slight airflow limitation in central airways.

Child, Preschool↗
PubMed1986

Prevention of subglottic stenosis in neonatal ventilation.

Mechanical ventilation of the newborn is now widely used in neonatal intensive care. The oro-tracheal route of intubation is simpler, but for long-term ventilation has been considered unstable. A method of fixation of oro-tracheal tubes is described which overcomes this instability. Five hundred consecutive ventilated infants were intubated by the oro-tracheal route and the tube was fixed by the method described. Of the 500 ventilated infants, 213 died without being extubated. Of the 287 survivors, 44 developed a degree of post-extubation stridor. No surviving infant developed clinical evidence of subglottic stenosis and in almost 200 postmortem examinations laryngeal narrowing was not identified. The method of oro-tracheal fixation described is stable and may reduce the incidence of subglottic stenosis.

Beclomethasone↗
PubMed1986

Upper airway obstruction in Hunter syndrome.

Patients with Hunter syndrome may have symptoms of hoarseness, stridor and breathing difficulties as a result of laryngeal and tracheal involvement. In planning their evaluation, we must prefer non-invasive methods as X-ray or CT scan, and avoid doing endotracheal intubation or bronchoscopies. Review of adult cases in the literature and description of the only case of a child with Hunter syndrome having life-threatening complications of his upper airways is discussed in this report. In this case and in the literature we cannot exclude intubation or bronchoscopy as a serious aggravating factor, causing further narrowing of the larynx.

Bronchoscopy↗
PubMed1986

A histologic study of the growth of the subglottis after endolaryngeal trauma.

In young rabbits the histologic features of the growth of the subglottis were studied after an endolaryngeal trauma. This lesion of the larynx leading to a subglottic stenosis, caused specific pathologic changes of the cricoid cartilage and the subepithelial tissues. Activation of chondrocytes resulted in proliferation and regeneration of destructed cartilage. The normal subepithelial structures were replaced by granulation tissue differentiating into a thick fibrous scar and into cartilage. This ectopic cartilage together with the repaired cricoid formed a composite thickened 'ring'-like cartilaginous structure in the adult stage.

Age Factors↗