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At least 487 records · Page 27Linked to original sources
PubMed2003

Long-term complications of artificial airways.

In summary, long-term complications of artificial airways are rare but important sequelae of artificial airways. Many of the potential long-term complications of translaryngeal intubation and tracheotomy are similar and overlapping. Although most patients who undergo these procedures tend to tolerate them without difficulties, significant morbidity and mortality may occur. Identifying the exact cause of the complication may not be possible at times, due to the multiple risk factors involved in the pathogenesis. It is hoped that understanding these potential complications will lead to a more vigilant preventive measures during the institution of long-term artificial airways and a judicious early search for the underlying pathology when a complication is suspected.

Granuloma↗
PubMed1992

A case of pharyngolaryngeal stenosis in Behçet's disease.

A rare case of pharyngolaryngeal stenosis in Behçet's disease is reported. A 44-year-old female who had Behçet's disease for 13 years complained of dysphagia and dyspnea, and was referred to our hospital for treatment in May 1988. The bilateral meso-hypopharyngeal walls were swollen, and the epiglottis was edematously folded, occluding the larynx. Epiglotectomy and thyrohyoidpexia were performed, with dysphagia and dyspnea disappearing after the operation. Two years after the operation, dysphagia and dyspnea recurred because of two stepped cicatricial stenoses at the mesopharynx. An enlargement operation, incising the pharyngeal cicatricial tissue bilaterally and covering raw surfaces with free skins and the pedunculated cervical flap, was performed. Colchicine, corticosteroid, and tranilast (anti-allergy drug) were administered to prevent re-stenosis. Stenosis was not observed for 10 months after the second operation. Two cases undergone surgical interventions have been reported, and this is the first case reporting long term result of the surgical procedure. Because the skin and mucosa of patients with Behçet's disease shows hyperreactivity to stimuli, the choice of surgical procedure is controversial and recurrence of stenosis is possible.

Adult↗
PubMed1991

Total laryngeal stenosis in cicatricial pemphigoid.

Cicatricial pemphigoid in the aerodigestive system is rare, but can be life-threatening. We report a case of total laryngeal stenosis. During an exacerbation, the airway of the patient was obliterated with a cicatrix and necessitated an emergency tracheostomy. Six years later when no recurrence of pemphigoid was confirmed, laryngofissure operations were performed with a satisfactory restoration of laryngeal function. Though otolaryngological treatment in the active phases is symptomatic including tracheostomy, surgical procedures should be encouraged once the disease has reached a remission.

Female↗
PubMed1983

Trauma of the larynx and cervical trachea. A 10-year review of 51 patients.

Trauma of the larynx and trachea is not a common condition. But once it happens, the management is not simple. This condition has been calling attention of physicians also because iatrogenic traumas have been increasing. In the 10-year period from 1971 to 1980, 51 patients with trauma of the larynx and/or the cervical trachea were treated in the Department of Otolaryngology, Kurume University Hospital. The purpose of this paper is to review these patients and to discuss the treatment of this difficult condition.

Accidents, Traffic↗
PubMed1982

Treatment of subglottic stenosis in a child utilizing a costal cartilage graft.

A nine-year old girl with severe subglottic stenosis secondary to an emergency tracheostomy is presented. Several conservative managements had no significant effect. The patient, however, was successfully extubated by surgical reconstruction with a costal cartilage graft. One year postoperatively, follow up showed no evidence of upper respiratory obstruction or interference with laryngeal growth. Management of severe subglottic stenosis in children is discussed and the usefulness of an autogenous graft for reconstruction of the larynx and upper trachea in the above-mentioned case is documented.

Cartilage↗
PubMed1985

Surgical treatment of laryngotracheal stenosis by a trough technique.

Many methods have been tried and reported in the treatment of laryngotracheal stenosis. Among them, a trough technique seems universal at present. To date, we have tried several methods of this technique, but each method had its own demerits. We used, as a cartilagenous framework, a homograft or tracheal ring cartilages for the last four cases of laryngotracheal stenosis. These tracheal ring cartilages were resected from relatively young patients with laryngeal carcinoma. Total laryngectomy was done just below the level of the fourth tracheal ring, then the fourth tracheal ring was resected and stored in 70% alcohol. The cartilage was used after it was made certain pathologically that there was no invasion of carcinoma at the third tracheal ring level. The operative procedure of this trough technique is as follows. In the first stage, a trough is created at the stenosed region and the trough is maintained by placing a Quick Set Silicone (Q.S.S.) stent mold over it. While waiting for scar formation of the tissues surrounding the trachea, the second stage reconstruction is performed four weeks after the first. The trough is closed with hinged skin flaps on both sides, and the reserved tracheal ring cartilages are sutured every 5 mm onto the outer surface of the hinged skin flaps to make a cartilagenous framework. The neck is closed with advanced neck skin flaps. A more ideal tracheal lumen is created by this technique. Our four patients are doing well two years or more after the operation.

Adult↗
PubMed2000

Preliminary results of intraoperative mitomycin-C in the treatment and prevention of glottic and subglottic stenosis.

Mitomycin-C is an antineoplastic antibiotic that acts as an alkylating agent by inhibiting DNA and protein synthesis. It can inhibit cell division, protein synthesis, and fibroblast proliferation. The purpose of this pilot study is to investigate intraoperative applications of topical mitomycin-C in treatment and prevention of glottic and subglottic stenosis. Eight patients with posterior glottic and/or subglottic stenosis were treated with endoscopic CO2 laser excision followed by topical application of 0.5 cc of 0.4 mg mitomycin-C per milliliter of saline for 4 minutes at the surgical site. After mean follow-up of 15 months (10-20) all patients had clinical improvement of their airway and resolution of their preoperative symptoms. No complications were noted in this study. Although a longer follow-up and further controlled studies are needed, the use of topical mitomycin-C may prove useful in the treatment and prevention of subsequent restenosis and scar formation in the larynx and trachea.

Adolescent↗
PubMed2002

Bilateral vocal fold posterior glottic/subglottic stenotic web resected with contact tip Nd-YAG laser.

The standard treatment for respiratory failure remains endotracheal intubation, with periods of 22 or more days being commonplace. Posterior glottic stenotic web formation, from scarring in the posterior interarytenoid area, may occur after endotracheal intubation, thermal, corrosive, or direct surgical injury. A commonly used classification system for posterior glottic stenosis divides the occurrence into four types. Type I involves an interarytenoid scar band between the vocal folds that is anterior and separate from the posterior interarytenoid mucosa. Type II stenosis involves scarring of the mucosa or musculature of the posterior interarytenoid area. Types III and IV involve unilateral and bilateral cricoarytenoid joint fixation, respectively. Strobovideolaryngoscopy (SVL), rigid and flexible fiberoptic bronchoscopy, electromyography (EMG), radiologic imaging of the neck, larynx, and trachea as well as pulmonary function tests, including flow volume loops, provide important objective measurements of upper airway obstruction. A representative case of a professional voice user who suffered a Type II posterior glottic stenosis is presented. The treatment utilized a specific contact-tip neodymium-yttrium aluminum garnet (Nd-YAG) laser delivery system to achieve precise cutting, vaporization, and coagulation simultaneously, returning tactile touch technique to the airway/voice surgeon. Completely successful restoration of voice and airway have been maintained for 2 1/2 years postoperatively.

Aged↗
PubMed1994

Laryngotracheal paratubal air envelope: a useful sign in voice and airway reconstructive surgery.

Aphonia, dysphonia, and laryngotracheal stenosis with upper airway compromise are diagnosed with increasing frequency. Endoscopic surgical reconstructive techniques accompanied by tracheal T-tube stenting successfully restore voice, airway function, and structure. Timing of tracheal T-tube removal remains controversial, particularly when the tip of the upper arm of the optimally sized T-tube is placed in a critical supraglottic position. The appearance of an air envelope, manifested as linear air densities between the outside wall of the T tube and the inside wall of the larynx and trachea, has proven to be a useful and reliable indicator of laryngotracheal structural integrity and functional stability. The paratubal air envelope sign is demonstrated by soft-tissue neck radiographs and delta scan topograms. This objective sign, videolaryngoscopy/stroboscopy, and clinical judgment combine to determine optimal timing for tracheal T-tube removal.

Adolescent↗
PubMed1998

Laryngeal injuries after short- versus long-term intubation.

Forty-five patients were seen over a 5-year period with laryngeal injuries following endotracheal intubation (ETI). The mean duration of ETI was 5.6 days (2 hours to 37 days). Patients intubated for less than 24 hours were most likely to present with a vocal fold immobility or an anterior glottic web. Long-term intubation was associated with the development of subglottic stenoses and granulomas. Patients with vocal fold immobility were seen more often after ETI for surgical reasons and had a significantly higher incidence of previous intubation and tobacco usage. Subglottic stenoses were seen in younger patients intubated for medical reasons and associated with nasogastric tubes and longer periods of intubation.

Adult↗
PubMed1998

Difficult intubation from gastroesophageal reflux disease in adults.

Two cases of difficult intubation are presented. Both cases presented with red swollen arytenoids, swollen false vocal cords, and subglottic stenosis. Tracheal intubation could not be achieved for these reasons. Both patients were placed on gastrointestinal prokinetic drugs and histamine-two blocker, as a diagnosis of gastroesophageal reflux disease (GERD) was made. In one case, follow-up by an otolaryngotic surgeon showed reversal of the above findings. In the other case, one tracheal intubation was achieved eventually. GERD occurs frequently. Clinicians need to maintain a high index of suspicion for GERD-related airway changes so as to avoid potential difficult intubations.

Arytenoid Cartilage↗
PubMed2002

Silicone T-tube for complex laryngotracheal problems.

OBJECTIVE: The use of a T-tube to manage complex laryngotracheal lesions, such as tracheal stenosis, tracheomalacia and tracheal injury, has previously been reported by other surgeons in the past. However, further validation of clinical details, including operative management and postoperative care, is needed. METHODS: From January 1991 to May 2000, 53 patients, including 24 with post-tracheostomy stenosis, received 55 silicone T-tubes for transient or permanent stenting of the airway. There were 20 patients for subglottic stenosis; eight for long segment tracheostensis; seven with tracheal stenosis for severe cervicomediastinal fibrosis not amenable for reconstruction; six for complex tracheal injury; four for glottic injury; two each for tracheomalacia, failed tracheal surgery and tuberculotic tracheostenosis; and one each for tracheo-esophageal fistula and necrotizing tracheitis. We retrospectively analyzed these patients. RESULTS: Thirty-eight out of 53 patients (71.8%) with T-tube stenting from 3 to 15 months was considered successful. Fifteen patients' operations failed due to patients' underlining diseases, previous intractable pulmonary infection, poor cognition and/or inadequate tube position. After removal of the tube, three patients (10.7%) developed partial airway obstruction with mild subglottic granulation tissue, which was resolved by carbon dioxide laser therapy. Two patients (7.1%) with prolonged tracheocutaneous fistula were conservatively treated by silver nitrate. CONCLUSION: Silicone T-tube can effectively resolve the complex laryngotracheal lesions with limited complications. Concurrent cardiopulmonary diseases and intractable infection were the two major causes for failure after the T-tube reconstruction.

Adult↗
PubMed2002

Benign tracheal and laryngotracheal stenosis: surgical treatment and results.

OBJECTIVES: Benign tracheal stenoses remain the most common indications for tracheal resection. We report lessons learned with surgical management of tracheal stenoses in a consecutive series of 65 patients from the beginning of our experience to date. METHODS: From December 1991 to January 2001 65 patients underwent primary tracheal and laryngotracheal resection and reconstruction for non-neoplastic stenoses. There were 39 males and 26 females with a median age of 33 years (range 14-74 years). There were 58 cases of postintubation and seven of idiopathic stenosis. A cervical approach was used in 60 patients, and a cervical incision with sternal split in four and with sternotomy in one. We performed 45 (69.2%) tracheal resections and 20 (30.8%) laryngotracheal resections. The length of resection ranged between 1.5 and 4 cm (median 2.5 cm). The range of resected rings was two to eight (median five). RESULTS: Fifty-four patients received a preoperative treatment. Preoperative procedures consisted of laser therapy (37), tracheostomy (38) and endotracheal prosthesis (16). We had major complications in eight patients (12.3%) and minor complications in 15 patients (23%). The most frequent complications were: temporary vocal cord dysfunction (eight patients), wound infection (five patients), anastomotic dehiscence (four patients), vocal cord paralysis (two patients), granulation tissue (two patients), deglutition dysfunction (one patient) and restenosis (one patient). Perioperative mortality was 1.5% (one patient). In classifying final results obtained, 54 patients achieved an excellent result, eight a good result and two satisfactory. CONCLUSIONS: The strategy for treatment of airway stenoses is now well established and leads to a high level of success with minimal or no sequelae. Meticulous preoperative assessment and preparation associated with a perfect surgical technique is mandatory to obtain good results. Preoperative treatments (laser and/or endotracheal prosthesis) could increase the extent of injury and the length of stenosis.

Adolescent↗
PubMed2003

Idiopathic laryngotracheal stenosis.

ILTS is a rare inflammatory disease that results in a cicatricial stenosis of the cricoid and upper trachea. It occurs almost exclusively in women and is without known cause. Patients present with dyspnea on exertion that progresses to dyspnea at rest, often with stridor. The diagnosis is usually made on the basis of patient history, physical examination, and radiography. Rigid bronchoscopy is usually reserved for the day of proposed surgery to confirm diagnosis and to plan the operative strategy. On occasion, the presence of active inflammation extending into the immediate subglottis or the patient's use of corticosteroids requires that surgery be postponed. In these cases, a patent airway is temporarily restored with careful bronchoscopic dilation. Single-staged laryngotracheal resection is successful in more than 90% of patients and is the most effective treatment when performed by experienced hands. Long-term follow-up shows stable airway and improvement in voice quality. Palliative procedures such as repeated airway dilations should be reserved for poor surgical candidates. Protective tracheostomy is rarely required.

Adult↗
PubMedDate not supplied

Management of respiratory compromise caused by cervical osteophytes: a case report and review of the literature.

BACKGROUND CONTEXT: Diffuse idiopathic skeletal hyperostosis (DISH) is a common condition in the aging spine. DISH is associated with large anterior osteophytes of the cervical spine, which can cause complications by compressing adjoining structures. Dysphagia is reported in up to 28% of patients, but respiratory compromise is rare. There have been no published recommendations for treatment. PURPOSE: To report that resection of cervical osteophytes, without cervical fusion, can be successful in the treatment of severe respiratory distress. STUDY DESIGN: This report describes the management of a patient with DISH and severe respiratory distress resulting from large anterior cervical osteophytes. METHODS: A team approach was used with collaboration between the orthopedic spine surgeons and the otolaryngologists. RESULTS: This patient was found to have compression of her posterior pharyngeal wall by the osteophytes. Tracheostomy was required for the management of the airway. The patient was dependent on the tracheostomy until the osteophytes were resected. The patient was then able to breathe normally. Treatment recommendations were developed based on this case of osteophyte-induced respiratory compromise as well as the previously published accounts of osteophyte-induced dysphagia. CONCLUSIONS: Airway obstruction resulting from DISH can be treated according to the same principles as dysphagia resulting from DISH: surgical excision of osteophytes if conservative support fails.

Airway Obstruction↗