Search PubMed⌕ Search

SEARCH · Search PubMed

Results for “LARYNGOSTENOSIS”

Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 559 records · Page 31Linked to original sources
PubMed1998

Stridor in the neonate and infant. Implications for the paediatric anaesthetist. Prospective description of 155 patients with congenital and acquired stridor in early infancy.

One hundred-and-fifty-five neonates and infants up to the sixth month of postnatal age were investigated to reveal the cause of clinically relevant stridor. In 100 patients congenital stridor was found, in 55 children the stridor was considered to be acquired. A curled, soft epiglottis, almost synonymously used with the diagnosis of congenital stridor, was found in 7% only, indicating different methods of investigation and different selection of patients compared to previous years. In acquired stridor the majority of infants showed laryngeal and tracheal trauma, mostly due to the use of too large tracheal tubes.

Airway Obstruction↗
PubMed2003

Double trouble: prolapsing epiglottis and unexpected dual pathology in an infant.

A 3-week-old full-term female neonate was admitted with a 4-day history of episodic stridor, desaturations and difficult feeding. Initial assessment using fluoroscopy suggested distal tracheomalacia. Inhalational induction for examination under anaesthesia of the upper airway at 4 weeks of age caused almost complete airway obstruction due to severe anterior, or epiglottic, laryngomalacia. This airway obstruction was unresponsive to continuous positive airway pressure, the use of an oropharyngeal airway and hand ventilation and required urgent tracheal intubation using suxamethonium. Epiglottopexy, a relatively unknown procedure, was performed uneventfully 2 days later, with complete relief of the respiratory compromise. However, the infant remained desaturated postoperatively. A ventilation perfusion scan subsequently revealed multiple pulmonary arteriovenous malformations, unsuitable for embolization and requiring nocturnal home oxygen therapy. Review at 3 months of age found a thriving infant with no airway obstruction and good epiglottic positioning on examination under anaesthesia. Although the patient's oxygen requirements had diminished, the long-term outcome remains uncertain.

Airway Obstruction↗
PubMed2004

Prevention and management of complications of airway surgery in children.

Preventing and managing complications of airway surgery in children requires proactive attention to both surgical and anaesthetic aspects of the planned procedure. Preoperative evaluation should include a thorough physical examination and, especially in children with multiple congenital anomalies, flexible fibreoptic nasopharyngolaryngoscopy, direct laryngoscopy and rigid or flexible bronchoscopy. The goal is to identify dynamic abnormalities such as laryngomalacia or vocal cord paralysis, tracheal or bronchial lesions, gastro-oesophageal reflux disease (GORD), aspiration, laryngotracheal stenosis, totally obstructing tracheostomy-associated granulation tissue and Noonan syndrome preoperatively, and then to plan surgical management to achieve the best possible outcome for each patient.

Child↗
PubMedDate not supplied

Improved airway healing using transforming growth factor beta-3 in a rabbit model.

Laryngeal wound healing is essential following laryngotracheal surgery. Patients with poor wound healing develop poor epithelial closure and increased granulation tissue which cause a stenosis of the repaired airway. Transforming growth factor-beta3 has been shown to enhance wound healing in cutaneous wounds, but has never been used in the airway. This study utilized a rabbit laryngeal wound-healing model that has been shown to be reproducible with limited morbidity. Thirty-four rabbits underwent a cricoid-split operation with collagen sponge insertion. All animals were classified randomly into three groups: local administration of placebo (Group G1, n = 13), 0.18 microg transforming growth factor-beta3 (Group G2, n = 11) and of 1.0 microg transforming growth factor-beta3 (Group G3, n = 10). All animals survived the postoperative period without respiratory distress. The airway was harvested six days after surgery and assessed by light microscopy. Histologic evidence for healing was subjectively graded by two blinded, independent investigators, and the results were statistically analyzed for significance. A significant improvement in the epithelial closure (p < 0.01) and subepithelial connective tissue closure (p < 0.005) was found in the 1.0 microg transforming growth factor-beta3 group (G3) compared with the placebo group (G1). Analysis of the 0.18 microg transforming growth factor-beta3 group (G2) did not reveal any significant differences compared with the placebo group (G1). These results suggest an application for transforming growth factor-beta3 in accelerating wound healing in the larynx.

Animals↗
PubMedDate not supplied

Tracheotomy tube placement in children following cardiothoracic surgery: indications and outcomes.

PURPOSE: To review the indications for and outcomes of children requiring tracheotomy tube placement following cardiothoracic surgery, charts were reviewed retrospectively at a tertiary care center for fifteen children who had undergone tracheotomy tube placement following cardiothoracic surgery between 1994 and 2000. Outcomes Measure: Morbidity and/or mortality associated with tracheotomy tube placement in this patient population, duration of tracheotomy tube, and rate of decannulation. RESULTS: Fifteen out of approximately 3000 children undergoing cardiothoracic surgery required tracheotomy tube placement over a 6-year period. Indications included diaphragmatic paresis (DP) (7 patients), vocal cord paresis (VP) alone (3 patients), DP and VP (2 patients), subglottic stenosis (SS) and DP (1 patient), VP and SS (2 patients), and cerebrovascular infarct (1 patient). The mean age at the time of tracheotomy tube placement was 36.5 months (range, 0.75-108 months). The mean duration of intubation between cardiothoracic procedure and tracheotomy was 31.6 days (range, 0-72 days). Six patients were successfully decannulated following a mean of 7.4 months of tracheotomy tube dependence. All 6 decannulated patients had DP necessitating tracheotomy and ventilatory support. Eight patients continue to be tracheotomy tube-dependent, and one patient died of unrelated causes. There was no short-term or long-term morbidity or mortality associated with tracheotomy tube placement. CONCLUSION: Tracheotomy tube placement is rarely indicated following cardiothoracic surgery in children. The most common indication is DP, which is usually transient. Most children will eventually be candidates for decannulation.

Cardiac Surgical Procedures↗
PubMed1999

Use of a revascularized, tubed costal myoperiosteal graft for repair of circumferential, segmental tracheal defects.

Reconstruction of extensive laryngotracheal stenosis continues to pose a significant surgical challenge. Previous work in our laboratory has demonstrated the utility of vascularized perichondrium for reconstruction of cervical tracheal defects in a rabbit model. Because most potential vascularized donor sites in human beings are periosteal, it was important to demonstrate that vascularized periosteum was also useful for laryngotracheal reconstruction in a larger animal model. We therefore performed a 2-stage reconstruction of a circumferential, segmental cervical tracheal defect using a revascularized, tubed myoperiosteal graft in a canine model (n = 8). A rigid, patent tube was produced in 6 animals (75%) after completion of the first stage (7 to 10 weeks). After transfer of the vascularized free graft to the tracheal defect, 5 of 6 animals survived from 4 to 18 weeks. Severe stenosis (>90%) was present in 2 animals, and moderate stenosis (40% to 60%) was present in the remaining 3 animals. One animal was observed for 18 weeks and was found to have a 40% circumferential stenosis at autopsy. Light microscopy revealed exuberant bone proliferation in all specimens. Unrestrained osteogenesis may limit the utility of vascularized periosteum in reconstruction of extensive tracheal defects.

Airway Resistance↗
PubMed1999

Gastroesophageal reflux: A critical factor in pediatric subglottic stenosis.

Gastroesophageal reflux (GER) plays a causative role in the development of subglottic stenosis (SGS) in children. This study examined the impact of aggressive antireflux therapy on the clinical outcomes of 35 children. Since 1994, 25 children were treated aggressively with omeprazole and cisapride before endoscopic surgical repair of their stenoses, which ranged from Cotton grades 1 to 3. Nine patients became asymptomatic on antireflux therapy alone. Endoscopic repair was performed in 16 patients. Endoscopic repair failed in only 1, who required tracheotomy. Before 1994, all children undergoing endoscopic repair of SGS were treated perioperatively for reflux. Endoscopic repair failed in 10 of the 57 children, and all required tracheotomy. The clinical outcome of these 10 patients after aggressive antireflux therapy is described. Five of the 10 have been decannulated. The role of double pH probe testing and the importance of the pharyngeal probe for monitoring the response to antireflux medication are described. The probe data suggest that in some instances GER may be limited to perioperative stress, but in many cases, especially in premature infants with SGS, GER can persist unabated for years and is not outgrown as the patient matures.

Child, Preschool↗
PubMed1999

Long-term growth of a vascularized auricular perichondrocutaneous flap in laryngotracheal reconstruction.

This study addresses the potential for ongoing cartilage proliferation after repair of laryngotracheal stenosis with vascularized perichondrium. We randomly assigned 32 New Zealand white rabbits to 1 of 3 groups: group 1 (early cartilage growth, n = 10), group 2 (long-term cartilage growth after pedicle ligation, n = 11), and group 3 (long-term cartilage growth without pedicle ligation, n = 11). Bilateral auricular perichondrocutaneous flaps were elevated and transposed into full-thickness anterior tracheal wall or anterior cricothyroid membrane defects. Six weeks after elevation of the flap, animals were randomly assigned to undergo ligation of either the right or left vascular pedicle (group 2), with the contralateral auricular flap used as a matched control (group 3). Neochondrogenesis was present at 6 weeks in group 1 (0.74 +/- 0.14 mm, n = 12 ears). Cartilage thickness did not differ between groups 2 and 3 one year after ligation of the vascular pedicle: group 2 (0.48 +/- 0.24 mm, n = 18) versus group 3 (0.42 +/- 0.12 mm); P > 0.05. We conclude that in the rabbit model, chondrogenesis did not appear to be ongoing and did not result in late stenosis of the reconstructed airway. Furthermore, delayed ligation of the vascular pedicle neither inhibited nor stimulated cartilage proliferation.

Animals↗
PubMed2001

Thyroid alar cartilage laryngotracheal reconstruction for severe pediatric subglottic stenosis.

BACKGROUND/PURPOSE: Laryngotracheoplasty has become an accepted treatment alternative for subglottic stenosis. However, the best autogenous material for laryngotracheoplasty remains controversial. Autogenous superior thyroid alar cartilage (TAC) has been used successfully in single stage laryngotracheal reconstruction in children with subglottic stenosis. METHODS: This is a retrospective study of 6 children (mean age, 16.6 months) undergoing TAC graft laryngotracheoplasty between September 1995, and June 1999. Two children had immediate tracheal intubation for congenital subglottic stenosis. Four others had previous tracheostomy: 3 for severe postintubation subglottic stenosis and 1 for congenital subglottic stenosis. After an anterior cricoid split, a piece of TAC was sutured between the cut ends of the cricoid, with the graft perichondrium facing intraluminally. Endotracheal intubation was maintained postoperatively. RESULTS: Four children underwent successfully extubation 9 to 21 days (mean, 15.5 days) postoperatively. Two required tracheostomy, which was maintained because of severe laryngomalacia and laryngotracheobronchomalacia. One child was treated with CO2 laser because of symptomatic recurrence of the subglottic stenosis 3 weeks after the surgery; another required fundoplication for gastroesophageal reflux 12 months after laryngotracheoplasty. There were no donor site complications in any of the 6 cases. Repeat laryngoscopy and bronchoscopy showed a patent subglottic airway. All of them are without symptoms after a mean follow-up of 26 months. CONCLUSIONS: (1) This preliminary experience indicates that the TAC graft technique is a viable option for laryngotracheal reconstruction; (2) the TAC graft has significant advantages, including a single operative incision and absence of donor-site morbidity.

Child, Preschool↗
PubMed2000

[Inner surface imaging of laryngeal and tracheal stenosis by spiral-CT: role of a new diagnostic procedure].

BACKGROUND: Inner-surface-reconstruction calculated from helical-CT data sets offers a new diagnostic option for upper airway assessment. Using a special software, it is possible to create a continuous overview on the inner surface of hollow viscera on a monitor, similar to an endoscopic view. However, reports on the clinical value of this examination procedure with regard to laryngeal or tracheal stenosis are rare. METHOD: We compared the results of this "virtual endoscopy" with real endoscopic or intraoperative findings in 11 patients suffering from laryngeal or tracheal stenosis of various etiologies. RESULTS: Data on extension and localization of airway stenosis obtained by virtual endoscopy corresponded well with our endoscopic or intraoperative findings in all patients. The grade of airway stenosis as assessed by inner-surface-reconstruction could be confirmed by endoscopy in 8 of 11 cases investigated. Detection of 2 additional airway stenoses distal to an endoscopically non-passable tracheal stenosis was possible by virtual endoscopy in one case. CONCLUSION: As a supportive diagnostic procedure, virtual endoscopy offers a valuable overview on extension and localization of laryngeal or tracheal stenoses with regard to a possible therapeutic management.

Adult↗
PubMed2001

[Open surgical treatment of laryngo-tracheal stenoses in children].

BACKGROUND: Treatment strategy in laryngo-tracheal stenoses in children has for a long time been conservative treatment with tracheostomy or bougination in hope of a more or less spontaneous resolution of the stenosis during growth of the child. The results of this option as well as the endoscopic treatment with different laser systems has proved to be rather disappointing. A child with a tracheostomy means a heavy load for the parents to look after this child as well as a constant threat from complications by displacement or plugging of the cannula. METHOD: A retrospective chart review of 22 children, aged between two months and 15 years at the time of surgery with laryngo-tracheal stenoses treated by different open surgical procedures. RESULTS: The aetiology of the stenoses was prolonged endotracheal intubation in 12 children, congenital stenoses in 3 children, unsuccessful laser treatment for acquired stenoses in 3 children, subglottic hemangioma in 3 children and a transglottic cyst in 1 child. 17 cases were treated by laryngo-tracheal reconstruction with rib cartilage graft, 3 crico-tracheal resections, and 2 laryngofissures. Five children could be treated without tracheostomy. From the remaining 17 cases 13 could be decannulated, 1 child died one week after surgery from his congenital heart disease. 3 children are still with a tracheostomy, two of them had had endoscopic laser therapy alio loco before. CONCLUSIONS: Open laryngo-tracheal surgery for paediatric airway stenoses is a successful treatment option besides endoscopic management for selected cases. Resection surgery seems to be indicated for severe stenoses with proliferative scar tissue formation. Depending on personal experience and post-operative facilities procedures without tracheostomy but prolonged post-operative intubation are possible single-stage-solutions.

Adolescent↗
PubMed2001

Use of cartilage grafts in the treatment of laryngotracheal stenoses and defects in children.

Stenosis of the laryngotracheal section is in most cases a sequel of intensive care treatment. Most of the children presenting with such stenoses need tracheostomy that in consequence impedes their physical, social and language development. Surgical treatment of stenosis and closure of tracheostomy as early as possible should be strived for. Reconstructive techniques using autogenous cartilage grafts have proved very effective. The aim of our study was to examine the influence of different methods on the structure and function of reconstructed airways. In 23 children between 2 and 16 years suffering from laryngotracheal stenosis we reconstructed the stenotic segments by insertion of autogenous cartilage grafts. Enlargement was achieved by cartilage implantation as a stent into the split cricoid plate in 16 children; in 3 cases we performed enlargement of the anterior wall and in 5 cases instable lateral walls of the trachea had to be reinforced. One child had to be treated with all three techniques at once. In another case the overstretched and soft posterior tracheal wall had to be stabilized. Enlargement of the cricoid plate has proved excellent in cases of a high degree of stenosis of the posterior commissure (Type III and IV of the Cotton classification). Subglottic stenoses Type II can be treated with anterior insertion of cartilage. The use of cartilage in surgical treatment of laryngotracheal stenosis in childhood leads to safe and sufficiently satisfactory results that do not hamper further development of either larynx or trachea.

Cartilage↗
PubMed2002

[The tracheostomy-sphincter procedure - case report of a modified tracheostomy].

BACKGROUND: For an adequate speech production after tracheostomy patients are dependant on a temporary closure of the stoma. This closure can either be done manually or by the use of various tracheostoma valves. The tracheostomy-sphincter procedure, which is introduced in this case, allows the voluntary constriction of the stoma. METHODS: This case describes the treatment of a paediatric patient with laryngeal stenosis. During tracheostomy formation, an artificial muscle-sphincter was created, using the sternohyoid muscle (strap muscle). RESULTS: Postoperative contractile movements were possible, which were improved by special exercises. After 3 months the complete closure of the tracheostoma was achieved. CONCLUSIONS: The establishment of a tracheostomy-sphincter can be carried out during tracheostomy and allows the patient to speak without the use of a device. Tracheobronchial secretions can be cleared via the pharynx by coughing.

Adolescent↗
PubMed2002

[Virtual laryngoscopy and multiplanar reformats with multirow detector CT for detection and grading of upper airway stenosis].

PURPOSE: A controlled trial was performed to compare non-invasive multislice CT (virtual laryngoscopy, axial CT slices, coronal and sagittal reformats) in the detection and grading of upper airway stenosis with fiberoptic laryngoscopy. MATERIAL AND METHODS: Multislice CT and fiberoptic laryngoscopy were used to examine 111 upper airway sections (supraglottis, glottis, subglottis, trachea) in 29 patients. CT data were acquired on a multirow detector CT (collimation 4 x 1 mm, reconstruction interval 1 mm, IV contrast) and postprocessing was performed using multiplanar reformatted images (MPR) and virtual laryngoscopy. RESULTS: All CT methods accurately detected upper airway stenosis (accuracy was 96 % for virtual laryngoscopy and MPR and 94 % for axial CT-slices). Correlation of fiberoptic and virtual laryngoscopy (r = 0.94) for grading of stenosis was closer than with sagittal reformats (r = 0.80), coronal reformats (r = 0.72), and axial CT slices (r = 0.57). Even high grade stenosis could be passed with virtual laryngoscopy that was impassable for fiberoptic laryngoscopy. CONCLUSIONS: Virtual laryngoscopy enabled better assessment of stenosis as compared to reading of axial CT slices or MPR. Virtual laryngoscopy is complementary to fiberoptic laryngoscopy and should be combined with axial CT slices and MPR readings for evaluation of the surrounding structures.

Adult↗