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 667 records · Page 37Linked to original sources
PubMed2001

Laryngotracheal anastomosis: primary and revised procedures.

OBJECTIVES: Acquired upper airway stenosis is usually associated with a complex of pathological conditions at the high tracheal and the subglottic levels. Reported reconstructive techniques include widening by incorporation of grafts, segmental resection, and anastomosis or combined procedures. The management of recurrent stenosis after reconstructive surgery is a major challenge and has rarely been discussed in the literature. The purposes of the present study are to compare the clinical course of primary versus revised reconstructive procedures and to analyze the effect of age, diabetes, chronic lung disease, grading of stenosis, extent of resection, and revised procedures on the operative rate of success. STUDY DESIGN: A cohort study in a tertiary referral medical center. METHODS: The clinical course of 23 consecutive patients undergoing laryngotracheal anastomosis was studied comparing a group of 13 primary with 10 revision procedures. Seventeen patients underwent cricotracheal and six patients thyrotracheal anastomoses. All patients but one were tracheotomized before the definitive reconstructive procedure. Suprahyoid release was routinely performed except for two cases, and only one patient required sternotomy. The Wilcoxon test was used to examine the relationship between preoperative clinical parameters and the postoperative success (i.e., airway patency). RESULTS: Twenty-two of 23 patients (95.6%) had successful decannulation. Four patients required a revision procedure because of repeat stenosis at the site of the anastomosis (2) or distal tracheal malacia (2). Residual airway stenosis of less than 50% was noted in six patients, although only three complained of dyspnea during daily-activity exertion. There was no associated mortality. Complications included subcutaneous emphysema (4), granulation tissue formation (3), pneumonia (2), cardiac arrhythmia (2), and one each of pneumomediastinum, neck hematoma, and urosepsis. Protracted aspirations were noted in one patient who had revision surgery. Age was the only parameter that correlated with postoperative airway patency (P <.07), whereas the presence of chronic obstructive lung disease and diabetes, grade of stenosis, type of surgery, and revision surgery were found to be insignificant. CONCLUSIONS: The clinical course of laryngotracheal anastomosis in primary and revised procedures was similar in our group of patients. The operation can be performed safely, with an expected high rate of success and acceptable morbidity.

Anastomosis, Surgical↗
PubMed2001

Single-stage adult laryngotracheal reconstruction without stenting.

OBJECTIVES/HYPOTHESIS: To present the indications, surgical technique, and results of single-stage laryngotracheal reconstruction (SSLTR) without stenting for laryngotracheal stenosis (LTS) in adults. Various open surgical techniques have been previously described for LTS in adults; however, these techniques usually involve placement of intraluminal stents. The practice of early extubation without stenting is common for pediatric SSLTR. The success of this technique in the pediatric population has led to a trial of the same technique in selected cases of adult LTS. STUDY DESIGN: Retrospective review. METHODS: A retrospective review was conducted on 15 patients with glottic, subglottic, or tracheal stenosis or a combination of these, who underwent SSLTR with composite nasal septal grafts or costal cartilage grafts without stenting. RESULTS: All patients were extubated or decannulated 1 to 7 days after surgery. Three of the 15 patients had no further procedures. Three patients had a second SSLTR to repair stenosis at a different level with no further difficulties. Eight patients had additional endoscopic airway procedures after extubation or decannulation, and one patient died in the immediate postoperative period. All 14 surviving patients are decannulated and well at the time of writing. CONCLUSION: For LTS in selected adult cases, SSLTR without stenting is a viable option. Indications, surgical technique, and complications are presented.

Adolescent↗
PubMed2001

The use of buccal mucosa graft at posterior cricoid splitting for subglottic stenosis repair.

BACKGROUND: Since 1955, when Réthi established the posterior cricoid split augmentation (PCSA) method, several authors have published supporting reports of the validity and proven efficacy of its basic principles. A 27-year prospective, retrospective study. OBJECTIVES: To report on experience in performing the PCSA method for subglottic and/or posterior-glottic stenosis repair using buccal mucosa interposition grafting at posterior cricoid split and stenting for 8 weeks, and to assess the impact on vocal function. METHODS: From 1972 on, 60 patients (45 adults, 15 children, aged 8 mo to 72 y) with subglottic and/or posterior-glottic stenosis were operated on using a modified PCSA method. The surgical technique consisted of posterior cricoid splitting, including or not the interarytenoid muscle; wide lateral retraction of the posterior cricoid halves; buccal mucosa interposition grafting and stenting for 8 weeks. The factors evaluated included the subglottic remodeling rate, donor and recipient sites morbidity, time to decannulation, rate of graft take, and phonatory function tests. RESULTS: The modified PCSA procedure resulted in a decannulation rate of 90%, 18 (30%) of which had further procedure to achieve decannulation, and 6 adult patients (10%) were considered failures because of restenosis. The rate of take of the mucosa graft was 100% in both children and adults, with complete epithelialization of the grafted area, the mucosa not becoming dry and crusty. No interarytenoid muscle division resulted in near-normal to normal glottic voicing. Interarytenoid muscle division determined supraglottic voicing with inspiratory noise and pneumophonic incoordination, breathy and hoarse voice, low fundamental frequency, limited dynamic range, and shortened phonation time. CONCLUSION: The PCSA procedure with buccal mucosa graft is reliable, safe, and highly successful with respect to the graft incorporation and subglottic remodeling. The division or not of the interarytenoid muscle is the most important factor influencing the postoperative vocal function.

Adolescent↗
PubMed2003

Subglottic stenosis associated with Wegener's granulomatosis.

OBJECTIVE: To evaluate the outcomes of subglottic stenosis in patients with Wegener's granulomatosis. STUDY DESIGN: Retrospective chart review. METHODS: A retrospective chart review was undertaken to review all patients evaluated in an otolaryngology-head and neck surgery department between 1993 and 2001 for active symptoms attributed to subglottic stenosis who had undergone cytoplasmic staining antineutrophil cytoplasm antibody and perninuclear staining antineutrophil cytoplasm antibody testing and who had a clinical diagnosis of Wegener's granulomatosis. RESULTS: Twenty-seven patients were identified with Wegener's granulomatosis and subglottic stenosis. Among these, 11 of 27 (40.7%) underwent tracheotomy; 13 of 27 (48.1%) required multiple surgical procedures. A history of open laryngotracheal repair was present in 7 of 27 patients (25.9%). CO(2) laser resection and dilation was used in 12 of 27 patients (44.4%). Three of 27 patients (11.1%) had a tracheotomy at last follow-up. Patients were followed for an average duration of 76.8 months (6.4 y) from the onset of symptoms attributed to subglottic stenosis. All patients who underwent open laryngotracheal reconstruction had successful decannulation. CONCLUSIONS: Wegener's granulomatosis is a necrotizing vasculitis that can involve the subglottis. Our approach to airway management in these patients involves a tracheotomy if obstruction occurs during acute inflammatory activity. We recommend minimizing airway manipulation during episodes of systemic disease activity. Once control of the disease process is obtained, consideration is given to either an endoscopic or an open approach based on the extent of stenosis. Either laryngotracheal reconstruction or CO(2) laser resection and dilation may be undertaken with safety and should result in favorable outcomes.

Adolescent↗
PubMed2003

Vascularized hemitracheal autograft for laryngotracheal reconstruction: a new surgical technique based on the thyroid gland as a vascular carrier.

BACKGROUND: The management of extensive laryngotracheal stenosis has been a challenge confronting head and neck surgeons for over a century. The key to the successful restoration of a stable airway is providing a cartilaginous infrastructure to provide support to withstand both the negative and positive lumenal pressures produced during normal respiration and deglutition. We introduce a novel technique for restoration of such defects. METHODS: The blood supply to the thyroid gland by way of the inferior thyroid artery and the superior thyroid artery and vein are mobilized for transfer. One half to two thirds of the circumference of the adjacent tracheal rings are mobilized on the basis of the requirements of the stenotic segment. This mucochondrial composite tracheal flap is advanced superiorly to the ipsilateral "laryngeal" region where insetting of the cartilage and the mucosa is performed. Primary reconstruction or, more likely, a staged repair of the secondary tracheal defect is performed. RESULTS: Three case reports are presented. The patients were successfully decannulated postoperatively, continue to have an adequate voice, and are tolerating a diet (3-27 months postreconstruction). CONCLUSION: A new surgical technique for reconstruction of benign laryngotracheal stenoses is introduced to restore phonatory capability and a stable airway. The composite thyroid-tracheal graft based on the inferior and superior thyroid arterial pedicles allows a single-staged, primary reconstruction of the hemilarynx with a well-vascularized composite thyrotracheal flap that allows resurfacing as well as replacement of the infrastructure of the glottis and subglottis. This technique would be an excellent method to restore the cricoid ring following partial resection for primary cartilaginous tumors.

Aged↗
PubMed2003

Endoscopic posterior cricoid split and rib grafting in 10 children.

OBJECTIVE: To report our experience with endoscopic posterior cricoid split and rib graft insertion (EPCS/RG) in children with posterior glottic (PGS) and subglottic stenosis (SGS). DESIGN: Retrospective analysis of case series, with 1 to 2 year follow-up. SETTING: Tertiary-care pediatric referral center. PATIENTS: Ten consecutive patients undergoing EPCS/RG. INTERVENTION: EPCS/RG is a new procedure that expands the posterior glottic opening by dividing the posterior cricoid lamina endoscopically with a laser and inserting a rib cartilage graft through the laryngoscope. MAIN OUTCOME MEASURES: Laryngeal function and hospital stay. RESULTS: Successful decannulation in two of two patients with PGS and one of five patients with PGS and SGS without further surgery. Of the four not initially decannulated, two were decannulated with adjunctive procedures, and the other two can now tolerate tracheostomy capping for extended periods of time. We achieved improvement in exercise tolerance in three nontracheotomy-dependent patients. For those with established tracheotomies, median hospital stay was 3 days and intensive care unit care was unnecessary. There were no major complications or deterioration of voice or feeding. CONCLUSIONS: EPCS/RG appears to be safe and effective in the management of PGS in selected pediatric patients. This minimally invasive procedure has advantages over traditional open approaches and destructive endoscopic techniques (cordotomy and arytenoidectomy). The role of EPCS/RG alone in the face of severe grades of SGS appears to be limited.

Adolescent↗
PubMed2004

Mitomycin does not prevent laryngotracheal repeat stenosis after endoscopic dilation surgery: an animal study.

OBJECTIVES/HYPOTHESIS: Conflicting data exist in the literature regarding the role of mitomycin in the prevention and treatment of laryngotracheal stenosis. The purpose of the study was to assess the value of mitomycin in preventing repeat stenosis after endoscopic dilation surgery of well-established stenoses. STUDY DESIGN: Prospective controlled animal study. METHODS: Laryngotracheal stenosis was induced in 16 dogs. After a period of 3 months the dogs underwent endoscopic dilation and were randomly divided into two groups. The control group received immediate topical application of normal saline. Dogs in the mitomycin group received immediate topical application of 0.5 mg mitomycin. The animals were then observed for 3 more months before euthanasia. The laryngeal lumens were measured endoscopically at baseline, before dilation, and before euthanasia. A comparison was made between the two study groups by means of the Wilcoxon rank-sum test for change in the percentage of stenosis attained by the endoscopic dilation. RESULTS: Nine dogs were included in the control group, and seven in the mitomycin group. Group comparison for initial occlusion before endoscopic dilation using Wilcoxon rank-sum test showed no difference between the two groups (z = 0.16 [P =.87]). Three months after endoscopic dilation, no difference was observed between the two groups regarding the change in the percentage of occlusion (z = -0.21 [P =.83]). CONCLUSION: Mitomycin exerts a benefit equal to that of normal saline when applied to a well-established laryngotracheal stenosis in dogs and does not prevent repeat stenosis after endoscopic dilation surgery.

Alkylating Agents↗
PubMed1983

Congenital subglottic stenosis: diagnosis and management.

In contrast to the generally accepted concept, I have classified congenital subglottic stenosis in a different way. During the first months of life, the abnormality may be recognized by its frequent association with acute respiratory infections, providing the opportunity to recognize it once the infection has been controlled. I emphasize the role of the radiologic examination of the larynx for diagnosis and follow-up of this disorder and its different evolution from that of pure subglottic laryngitis. A comparison with subglottic laryngitis and laryngotracheobronchitis emphasizes the seriousness of this retardation in the normal development of the larynx.

Bronchoscopy↗
PubMed1987

Vocal cord paresis and glottic stenosis: a late complication of poliomyelitis.

A patient with spinobulbar poliomyelitis had residual dysfunction of the ninth and tenth cranial nerves, which produced bilateral vocal cord paresis and recurrent aspiration. Critical glottic stenosis developed 28 years after the initial episode of poliomyelitis; this course appeared to be explained by fibrosis of the intrinsic laryngeal muscles and ankylosis of the right cricoarytenoid joint. Thus it appears that significant upper airway obstruction may develop as a late complication in patients with stable neurologic deficits and chronic immobility of the vocal cords.

Humans↗
PubMed1989

Acute upper airway obstruction in rheumatoid arthritis of the cricoarytenoid joints.

We have reported two cases of acute, life-threatening upper airway obstruction due to previously unrecognized rheumatoid arthritis of the cricoarytenoid joints with severe acute and chronic deformities of the larynx. Attempted endotracheal intubation with the rigid laryngoscope failed in each case, resulting in the need for emergency tracheostomy. We recommend the use of the fiberoptic bronchoscope for elective or emergency endotracheal intubations in patients with severe rheumatoid arthritis involving the cervical spine and the larynx.

Acute Disease↗
PubMed2000

Short limbed skeletal dysplasia associated with combined immunodeficiency and congenital subglottic stenosis: a new constellation of features.

A newborn male is described with an association of short limbed dwarfism with hip dislocation, combined immunodeficiency characterized by absent B cells and CD4 lymphopaenia and congenital subglottic stenosis. This constellation of abnormalities is distinct from other described skeletal dysplasias associated with immunodeficiency such as ADA deficiency and cartilage hair hypoplasia.

CD4 Lymphocyte Count↗
PubMed2003

Adult laryngotracheal stenosis: etiology and surgical management.

PURPOSE OF REVIEW: The most common causes of laryngotracheal stenosis have changed over the last 100 years, with external trauma and infection being supplanted by iatrogenic trauma from intubation and tracheotomy. Modern-day surgeons continue to struggle with the prevention and the treatment of this difficult problem, and the purpose of this review is to examine new causes, diagnostic methods, and treatments in laryngotracheal stenosis. RECENT FINDINGS: Recent publications have focused on the topics of idiopathic subglottic stenosis; percutaneous dilational tracheotomy, with the possibility of this technique increasing the incidence of stenosis; the role of laryngopharyngeal reflux; and the use of primary resection with anastomosis as a curative treatment. SUMMARY: Although promising work has been reported in the treatment of laryngotracheal stenosis, notably with primary resection and anastomosis, many questions remain to be answered, especially in the causes of this potentially life-threatening disease.

Adult↗
PubMed2004

Spondyloepimetaphyseal dysplasia (Hall type) with laryngeal stenosis: a new diagnostic feature?

The spondyloepimetaphyseal dysplasias (SEMD) are a large, genetically heterogeneous group of disorders of variable severity, which are classified according to their clinical and radiological features. SEMD with multiple dislocations (Hall type) has been recently delineated (MIM 603546). This condition is characterized by striking epiphyseal and metaphyseal changes in the long bones, joint laxity, multiple dislocations of the large joints including the knees, and dysmorphic features including a short and upturned nose with a depressed nasal bridge and midface hypoplasia. An autosomal dominant mode of inheritance has been suggested. We report a further patient with a mild form of this condition and persistent inspiratory stridor secondary to laryngeal stenosis. This complication has been reported in previous reports and is certainly an important diagnostic feature.

Abnormalities, Multiple↗