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At least 703 records · Page 39Linked to original sources
PubMed1985

Subglottic stenosis: a clinicopathological study.

Subglottic stenosis is the most common serious long-term complication of endotracheal intubation in neonates and its pathogenesis is poorly understood. We describe the experience of one unit with 15 cases of subglottic stenosis requiring operative intervention seen over a 3-year period and review the pathology and pathogenesis of the condition. In 1 instance operative intervention was successful in treatment and avoided the need for long-term tracheostomy. A possible aetiological factor in at least 2 of the cases of subglottic stenosis was insertion of the wide shoulder of the endotracheal tube through the vocal cords. It is suggested that subglottic stenosis is due to reparative fibrosis following particularly severe acute intubation injury. Another factor may be delayed healing of the subglottic mucosa possibly exacerbated by full thickness cricoid cartilage necrosis. Although severe subglottic injury may occur at any time that the endotracheal tube is in situ, the most critical period is the first week of intubation.

Cricoid Cartilage↗
PubMed1987

Subglottic stenosis in children: a conservative approach.

Subglottic stenosis may be either congenital or acquired and is one of the commonest causes of acute and chronic airways obstruction in neonates and infants. Most acquired stenoses result from perinatal intubation. The management of these lesions remains controversial, particularly regarding the timing of surgical intervention. At Alder Hey Children's Hospital a series of 33 patients with subglottic stenosis have been reviewed. A conservative approach, employing long-term tracheotomy as the mainstay of treatment, has achieved a success rate of 72.7%, and only 3 patients have so far needed corrective surgery (9%), of which 1 has been decannulated to date. One patient (3%) died of bronchopulmonary dysplasia. We believe that, where close follow-up is possible, a conservative approach is the method of choice.

Follow-Up Studies↗
PubMed1988

Percutaneous transtracheal ventilation for laser endoscopic treatment of laryngeal and subglottic lesions.

Obstructive lesions of the larynx and subglottic space are always a challenging problem for the endoscopist and anaesthetist. At this level, the efficacy and innocuity of a carbon dioxide laser treatment are related to the degree of endoscopic exposure. Thanks to the transtracheal high frequency jet ventilator, it is now possible to assure a free laryngeal endoscopic operative field. The transtracheal catheter is introduced percutaneously through the cricothyroid membrane into the trachea under endoscopic control and connected to a high frequency jet ventilator. From November 1983 to April 1985, this technique has been used in 65 cases. In 12 cases, it was the only alternative to avoid a tracheostomy. The other indications were: laryngeal papillomatosis, resection of T1a cancers of the vocal cords, fibrous strictures secondary to long term intubation, laser arytenoidectomies and benign lesions of the vocal cords. Among many advantages, the following are the most convincing: clear vision of the operative field for the surgeon, complete relaxation of the patient, good respiratory gas exchange, elimination of the risk of ignition of an endotracheal tube by laser, decreased risks of broncho-aspiration of blood and debris, and the facility to provide oxygen and/or mechanical ventilation in the postoperative period. The only complication encountered was a case of cervico-mediastinal emphysema caused by displacement of the tracheal catheter.

Adult↗
PubMed1992

Photometrics: a new method of measuring the cross-sectional area of the subglottis.

A new endoscopic method of measuring the cross-sectional area of a subglottic stenosis is presented. The method was tested against existing techniques using a model. By standardizing the distance from the objective of the endoscope to the stenotic area we were able to measure the cross-sectional area using a graduated grid held against the video screen. This technique was then compared with the standard one of estimating the diameter of a stenosis from the external diameter of the bronchoscope which can be passed through the stenosis. The methods were found to be equally accurate in measuring the lumen diameter. However, when measuring the minimum cross-sectional area, three of five observers were significantly better (P less than 0.01) using the photometric method rather than the standard method (Wilcoxon's rank sum test for paired data). The photometric technique of measuring the cross-sectional area of the subglottis is easily performed, non-traumatic, and allows a visual record to be kept.

Bronchoscopes↗
PubMed1993

Does the location of the laryngectomy stoma influence its ultimate size?

The stoma following laryngectomy may be placed either within the incision or separately. To determine if this variation had a bearing on its ultimate size, measurements of the stoma size were carried out in 61 patients who underwent laryngectomy by one of these methods. It was found that the stoma was nearly twice the size in patients in whom the stoma had been sited within the main wound and that there was a minimal need for the use of a tube or stoma button post-operatively in these patients.

Aged↗
PubMed1995

Management of subglottic haemangioma.

Between 1980 and 1993, 10 infants underwent endoscopic treatment and/or open surgical excision of a subglottic haemangioma. Of the eight children treated with the laser, four showed simple evolution following a single laser treatment, one required repeated laser treatments and two needed tracheotomy despite repeated laser treatments. The last three children developed moderate subglottic stenosis. Laser treatment was followed by open surgical excision in one child. Two children underwent primary surgical excision, allowing extubation between 8 and 10 days post-operatively. After a period in which we systematically treated subglottic haemangiomas with the laser, these findings have led us to employ open surgery in children with large subglottic haemangiomas or when airway obstruction requires a tracheostomy.

Airway Obstruction↗
PubMed1996

Agenesis of the corpus callosum in Schinzel-Giedion syndrome associated with 47,XXY karyotype.

The Schinzel-Giedion syndrome is a rare autosomal recessive condition with typical facial features, skeletal manifestations and congenital hydronephrosis and/or hydroureter. We report a male infant with Schinzel-Giedion syndrome, also showing the karyotypic abnormality 47,XXY. Agenesis of the corpus callosum and laryngeal stenosis were determined at autopsy. Besides typical Schinzel-Giedion syndrome, our propositus was found to be affected by Klinefelter syndrome. This represents a fortuitous anomaly, which is probably of no importance in the phenotype of the patient.

Abnormalities, Multiple↗
PubMed1994

Experience with anterior cricoid split for infantile subglottic stenosis.

A retrospective study of infants undergoing anterior cricoid split (ACS) from 1989 to 1993 was performed to evaluate our unit's experience with ACS in the management of infantile subglottic stenosis (SGS). Twelve children were identified ranging in age from 10 to 30 weeks and weighing between 1200 and 6500 g. Nine were born at or less than 30 weeks' gestation. Indications for surgery were endotracheal tube dependency, nasopharyngeal continuous positive airway pressure dependency and recurrent croup. All had varying degrees of SGS. Eleven of the 12 patients were extubated successfully following surgery. Two of these required subsequent repeat ACS 6 and 9 months later with one patient eventually requiring tracheostomy. These results suggest that ACS can be safely employed as an alternative to tracheostomy for a variety of clinical presentations of infantile SGS, with a relatively high rate of successful extubation.

Bronchoscopy↗
PubMed1980

Therapeutic effects of tracheostomy in two cases of hypersomnia with respiratory disturbance during sleep.

Recently the association of hypersomnia and respiratory insufficiency without lesion in the respiratory organ has attracted attention of many investigators. Obese patients with such a condition have been called the Pickwickian syndrome. In this report, two non-obese patients with a similar condition were presented, one with micrognathia and frequent apneic episodes during sleep, and the other with laryngeal stenosis due to paralysis of the bilateral laryngeal nerves and chronic laryngitis. Tracheostomy had a prompt and long-lasting therapeutic effect to make their sleep stable and also to relieve their excessive daytime sleepiness. These findings suggest that the obstruction or stenosis of the upper airway during sleep disturbed their nocturnal sleep, and that their excessive daytime sleepiness was a phenomenon compensating for their disturbed nocturnal sleep.

Adult↗