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PubMedDate not supplied

Hyoid autograft repair of chronic subglottic stenosis.

A previously unreported surgical technique has been evaluated for the correction of chronic subglottic (cricoid) stenosis. The principle of skeletal support as the primary means of repair was examined. Severe stenoses were created in sixteen adult, mongrel dogs. One to three months later a hyoid bone autograft on a sternohyoid muscle pedicle was employed for repair. The dogs were sacrificed at regular intervals from two weeks to six months. The majority of the animals maintained a widely patent lumen after repair. Vocal cord mobility remained normal in every case. The results are illustrated by photographs and histologic sections. This study convincingly demonstrates a successful surgical technique for correcting a most difficult laryngeal lesion.

Adult↗
PubMedDate not supplied

Nontraumatic, nonneoplastic subglottic stenosis.

During a 20-year period, 12 patients with nontraumatic, nonneoplastic subglottic stenosis were seen at the Mayo Clinic. The etiologic factors were relapsing polychondritis, amyloidosis, sarcoidosis, and Wegener's granulomatosis. Because of the diverse initial presentation of the disease, the clinician should consider that the stenosis is a manifestation of a systemic disorder and carry out an otolaryngologic and physical examination with the appropriate roentgenograms and blood and urine tests. Treatment, if a systemic disease is proved, consists of appropriate medication. Surgery may be necessary, depending on the nature of the lesion. Small strictures may not need to be treated.

Adolescent↗
PubMedDate not supplied

Laryngeal suspension and epiglottic flap in laryngopharyngeal trauma.

Physicans treating laryngeal trauma are still looking for ways to improve results. Severe disruption of the supporting structures between hyoid and trachea may allow stretching and narrowing of the laryngeal lumen during the healing period. This can easily be prevented by placing wires across the disrupted zone. In addition, loss of the epithelial lining of the larynx is a serious cause of stenosis. By dissecting out the epiglottic cartilage, one can create a sizeable, useful flap of mucous membrane based in the vallecula to use in relining of the anterior larynx.

Adult↗
PubMedDate not supplied

Acquired and congenital subglottic stenosis in the infant.

During the calendar year of 1974, the Intermountain Newborn Intensive Care Center at the University of Utah Medical Center had 603 admissions. A representative group of 293 charts were reviewed which indicated that 44% of these children were intubated from hours to weeks. The overall mortality rate for the 293 children was 29%. Eighteen of the 603 children were diagnosed as having subglottic stenosis. Fifteen of these children appeared to have acquired subglottic stenosis secondary to endotracheal intubation. Three children had congenital subglottic stenosis. Tracheostomy was necessary in the management of 15 patients. Ten of the 18 patients have survived and two of these patients still have tracheostomy tubes in place. The survival and thickness of the stenotic area are inversely proportional to the birth weight and the duration of intubation. Endoscopic excision, dilatation and stenting were techniques utilized in the treatment of these stenotic lesions. The extubation technique utilized is described. The factors involved in the production of acquired subglottic stenosis are presented along with suggestions to decrease the incidence of this problem in the intubated child.

Glottis↗
PubMedDate not supplied

Subglottic stenosis in infants and children.

Of 158 cases of subglottic stenosis 115 were congenital and 43 acquired. Current follow-up has been obtained in 146 (92%) which constitutes the determinate group. Although stridor was the most common presenting symptom of the congenital group, 34% presented with recurrent or prolonged episodes of croup. Tracheotomy was required in 47 of the 107 determinate cases (44%). Further management of the congenital cases was based on the experience that children outgrow this disorder; periodic dilatation may augment the natural process. Of those infants and children tracheotomized, all but five have been decannulated, and there was one death - a mortality rate of 2.1%. Acquired subglottic stenosis proved to be a more difficult management problem. Tracheotomy was necessary in 38 of the 39 determinate cases (97%). Repeated active dilatations for prolonged periods were usually required as well as endoscopic removal of granulation tissue. Of those infants and children tracheotomized, all but eight have been decannulated. There were nine deaths; five were due to unrelated underlying disease; four were attributable to complications of long-term tracheostomy. Thus, in the entire series, 85 infants and children required tracheotomy and five deaths may be attributable to long-term tracheostomy complications - a mortality rate of 5.9%.

Child↗
PubMedDate not supplied

Repair of laryngeal stenosis with nasal septal grafts.

Autogenous nasal septal grafts were utilized in 18 dogs. The availability, method of transfer, placement, take, stability and long-term survival of these grafts are presented. Transfer of septal cartilage or composite grafts of nasal mucosa and cartilage to surgically created defects of cricoid and thyroid cartilage was performed on eight animals. Ten animals had composite grafts three months after stenosing procedures. Results were excellent in all grafts to the cricoid and subglottic areas. Grafts to the thyroid and glottic regions were characterized by severe resorption of cartilage and fibrosis. Composite grafts to the glottic area were successful in improving the airway. Results are documented by microlaryngeal photographs and histologic sections. A literature review accompanies the presentation with emphasis on clinical utilization of composite nasal septal grafts. Twelve previously reported cases of repair by this method for laryngeal and upper tracheal stenosis are discussed. A patient with severe traumatic laryngeal stenosis successfully rehabilitated is added to this list and details the clinical value of these grafts.

Aged↗
PubMedDate not supplied

Permanent tracheostomy: a new surgical technique.

A new method of permanent tracheal fenestration is reported, utilizing cervical skin and tracheal flaps. It has been performed on four patients without complications and has the advantage of being a quick, simple, one-stage operation that is reversible should conditions change. The procedure is utilized in patients with posttraumatic or postirradiation fibrosis of the larynx, chronic obstructive pulmonary disease and patients with sleep apnea.

Adult↗
PubMedDate not supplied

Idiopathic subglottic stenosis.

A 2 1/2-year-old child was found to have subglottic stenosis with no obvious etiology. He initially responded well to dilatation, injection of triamcinolone and intermittent stenting of the airway, but four months later developed a marked, unyielding subglottic stenosis requiring tracheostomy. He had a gradual good response to dilatations and injections with triamcinolone and acquired a good subglottic lumen. However, he developed a recurrence following an episode of croup. Systemic steroids were added to the regimen leading to gradual resolution of the stenosis and successful decannulation. The embryogenesis of subglottic stenosis and the correlation with the known anatomy and histology are discussed. Subglottic stenosis may be congenital, traumatic, inflammatory, neoplastic or neurogenic. An additional group of patients has no obvious etiology and are classified as idiopathic. Treatment consists of various combinations of stents, systemic and intralesional steroids, dilatations and various operative procedures in the more refractory cases.

Airway Obstruction↗