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At least 883 records · Page 49Linked to original sources
PubMed1990

Minicricothyrotomy for tracheobronchial toilet.

Thirty-six patients underwent percutaneous cannulation of the cricothyroid membrane, using a small endotracheal tube, for the purpose of repeated suction of secretions from the tracheobronchial tree. The duration of cannulation ranged from 4 to 62 days (average, 12 days). Twenty-eight patients were followed up for a maximum of 3.5 years (mean, 20 months). There were no immediate or delayed postoperative complications. Subglottic stenosis did not occur in any of the patients. Minicricothyrotomy is a relatively safe and simple and efficient technique for tracheobronchial toilet in patients with chronic lung disease and in the postoperative period.

Adolescent↗
PubMed1990

Pulmonary parameters in children after laryngotracheal reconstruction.

Laryngotracheal reconstruction in children with autogenous rib cartilage has proved successful in relieving laryngotracheal stenosis. To date, no objective measurements have been available to assess the upper airway's functional ability in these children after decannulation. A pilot study analyzing pulmonary function in 18 children successfully decannulated after laryngotracheal reconstruction was performed. The children ranged in age from 24 months to 12 years and were several months postdecannulation at the time of testing. The results of this pilot study offer an objective assessment of functional capacity after laryngotracheal reconstruction in older children and serve as a basis for objective follow-up. In younger children, pulmonary function values were difficult to obtain and proved to be of no significant value to the overall assessment of functional capacity of the airway.

Age Factors↗
PubMed1990

Prospective study of subglottic stenosis in intubated neonates.

Although numerous retrospective studies have attempted to investigate the incidence, etiology, and pathogenesis of subglottic stenosis, there have been few prospective studies. The retrospective studies focused initially on diagnosed cases, then drew inferences regarding incidence and causality based upon data obtained from review of patient records. In contrast, this prospective study accrued data on all neonates intubated for 48 hours or longer during the 1-year intake period. There were 195 neonates entered in the study; then 36 were excluded, leaving 159 for data analysis. Parameters assessed included age at intubation (mean, 5.7 days), duration of intubation (mean, 12.3 days), and number of times reintubated (mean, 0.79). Results of this prospective study are compared to results from previous retrospective studies.

Causality↗
PubMed1991

Management of subglottic stenosis in the adult.

Twenty-one adult patients were surgically treated for severe subglottic stenosis refractory to endoscopic treatment. Patients were treated by anterior or anterior and posterior cricoid division with costal cartilage grafting. Seventy-six percent of the patients were successfully decannulated. Success of treatment was not dependent on cause of the stenosis or age or sex of the patient. There was a significantly better outcome (p less than .05) in patients with isolated subglottic stenosis versus those with combined glottic and subglottic stenosis.

Adolescent↗
PubMed1991

Surgical treatment of laryngeal web with mucosa graft.

Surgical treatment of laryngeal webbing varies with the extent and site of the web. An extensive one seems to be best treated by laryngofissure and skin or mucosa transplantation. Recent experiences with four cases of thick glottal webbing indicated that a mucosa graft was better for the voice result than a skin graft. For success in the airway and voice results, the salient points in surgery include 1) precise midline thyrotomy, 2) shaping of the vocal cord under fiberoptic control, and 3) mucosa grafting with the combined use of a pliable stent or fibrin glue for fixation.

Adult↗
PubMed1991

Neonatal and pediatric microsubglottiscope set.

A microsubglottiscope for infants and children has been developed for microlaryngeal surgery in the glottic and subglottic regions of the larynx. The universal handle allows selection of several sizes of blades to be used according to the patient's anatomic limitations. The tips of these blades have been designed specifically to give exposure to the subglottis and upper trachea under microscopic magnification. A needle adapter for jet ventilation has been included. The authors have used this instrument in young infants and children for diagnosis and for laser resection of subglottic stenosis, hemangioma, and suprastomal granuloma, and have found the exposure to be superior to that obtained with conventional microlaryngoscopes.

Child↗
PubMed1991

Microtrapdoor flap repair of laryngeal and tracheal stenosis.

Twenty patients have undergone repair of laryngeal and tracheal stenosis by microtrapdoor accessing of scar or soft tissue and removal with the carbon dioxide laser. A total of 34 flap procedures were performed in the 20 patients. Follow-up ranged from 8 months to 4 years, and 30 of these flaps were considered successful on the basis of improvement of the airway. The only complications were postoperative granulation tissue in 2 patients that responded to endoscopic removal.

Adult↗
PubMed1991

Epiglottoplasty for reconstruction of posttraumatic laryngeal stenosis.

Laryngeal stenosis secondary to blunt laryngeal trauma is mostly localized at the supraglottic and glottic levels. The epiglottis is ideally suited to reconstruct the defect after excision of supraglottic and glottic scar tissue and anterior thyroid cartilage. It is the conclusion of the authors that epiglottic reconstruction is an effective procedure for repair of laryngeal stenosis at the supracricoid level. Two case reports are given.

Adult↗
PubMed1991

Endoscopic holmium laser laryngotracheoplasty in animal models.

Subglottic stenosis remains a difficult clinical problem with varied management approaches. An accepted procedure has been anterior and posterior cricoid incisions through an external approach for treatment of severe stenoses without a tracheotomy. The holmium:yttrium-aluminum-garnet laser, 2.1 microns wavelength with a pulsed output, is transmissible through standard fibers and ablates soft tissue and cartilage with minimal surrounding damage. This study in in vitro and in vivo animal models shows that this new laser can be used to incise the anterior and posterior cricoid and tracheal cartilages with precise control and may be suitable for endoscopic laryngotracheoplasty.

Animals↗
PubMed1992

Treatment of tracheal and endobronchial lesions with the potassium titanyl phosphate laser.

Lower tracheal and endobronchial lesions represent a difficult management problem. While there has been some success in the treatment of these lesions with the carbon dioxide laser, the limitations of its delivery system have restricted its use in infants and neonates. The potassium titanyl phosphate (KTP) laser, transmitted via a flexible quartz fiber, can be precisely manipulated even through rigid pediatric bronchoscopes as small as 3.0 mm. In addition, the Hopkins telescopic lens may be used to improve visualization and control. We report our experience using the KTP laser to treat 15 pediatric patients with tracheal and endobronchial lesions. The nature of the lesions, the details of the technique, and the results are presented.

Adolescent↗
PubMed1992

Pediatric airway reconstruction at Great Ormond Street: a ten-year review. II. Revisional airway reconstruction.

One hundred eight consecutive patients with pediatric laryngotracheal stenosis requiring airway reconstruction over a 10-year period were reviewed. Thirty-two patients required revisional airway reconstruction in an attempt to achieve decannulation. Patients underwent from one to four revisional airway reconstructions, most often laryngotracheal reconstruction with costal cartilage grafting. In the Cotton grading scheme of preoperative stenosis, those patients requiring revisional airway surgery tended to come from the more severely affected categories. Twenty-two patients of 32 (69%) achieved decannulation with revisional airway reconstruction. Thus, revisional airway reconstruction is indicated if the first attempt fails.

Child↗
PubMed1992

Stenting for pediatric laryngotracheal stenosis.

The treatment of pediatric laryngotracheal stenosis using open surgery to expand the airway has become a widely accepted and effective method. Stents and cartilage grafts represent the main features of expansion laryngotracheal surgery, which is indicated after failure of endoscopic treatment and/or in the presence of severe stenosis. Stenting is needed in all situations with the exception of using a single cartilage graft in the anterior subglottic lumen. There are several options available for stenting. The most valuable and commonly used stents are the Aboulker stent and the Silastic sheet roll. In looking for the features of an ideal stent, I analyzed 51 procedures using the Aboulker stent on 48 patients. The purpose of this report is to discuss these features and relate them to the Aboulker stent.

Child↗
PubMed1992

Pediatric airway reconstruction at Great Ormond Street: a ten-year review. III. Decannulation and suprastomal collapse.

One hundred eight consecutive patients with pediatric laryngotracheal stenosis requiring airway reconstruction over a 10-year period were reviewed. Ninety (83%) of the patients were decannulated. Over three quarters of the decannulations took place within 20 months of primary reconstruction. More than half of the patients (47, or 52%) had persistent tracheocutaneous fistulae after decannulation, which required elective closure. The likelihood of a persisting tracheocutaneous fistula is directly related to duration of cannulation.

Bronchoscopy↗
PubMed1992

Phonation and swallowing considerations in pediatric laryngotracheal reconstruction.

Experience with laryngotracheal reconstruction (LTR) has resulted in and continues to yield modifications and refinements in approach and technique with the goal to restore and maintain total laryngeal function. In addition to airway obstruction, the laryngeal functions of phonation and swallowing also may be affected by the underlying injury as well as by procedures designed to enlarge the airway. This paper discusses various problems encountered with phonation and swallowing in pediatric patients who underwent LTR and postoperative patients who were seen during the year July 1, 1990, through June 30, 1991. Phonation problems became apparent as long-term difficulties that persisted after tracheotomy decannulation. Swallowing was frequently a short-term perioperative problem while a stent was in place following LTR. The approaches and techniques that have been employed to treat, minimize, and prevent these problems are discussed.

Adolescent↗
PubMed1992

Subglottic ulceration and healing following endotracheal intubation in the neonate: a morphometric study.

In neonates, acquired subglottic stenosis is the most serious long-term complication of endotracheal intubation and is due primarily to posttraumatic fibrosis of the infant larynx. We have examined 78 larynges, 75 of which were intubated, from infants ranging in gestation from 22 to 40 weeks, and who survived from a few hours to up to 300 days. Each larynx was morphometrically assessed for the extent of acute injury, indicated by the percentage of epithelial loss, and healing, indicated by the percentage of a subglottic ulcer covered by metaplastic squamous epithelium. Results show that acute injury is almost invariable, and up to 100% of the subglottic epithelium may be lost within a few hours of intubation, but that progression of injury is relatively short-lived. Ulcer healing starts after a few days, rapidly progresses from day 10, and in the majority of cases is complete after 30 days. This study suggests that long-standing acute injury in the subglottis is the exception rather than the rule, even with the endotracheal tube remaining in place.

Humans↗
PubMed1992

Laryngotracheal reconstruction in adults with the sternocleidomastoid myoperiosteal flap.

Subglottic or tracheal reconstruction may be required in cases of subglottic stenosis, invasive thyroid carcinoma, or trauma. The sternocleidomastoid myoperiosteal flap uses clavicular periosteum on a muscle pedicle to provide vascularity. Clavicular periosteum is fibrous and durable and will conform to the shape of the trachea, forming bone to provide stability to the airway. The procedure is relatively simple and involves single-stage reconstruction. Success has been achieved in reconstruction of long-standing subglottic and/or tracheal stenosis and in cases of extreme tracheal defects. On the basis of 8 years' experience with this flap, we present the results from a series of 26 patients who underwent subglottic or tracheal reconstruction with the sternocleidomastoid myoperiosteal flap. Twenty-five of the 26 patients were successfully decannulated. Complications have been expanded to include one case of osteomyelitis of the sternum with mediastinitis, and 1 patient required revision. Subsequently, modifications of technique and patient management have been adopted. The complications compare favorably in frequency and in seriousness with those of other techniques for laryngotracheal reconstruction. We describe additional experience with this procedure and longer follow-up to establish its position as a first-line reconstructive approach for widespread clinical use.

Adult↗
PubMed1993

Endoscopic laser medial arytenoidectomy for airway management in bilateral laryngeal paralysis.

A review of our recent experience in patients with bilateral laryngeal paralysis is described. While we continue to use phrenic nerve transfers in patients with mobile arytenoids, patients with fixed arytenoids generally require some sort of vocal cord lateralization, either by arytenoidectomy and arytenoidopexy or by partial vocal cord resection. The endoscopic laser medial arytenoidectomy is a convenient and effective method for opening the posterior glottic airway. One arytenoid is reduced medially with the carbon dioxide laser. After about 3 months the opposite arytenoid can be treated similarly, if necessary. The procedure does not appear to affect arytenoid mobility, as the posterior commissure mucosa and underlying interarytenoid muscle are protected and hence unaffected by the procedure. Those patients with at least one mobile arytenoid cartilage are candidates for posterior cricoarytenoid muscle reinnervation. Although ansa cervicalis and phrenic nerve techniques have been described, the author has concentrated efforts on the phrenic nerve. This report describes the endoscopic laser medial arytenoidectomy procedure, while the phrenic nerve patients will be reported in a subsequent manuscript.

Arytenoid Cartilage↗
PubMed1993

Laryngotracheal reconstruction for subglottic stenosis.

Laryngotracheal reconstruction (LTR) has been employed for the treatment of severe laryngotracheal stenosis for the past 6 years at Johns Hopkins Hospital. Thirty-one children underwent LTR with costal cartilage grafting, 24 of whom had Aboulker stents placed. Short stents were used in 22 patients. Six patients received definitive treatment in a single-stage LTR; 1 child had no stent placed. Twenty-six (84%) of the 31 patients were decannulated. It was concluded that decannulation can be obtained in selected patients with the short Aboulker stent or single-stage LTR. A new classification system for laryngotracheal stenosis, based on objective measurements and the separate analysis of posterior glottic fibrosis, was developed. The proposed classification system allows recommendations for treatment. Moreover, it can be easily reproduced and may facilitate comparison of results.

Cartilage↗