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2007, The Journal of Laryngology & Otology
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6 pages
1 file
Background:The management of laryngotracheal stenosis is still a serious surgical challenge. The fact that there are currently numerous reconstruction procedures indicates that there is at present no standard treatment.Study design:Titanium mesh was used instead of traditional homografts in reconstruction of the anterior laryngotracheal wall in 12 tracheostomised patients with benign chronic laryngotracheal stenosis. The anterior laryngotracheal wall was split, followed by excision of scar tissue and fixation of the titanium plate at the split end. A Silastic®stent was inserted above the tracheostomy tube and fixed in place by running sutures fixed to the skin by buttons. The stent was removed endoscopically six weeks later and a trial of decannulation was undertaken.Results:Endoscopically, good epithelisation was seen on the inner surface of the mesh in 10 cases and decannulation was possible. Four of these patients required endoscopic debulking of granulation tissue. Decannulation...
Journal of Voice, 2010
Background. Subglottic stenosis is congenital or acquired narrowing of subglottic area. The management of subglottic stenosis is still a serious surgical challenge. Although different surgical techniques are accomplished to manage the condition, no standard treatment has been presented yet. Study Design. Titanium mesh was used in the reconstruction of the anterior laryngotracheal wall in 10 tracheostomized patients with laryngotracheal stenosis because of prolonged intubation. The anterior laryngotracheal wall was split, followed by excision of scar tissue. After several weeks, in a second-stage performance, the titanium plate was fixed at the split edges.
European Archives of Oto-Rhino-Laryngology, 2010
Titanium mesh may be an alternative material to be used in laryngotracheal reconstruction. Twenty New Zealand rabbits were divided into two groups. Group A underwent laryngotracheoplasty with titanium mesh-buccal mucosa-muscle complex, and Group B received auricular cartilage grafts. All animals survived without complications. The animals were killed at 60 days, and laryngotracheal regions were evaluated. There was no subglottic collapse at physiologic and supraphysiologic negative airway pressures in Group A and mild-moderate collapse in Group B. Macroscopically the average antero-posterior and lateral diameters were not statistically different among two groups. Light microscopic examination revealed no fibrosis, necrosis or new cartilage formation in both groups. Inflammation and granulation were more pronounced in Group A. The lumens in both groups were moderately obstructed. Reconstruction of the upper airway with titanium mesh may be used in very selected cases where autologous grafting materials are inadequate and unsatisfactory.
The Journal of thoracic and cardiovascular surgery, 2016
Repair of laryngotracheal stenosis with pronounced side-to-side narrowing and involvement of the glottis is challenging and usually requires laryngotracheal reconstruction with rib cartilage interpositions. This technique, as first described by Couraud, needs prolonged postoperative stabilization with Montgomery T-tubes, imposing significant morbidity and discomfort on patients. We describe our initial experience with a modified laryngotracheal reconstruction technique that avoids the need for prolonged postoperative stenting. From November 2012 through May 2015, a series of 5 adult patients with glottosubglottic stenosis were operated in our institution. All patients had pronounced scar formation in combination with advanced side-to-side narrowing extending up to the level of the vocal folds. Operative technique consisted of a complete anterior and posterior laryngeal split followed by rib cartilage interposition in the cricoid plate posteriorly to enlarge the glottosubglottic diam...
Otolaryngology - Head and Neck Surgery, 1997
A new technique using endoscopically introduced, expandable stents for the management of upper airway stenosis is presented. Evaluation of this technique in the canine model forms the basis of this pilot study. Stenosis was surgically induced in a controlled fashion by resection of cartilage from the anterior cricoid arch and tracheal wall to reduce the airway diameter by approximately 50%. A period of 8 weeks was allowed for complete healing and maturation of the surgical stenosis. This was followed by endoscopic introduction of expandable titanium-mesh stents. The stents were then balloon-inflated to dilate the stenotic region. Airway patency was assessed clinically, radiologically, and endoscopically, before expansion and at 4 and 8 weeks after expansion. This assessment was followed by euthanasia of the animals and gross examination of the expanded stenotic segments. in general, the stents were well tolerated with adequate expansion of the airway, in some instances granulation tissue formation was noted around the stents. This was less pronounced when stents coated with Tecofiex (Advanced Surgical intervention Co., San Clemente, Calif.) were used. This is probably because of their "inert" nature, which induces less tissue reaction. A literature review of the subject is presented. The significance of this endoscopic modality for management of upper airway stenosis is discussed, and the indications, alternatives, potential pitfalls, and complications are depicted. (Otolaryngol Head Neck Surg 1997;116:97-103.) I Laryngotracheal stenosis (LTS) may result from various insults to the upper airway, including prolonged endotracheal intubation, tracheostomy, direct trauma, postsurgical resections and reconstructions, congenital lesions, and tumors.t The ventilatory effects of permanent upper airway narrowing can be incapacitating and potentially lethal.2 The goals of any treatment modality, in order of priority axe (1) to maintain a patent airway, (2) to maintain glottic competence for airway protection against aspiration, and (3) to maintain an acceptable voice quality.
Otolaryngology - Head and Neck Surgery, 1997
Many surgical procedures, including laryngotracheal expansion with or without grafting, have been suggested for repairing laryngotracheal stenosis in children, and although a variety of stents have been described, the practice of prolonged stenting continues to diminish. We describe 21 pediatric patients with moderate-to-severe subglottic or tracheal stenosis who had laryngotracheal reconstructions with anterior rib cartilage grafts without stenting or intubation. The patients were between 6 months and 7 years of age at the time of surgery. All patients were extubated in the operating room after the procedure was terminated. One patient required reintubation in the intensive care unit for 48 hours after surgery, and another patient required a tracheotomy. Wound infection occurred in one patient. Most patients were discharged to their homes 3 to 5 days after surgery. We report the indications, technique, results, and complications of laryngotracheal reconstruction using a rib graft without stenting.
Annals of the National Academy of Medical Sciences (India), 2019
Introduction Laryngotracheal stenosis (LTS) is mostly due to road traffic accidents, prolonged intubation, and tracheostomy. Objectives This study focused on a 10-year experience on the role of stents in the management of LTS in a tertiary referral hospital. The aims of this study were to study the internal dimensions of the subglottis and upper trachea in the Indian adult population; to study the mucosal response to injury to the subglottis and the trachea; and to develop an ideal stent for use in LTS in a rabbit model. Materials and Methods The authors have been treating patients with LTS since 2000. The present study deals with the experience of 82 cases of LTS treated over the past 10 years using stents as well as surgical procedures such as Shiann Yann Lee tracheoplasty and tracheal resection and anastomosis. The work also involved a focused research on LTS using rabbits by inducing injury to the mucosa of the upper trachea and subglottis and histological study of the response ...
European Archives of Oto-Rhino-Laryngology, 2005
The purpose was to evaluate the outcome following the surgical management of a consecutive series of 26 adult patients with laryngotracheal stenosis of varied etiologies in a tertiary care center. Of the 83 patients who underwent surgery for laryngotracheal stenosis in the Department of Otorhinolaryngology and Head and Neck Surgery, University Hospital of Lausanne, Switzerland, between 1995 and 2003, 26 patients were adults ( ‡16 years) and formed the group that was the focus of this study. The stenosis involved the trachea (20), subglottis (1), subglottis and trachea (2), glottis and subglottis (1) and glottis, subglottis and trachea (2). The etiology of the stenosis was post-intubation injury (n =20), infiltration of the trachea by thyroid tumor (n =3), seeding from a laryngeal tumor at the site of the tracheostoma (n =1), idiopathic progressive subglottic stenosis (n =1) and external laryngeal trauma (n =1). Of the patients, 20 underwent tracheal resection and end-to-end anastomosis, and 5 patients had partial cricotracheal resection and thyrotracheal anastomosis. The length of resection varied from 1.5 to 6 cm, with a median length of 3.4 cm. Eighteen patients were extubated in the operating room, and six patients were extubated during a period of 12 to 72 h after surgery. Two patients were decannulated at 12 and 18 months, respectively. One patient, who developed anastomotic dehiscence 10 days after surgery, underwent revision surgery with a good outcome. On long-term outcome assessment, 15 patients achieved excellent results, 7 patients had a good result and 4 patients died of causes unrelated to surgery (mean follow-up period of 3.6 years). No patient showed evidence of restenosis. The excellent functional results of cricotracheal/tracheal resection and primary anastomosis in this series confirm the efficacy and reliability of this approach towards the management of laryngotracheal stenosis of varied etiologies. Similar to data in the literature, post-intubation injury was the leading cause of stenosis in our series. A resection length of up to 6 cm with laryngeal release procedures (when necessary) was found to be technically feasible.
Otolaryngologic Clinics of North America, 2008
The treatment of laryngotracheal stenosis (LTS) has been a persistent challenge in pediatric otolaryngology. As a result, the management strategies have undergone constant scrutiny and refinement in the last several decades. The initial description of cricoid framework expansion using costal cartilage was described by Fearon and Cotton [1] in 1972. Although the initial open techniques for laryngotracheal reconstruction (LTR) had a high success rate for decannulation, the surgical approach recommended total laryngofissure with prolonged postoperative stenting to prevent restenosis and ensure graft stability. Displacement of the epiglottic petiole can result in blunting of the anteroposterior dimension of the supraglottis at the level of the false vocal cords. Production of scar in the lamina propria inhibits normal vocal cord vibration. Not surprisingly, the resulting anterior commissure blunting, arytenoid fixation, vocal fold asymmetry, and glottic insufficiency often contributed to patient dysphonia. The compromised voice quality was subjectively described as low-pitched, breathy, or hoarse . Objective evaluation of voice quality with fiberoptic laryngoscopy and videolaryngostroboscopy revealed that both voice quality and speech intelligibility were compromised postoperatively . Swallowing difficulties were also encountered in the perioperative period because of long-term stenting.
otolaryngology, 2017
Current trends in laryngeal surgery involve organ-sparing approaches, which do not impair it basic physiology, preserving the respiratory, phonation and swallowing function [2,3,6-13]. Such approach can be safely assumed when planning endoscopic laser, open partial laryngectomy or radiotherapy [1,4,7-15]. Treatment choices depend on the presence of local and regional tumor spread and its distant metastases [1,11]. In early tumors, clinical efficacy of surgery is comparable to the one of radiotherapy. However, radiotherapy cannot be repeated, so the surgery, which can be used as monotherapy or as a part of combined treatment, for instance followed by subsequent radiation therapy, appears a reasonable alternative [1-3,11]. There are many different types of open partial laryngectomies. We can divide them into two main groups: vertical partial laryngectomies (VPL) and open partial horizontal laryngectomies (OPHL) [1,4,5,11,14,16-18]. There are different types of reconstructions for different types of tumor localizations. The Sedlacek-Kambic-Tucker epiglottic reconstruction after vertical partial laryngectomy or are those of the most complicated examples [2,14-16]. Laryngeal reconstruction should restore laryngeal framework stability, undisturbed airflow and epithelial regrowth. It should also ensure sufficient speech quality, while not causing dysphagia [7,19]. Titanium and titanium alloys are currently the most commonly used
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