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Abstract
OBJECTIVES/HYPOTHESIS Tracheostomy is a commonly performed operative procedure that has been described since 2000 B.C. The early indications for tracheostomy were for upper airway obstruction, usually occurring in young people as a result of an infectious process. Recently, tracheostomies are more commonly performed in the critically ill patient to assist in long-term ventilatory support. Granulation tissue at the stoma and the trachea has been described as a late complication resulting in bleeding, drainage, and difficulty with maintaining mechanical ventilatory support. STUDY DESIGN The present report is of an observational study of a newly implemented policy that required regular changing of tracheostomy tubes. Comparable groups of patients were compared before and after this procedural change to document complications. Data collection consisted of chart reviews of all admissions for 1 year before the policy change and the subsequent 2 years. Complication rates were compared using standard statistical techniques. METHODS A policy change was instituted that required all tracheostomy tubes to be changed every 2 weeks in conjunction with a detailed evaluation of the tracheostomy stoma. Charts were reviewed the year before the change in policy and in the subsequent 2 years to determine the incidence of granulation tissue requiring operative intervention. RESULTS The number of patients requiring surgical intervention secondary to granulation tissue showed a statistically significant decrease (P =.02). A review of policies and procedures from the six largest hospitals in southeastern Michigan had no recommendations for routine tracheostomy tube changes. CONCLUSIONS A policy requiring a routine change of tracheostomy tubes results in fewer complications from granulation tissue. Tracheostomy tube changes to prevent granulation tissue and its complications.
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Hotchkiss KS, McCaffrey JC. Laryngotracheal injury after percutaneous dilational tracheostomy in cadaver specimens. Laryngoscope 2003; 113:16-20. [PMID: 12514375 DOI: 10.1097/00005537-200301000-00003] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To evaluate the stoma and surrounding insertion site for common laryngotracheal injury patterns after percutaneous dilational tracheostomy that may contribute to clinically significant tracheal stenosis. STUDY DESIGN Preliminary prospective cadaver study. METHODS A preliminary prospective cadaver study was performed in which percutaneous dilational tracheostomy (Ciaglia Blue Rhino kit) was placed in six fixed cadaveric specimens. Laryngotracheal segments were harvested. Two independent evaluators graded cadaver features and characteristic injuries in laryngotracheal specimens the tracheal site of stoma placement was identified. Cadaver features evaluated included gender, obesity, and ease of landmark identification. Mucosal and cartilage injuries were evaluated on a scale of 0 to 4, with 4 representing severe comminuted injuries beyond the intended stoma site. RESULTS Accurate prediction of tracheal placement was achieved in only three (50%) of the specimens. In the remaining cadavers, one stoma site was placed higher than intended (16%) and two sites were lower than intended (33%). Mucosal injury was most severe at the anterior internal surface of the trachea with all specimens sustaining tears beyond one tracheal ring (mean mucosal injury score, 3.5). Cartilaginous injury was severe in five of six specimens (83%) that sustained multiple comminuted injuries to two or more adjacent rings (mean cartilage injury score, 3.34). Cricoid comminutions and a posterior membranous tracheal wall injury were each found in one specimen. CONCLUSIONS Laryngotracheal injuries found after percutaneous dilational tracheostomy in the study indicated that severe damage to mucosa and cartilage surrounding the intended stoma site occurs at the time of placement. These injuries may contribute to clinically significant tracheal stenosis preventing decannulation in patients undergoing percutaneous dilational tracheostomy. Two case studies that support this hypothesis are also presented.
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Granja C, Faraldo S, Laguna P, Góis L. [Control of the endotracheal cuff balloon pressure as a method of preventing laryngotracheal lesions in critically ill intubated patients]. REVISTA ESPANOLA DE ANESTESIOLOGIA Y REANIMACION 2002; 49:137-40. [PMID: 12136455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/25/2023]
Abstract
OBJECTIVES To study the development of tracheal stenosis after endotracheal intubation, percutaneous tracheotomy or both; to assess risk factors for tracheal stenosis and the relation of risk to endotracheal cuff pressure. PATIENTS AND METHODS A prospective study enrolling patients sustaining endotracheal intubation longer than 8 hours and/or undergoing percutaneous tracheotomy. Cuff pressure was recorded at the moment of intubation and every 8 hours thereafter; a ceiling of 25 mm Hg was targeted. The patients were examined 6 months after discharge. RESULTS Sixteen percutaneous tracheotomies were performed in the 95 patients enrolled (58 men, 37 women). The mean age was 54.1 +/- 19.7 years. The mean APACHE II score for all patients was 16.3 +/- 7.7 and the mean intubation time was 7.3 +/- 11 days, whereas the respective means for patients undergoing percutaneous tracheotomy were 18.4 +/- 7.6 and 20.5 +/- 19 days. Six months after discharge, 55 patients were examined for laryngotracheal lesions by fiberoptic endoscopy. Twenty-three of the remaining patients had died, 7 were lost to follow-up and 10 were only interviewed by telephone. Fiberoptic laryngotracheal endoscopy revealed minimal scarring and reduction of the endotracheal lumen. Reduction of the lumen was observed only in patients who had undergone percutaneous tracheotomy. CONCLUSIONS Monitoring cuff pressure three times per day seems to contribute to preventing ischemic lesions and tracheal stenosis.
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Behrend M, Klempnauer J. Tracheal reconstruction under tension: an experimental study in sheep. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2001; 27:581-8. [PMID: 11520093 DOI: 10.1053/ejso.2001.1165] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
AIMS Invasion of the trachea by thyroid cancer is a difficult problem. Circumferential resection and end-to-end reconstruction is the treatment of choice. The objective of our study was to investigate the effect of tension on tracheal healing and stenosis formation, and to ascertain the maximum tolerable tension. METHODS Tracheal resections of 3, 6 and 9 cm with end-to-end anastomosis were performed on 25 sheep. The intraoperative force required for approximation of the tracheal stumps was measured. Luminal stenosis was determined with the aid of computerized planimetry 1, 2, 4, 8 and 24 weeks post-operatively. RESULTS A gradual increase of the stenosis rate occurred with increasing tension on the anastomosis. Acceptable results were achieved in the majority of cases without release techniques or tension suture. CONCLUSIONS Tracheal anastomosis under tension does not always lead to disruption or separation of the anastomosis. With the additional use of release manoeuvres and tension sutures, tracheal anastomosis under tension are possible without severe stenosis. The additional use of temporary stenting needs to be elucidated.
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Le Huu L, Phan Thanh H, Hoeffel CC. [Active tracheo-bronchial caseous tuberculosis. Ten patients]. REVUE DE PNEUMOLOGIE CLINIQUE 2001; 57:289-295. [PMID: 11593155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
BACKGROUND We report 10 cases of active endobronchial tuberculosis in female patients. PATIENTS AND METHODS Diagnosis of endobronchial tuberculosis was established by demonstrating the presence of Koch bacilli in the bronchial washings or at pathology examination of a bronchial mucosa biopsy. Follow-up was available for 5 of the 10 cases. RESULTS These women were aged 19 to 756 years. Clinical signs included persistent cough (n=10), wheezing (n=10), dyspnea (n=5), dysphonia (n=4) and fever (n=8). Chest x-ray was normal in 4 cases but showed condensation in 4 others with infiltration of the superior lobe in 2 cases. Bronchoscopy findings were characteristic with a thick layer of white caseum on the mucosa. Koch bacilli were found in all bronchial wash specimens. Pathology examination confirmed the diagnosis of tuberculosis in 5 of the 10 cases.
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Parshin VD, Gudovskiĭ LM, Rusakov MA, Vyzhigina MA. [Post-resuscitation cicatricial stenosis of the trachea: causes, prevention and first emergency care]. ANESTEZIOLOGIIA I REANIMATOLOGIIA 2001:33-7. [PMID: 11510354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/21/2023]
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Chizh GI. [Method of non-cannula tracheostoma creation after laryngeal extirpation]. Vestn Otorinolaringol 2000:50-1. [PMID: 10771615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
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Janni A, Menconi G, Mussi A, Ambrogi MC, Angeletti CA. Postintubation tracheal tear repair by cervicotomy and longitudinal tracheotomy. Ann Thorac Surg 2000; 69:243-4. [PMID: 10654522 DOI: 10.1016/s0003-4975(99)01319-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
BACKGROUND Membranous tracheal lacerations are a serious complication of endotracheal intubation. Smaller tears are often better managed with a conservative treatment. Larger ruptures, especially when associated with important manifestations, need an early surgical repair. METHODS In the last 3 years, three female patients with a posterior tracheal wall laceration, related to endotracheal intubation, underwent surgical procedure in our institution. All tracheal tears were repaired with a running suture through a small cervical collar incision and longitudinal tracheotomy. RESULTS All surgical procedures were effective and lasted less than 1 hour. Patients were discharged on average after 5 days. Endoscopic follow-up showed a perfect repair of the tear without signs of tracheal stenosis. CONCLUSIONS This is a reliable, quick, and safe approach to a rare but insidious complication of general anesthesia. It avoids lateral and posterior dissection of the trachea, reducing the risk of a recurrent laryngeal nerve injury.
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Eliashar R, Eliachar I, Esclamado R, Gramlich T, Strome M. Can topical mitomycin prevent laryngotracheal stenosis? Laryngoscope 1999; 109:1594-600. [PMID: 10522927 DOI: 10.1097/00005537-199910000-00009] [Citation(s) in RCA: 90] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES/HYPOTHESIS Early topical application of mitomycin to a laryngotracheal lesion may prevent or reduce laryngotracheal stenosis (LTS). STUDY DESIGN Prospective controlled animal study. METHODS LTS was induced in 60 dogs randomly assigned to four groups. Controls received an immediate topical application of normal saline. The suction-control group received an immediate application of normal saline followed by suction of secretions on day 2. The mitomycin group received immediate application of 0.7 mL mitomycin (0.2 mg/mL). The repeat-mitomycin group received an immediate application of mitomycin and a second application on day 2, after secretions were suctioned. The laryngeal lumens were measured endoscopically at baseline, day 12, and day 21. Animals were euthanatized if stenosis approximated 95% or at day 21. RESULTS All dogs in the mitomycin groups survived to day 21, compared with 12 in the suction group and only 2 controls. No side effects of mitomycin were observed. At day 21, surviving controls had 85% and 95% stenosis. In the mitomycin group, median stenosis was 27% (interquartile range, 29% to 42%); in the repeat-mitomycin group, 30% (22% to 40%); and in the suction-control group, 84.5% (72.5% to 93.5%). The mitomycin group differed significantly from controls on day 12 (median difference = 85%, 95% CI = 80%-94%, P < .0001) and day 21 (difference = 63.9%, 95% CI = 58%-85%, P = .031). CONCLUSION A single topical application of mitomycin significantly reduces the severity of LTS in dogs. Reapplication after 2 days does not improve results. Prospective clinical studies are warranted to assess the efficacy in humans.
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Abstract
OBJECTIVE To demonstrate the potential use of Mitomycin-C (MMC) in the treatment of difficult and recurrent tracheal stenosis. DESIGN Case series. SETTING Tertiary care setting. PATIENTS A retrospective chart review was performed on five pediatric patients with severe, recurrent tracheal granulation and cicatrix after tracheal reconstruction who were treated with topical MMC as an adjunct to bronchoscopy and laser treatment. MMC was applied intraoperatively on saturated pledgets at a dose of 0.1 mg/ml for 2 min to the area where the cicatrix had been lysed. The five patients were able to be decannulated. DISCUSSION Mitomycin-C is an anti metabolite known to inhibit fibroblast proliferation in vitro. This agent has been used with a high success rate in glaucoma filtration surgery to promote patency of the trabecula. The results of this preliminary application in the pediatric airway as well as the mechanism of action will be discussed.
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Abstract
We report a case of primary tuberculous tracheitis in an otherwise healthy woman who presented with cough and stridor due to diffuse tracheal narrowing by tuberculous pseudomembranous lesion, which resolved completely with antituberculosis chemotherapy.
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Jorge RG, Armengod AC, Caravajal JM. As originally published in 1990: Experimental study of a new porous tracheal prosthesis. Updated in 1998. Ann Thorac Surg 1998; 65:1830-1. [PMID: 9647122 DOI: 10.1016/s0003-4975(98)00341-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Vlantis AC, Marres HA, van den Hoogen FJ. A surgical technique to prevent tracheostomal stenosis after laryngectomy. Laryngoscope 1998; 108:134-7. [PMID: 9432083 DOI: 10.1097/00005537-199801000-00026] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Tracheostomal stenosis after total laryngectomy is a frequently occurring nuisance to both the patient and the surgeon. Although many causes may contribute to the development of tracheostomal stenosis, operative technique seems to play a major role. The authors describe and explain their method of stomal construction. Over a 10-year period they have used the described method on 260 patients undergoing a total laryngectomy, with an incidence of tracheostomal stenosis of 6%.
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Gonzálvez-Piñera J, Pérez-Martínez A, Marco-Macián A, García-Olmo D. An experimental model for the prevention of postanastomotic tracheal stenosis. J Thorac Cardiovasc Surg 1997; 114:76-83. [PMID: 9240296 DOI: 10.1016/s0022-5223(97)70119-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE The aim of the current study is to determine the efficiency of an external prosthesis made of expanded polytetrafluoroethylene reinforced with a continuous silicone spiral to prevent postanastomotic stenosis after surgical correction of extensive tracheal defects in rabbits. METHODS Forty-five rabbits were used, divided into three groups of 15 animals each. Group A was the control group. Group B animals underwent resection of six-ring segments of the cervical trachea and primary anastomosis. The procedure used in group C was similar to that used in group B, but the tracheal anastomosis was supported by an external expanded polytetrafluoroethylene prosthesis. RESULTS Direct anastomosis after resection of six tracheal rings caused anastomotic stenosis in 100% of the animals. We did not observe tracheal stenosis in any rabbit when we applied an expanded polytetrafluoroethylene tube as an external stent for the tracheotracheal suture. CONCLUSION We conclude that an external stent can be used to prevent tracheal stenosis resulting from the resection of six cervical tracheal rings in rabbits.
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Dumon MC, Dejean B, Hugouvieux C, Lichtle C, Leclerc ML. [Iatrogenic tracheal stenosis. Prevention of iatrogenic complications]. SOINS. CHIRURGIE (PARIS, FRANCE : 1982) 1996:31-2. [PMID: 9026867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
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Kai Y, Yamaoka A, Irita K, Zaitsu A, Takahashi S. [Transient tracheal obstruction during surgical correction of scoliosis in a patient with Marfan's syndrome]. MASUI. THE JAPANESE JOURNAL OF ANESTHESIOLOGY 1995; 44:868-73. [PMID: 7637168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
A 13-yr-old male with Marfan's syndrome underwent surgical correction of severe scoliosis. He had not manifested dyspnea previously in any position. Under anesthesia with thiamylal and vecuronium, his trachea was intubated with a reinforced endotracheal tube without any difficulty. Anesthesia was maintained with nitrous oxide and fentanyl, 8 micrograms.kg-1. The patient was placed in a prone position. Thirty min after the start of operation, when orthopedists compressed the thoracic vertebrae vertically, positive pressure ventilation became impossible abruptly, even with a high airway pressure. Three min later, ventilation became possible after cessation of compression and by mouth-to-tube insufflation. SpO2 monitored with a pulse oximeter recovered immediately from 61% to 99%. A capnogram showed a lengthy retardation of an inspiratory phase. Emergency fibreoptic bronchoscopy revealed that the trachea had been compressed vertically; the compression was reduced by moving the chest supporters laterally. After the apneic episode, the operation continued uneventfully, and he was discharged a month later. A severe deformity of the thorax due to severe scoliosis and weak tracheal tissue due to connective tissue defect caused partial tracheal compression before the surgery, and made his trachea susceptible to complete obstruction by vertical external compression on the thorax. Patients with Marfan's syndrome and scoliosis should have careful preoperative airway evaluation. The selection and positioning of endotracheal tubes should be done with care. During surgery, the patient's body position and the condition of the trachea should be checked frequently. Capnography and fiberoptic bronchoscopy seem to be mandatory for early detection of tracheal stenosis and prevention of tracheal obstruction.
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Chelly H, Amamou M, Ben Lakhal S, Ben Salah N, Thabet H, Yakoub M. [Complications of endotracheal intubation and tracheotomy. Retrospective study of 797 cases]. LA TUNISIE MEDICALE 1994; 72:687-92. [PMID: 7624976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
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Hoheisel G, Chan BK, Chan CH, Chan KS, Teschler H, Costabel U. Endobronchial tuberculosis: diagnostic features and therapeutic outcome. Respir Med 1994; 88:593-7. [PMID: 7991884 DOI: 10.1016/s0954-6111(05)80007-1] [Citation(s) in RCA: 77] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
BACKGROUND Endobronchial tuberculosis (EBTB) is not seen often in the adult population. In most cases it is associated with pulmonary tuberculosis. During its course significant tracheobronchial stenosis may develop. In this study we report our experience with patients with EBTB. METHODS The records of 38 patients in whom EBTB had been proved by fibre optic bronchoscopy, microbiology and histology studies were evaluated. RESULTS Symptoms were non-specific and represented mainly the co-existing pulmonary tuberculosis. Signs characteristic of airway obstruction were rare (localized wheezing in 6%). Indications for bronchoscopy were radiographic features (87%), microscopy smear negatives (8%), wheezing (3%), and blood stained sputum (3%). The lesions were more likely to be seen in the main and upper bronchi. In 5% of patients the lower trachea was involved. Most lesions looked inflamed (51%), followed by caseous (19%), granulomatous (17%), ulcerative (12%), and fibrotic appearance (1%). The degree of stenosis was nil (22%), minor (45%), significant (13%), subtotal (13%), or total (7%). The patients were treated with a combination of antituberculosis drugs. Four patients underwent surgical procedures. Dilatation techniques were used in two patients for a right and left main bronchus stenosis respectively, with significant improvement in one. Dilatation in combination with laser therapy of a right intermediate bronchus stenosis did not result in re-expansion of the dependent part of the lung due to pleural adhesions. Left pneumonectomy was performed in one patient for destroyed lung. Twenty-two patients agreed to follow up bronchoscopy. The macroscopic appearance of the mucosa had improved in most cases but the degree of stenoses was unchanged in a considerable proportion (58%). Bronchial stenosis in one patient subsided during therapy but developed again at a later stage. CONCLUSIONS Patients with pulmonary tuberculosis and radiographic evidence of volume loss are recommended to undergo bronchoscopy to rule out EBTB. Specific symptoms for EBTB are rare. Biopsy of inflamed areas of bronchial mucosa seems to be indicated. Despite adequate antituberculosis therapy tracheobronchial stenosis may develop. Long term follow up including bronchoscopy seems therefore advocated. Dilatational intervention may be indicated in selected cases.
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Duff BE, Wenig BL, Applebaum EL, Yeates DB, Wenig BM, Holinger LD. Tracheal reconstruction using an epithelial equivalent. Laryngoscope 1994; 104:409-14. [PMID: 8164478 DOI: 10.1288/00005537-199404000-00003] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
The application of a rapidly vascularized epithelial equivalent that inhibits wound contraction would have great potential in the prevention and repair of tracheal stenosis. An animal model was developed to simulate the effects of circumferential tracheal injury and an autologous epithelial equivalent was created from a fibroblast-collagen matrix and subsequently implanted in the traumatized site in an attempt to prevent stenosis. Postinjury physiologic and histologic evaluation revealed near-normal mucosal flow analysis in the treated sites and an area of less than 20% stenosis versus 95+% in controls. This study's findings indicate that tracheal stenosis can be limited by the use of an epithelial equivalent.
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Abstract
This article describes a technique of making custom flexible and combined flexible/rigid tracheostoma vents. The combined flexible rigid tracheostoma vent provides a flexible material that is nonirritating in the peristomial region and maintains a patent tracheostoma by the rigidity of the hard acrylic resin section. The flexible tracheostoma vent can be easily inserted and is more comfortable than the rigid commercially available tracheostomy tube. The use of microwave-cured materials permits fabrication during a single visit. The steps involved in the fabrication of the tracheostoma vents are simple and require no elaborate laboratory equipment.
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Abstract
Failure of decannulation after paediatric tracheostomy, once the underlying disorder has resolved, is almost always due to peristomal complications. Granulation tissue formation in the raw tissue of the stoma and its subsequent fibrosis requires removal (50 of the 293 tracheostomies from the Red Cross War Memorial Children's Hospital). It is suggested that this can be avoided by creating a formal skin-to-trachea stoma at the time of tracheostomy. Suprastomal depression of the anterior wall of the trachea (52/293) appears to be unavoidable when using standard tracheostomy tubes. Localised stomal site tracheomalacia and stenosis (numbers of this complication are unknown) results from damage to cartilage of the trachea either by incision or by necrosis from pressure of the tracheostomy tube. Trauma to the cartilage needs to be minimised by careful design of the tracheal incision. It is suggested that consideration should be given to creating a formal tracheostomy stoma for any paediatric tracheostomy that is likely to be required for more than a short period of time.
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Vol EE, Egorov VM. [Respiratory maintenance of plastic maxillofacial surgeries in children]. Vestn Otorinolaringol 1991:63-6. [PMID: 2048260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Eighty nine children with the cleft lip and cleft palate underwent 95 surgical interventions under ketamine anesthesia. During 51.6% of interventions traditional AVL and during 48.4% of interventions high frequency AVL were used. It was demonstrated that central hemodynamics, systolic time intervals and metabolic parameters were similar in the case of traditional and high frequency AVL; however high frequency AVL proved more efficient in preventing complications during cleft lip and cleft palate surgery.
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Khadartsev AA. [Diagnosis, prevention and treatment of expiratory tracheal and bronchial stenosis]. FEL'DSHER I AKUSHERKA 1989; 54:23-5. [PMID: 2744164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
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