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Ghauth S, Tan SH. How I do it: novel use of a modified nasopharyngeal airway in laryngotracheal stenosis as a temporary stent. J Laryngol Otol 2024; 138:696-698. [PMID: 37926907 DOI: 10.1017/s0022215123001858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2023]
Abstract
BACKGROUND This paper reports the innovative use of a modified nasopharyngeal airway device as a temporary stent in patients with laryngotracheal stenosis. It also discusses the technique of endoscopic stent placement, and our experience in terms of the indications and suitability. METHOD The nasopharyngeal airway device was modified to use as an airway stent by trimming it to the desired length. Next, the stent was inserted endoscopically and anchored using a novel approach. RESULTS The surgery was performed successfully without complications. The patients had full use of their voice while the stent was in situ. No significant granulation tissue was observed. CONCLUSION This paper demonstrates the feasibility of using a nasopharyngeal airway device as a temporary stent to prevent restenosis in cases where the patients have a strong demand for phonation. The modified nasopharyngeal airway device is potentially very promising, but cases must be selected carefully to avoid compromising efficacy and safety.
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Affiliation(s)
- Sakina Ghauth
- Department of Otolaryngology, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Sien Hui Tan
- Department of Otolaryngology, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
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2
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Acquired supraglottic stenosis. Asian J Surg 2023; 46:1380-1381. [PMID: 36117070 DOI: 10.1016/j.asjsur.2022.08.127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Accepted: 08/30/2022] [Indexed: 11/23/2022] Open
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Melley LE, Alnouri G, Sataloff RT. A Novel Surgical Technique for Posterior Glottic Stenosis Using a Silastic Implant. J Voice 2023; 37:110-116. [PMID: 33358410 DOI: 10.1016/j.jvoice.2020.10.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Accepted: 10/28/2020] [Indexed: 01/11/2023]
Abstract
OBJECTIVES To introduce a novel surgical technique for the management of posterior glottic stenosis (PGS). METHODS Literature review (PubMed 1973-2020) and case example of a patient treated with novel technique by principal investigator (R.T.S.) RESULTS: Numerous techniques for the treatment of PGS have had varying success. Our patient, a 67-year-old male with a 2-year history of posterior glottic stenosis secondary to multiple, prolonged intubations previously had been treated with several surgical and medical interventions. Three weeks following an additional endotracheal intubation, he presented to our office with PGS recurrence, exhibiting hoarseness, and shortness of breath with any physical activity. He was treated with a silastic sheet placed through a tunnel in the stenosis and sutured posteriorly as a stent. The stent was removed 3 weeks later and the remaining stenosis was divided, successfully treating our patient's PGS with long-term improvement in both respiratory and voice complaints. This led to the design of a stent to be used for this purpose. CONCLUSIONS This new surgical technique addresses a complex clinical problem and provides otolaryngologists with a minimally invasive option for the surgical treatment of PGS that offers advantages over existing techniques. The two-stage procedure should reduce the risk of recurrence, but more experience is needed. This novel implant may be a valuable tool in the treatment of select patients with mild-moderate PGS.
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Affiliation(s)
- Lauren E Melley
- Philadelphia College of Osteopathic Medicine, Philadelphia, Pennsylvania
| | - Ghiath Alnouri
- Department of Otolaryngology - Head and Neck Surgery, Drexel University College of Medicine, and Lankenau Institute for Medical Research, Philadelphia, Pennsylvania
| | - Robert T Sataloff
- Department of Otolaryngology - Head and Neck Surgery, Drexel University College of Medicine, and Lankenau Institute for Medical Research, Philadelphia, Pennsylvania.
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Carta F, Piras N, Mariani C, Marrosu V, Tatti M, Chuchueva N, Bekpanov A, Medeulova AR, Shetty SA, Puxeddu R. The surgical treatment of acquired subglottic stenosis in children with double-stage laryngotracheal reconstruction. Int J Pediatr Otorhinolaryngol 2022; 158:111164. [PMID: 35490607 DOI: 10.1016/j.ijporl.2022.111164] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Revised: 12/05/2021] [Accepted: 04/24/2022] [Indexed: 11/18/2022]
Abstract
OBJECTIVES The aim of this study is to report our experience with double-stage laryngotracheal reconstruction with anterior or antero-posterior cartilage grafting in the management of acquired laryngotracheal stenosis in children. Patients were treated by the same surgeon at the UMC National Research Center for Maternal and Child Health of Astana (Kazakhstan), and Sfendiyarov Kazakh National Medical University, Almaty (Kazakhstan). METHODS From November 2011 to September 2019, 9 children underwent surgery for grade III and IV laryngotracheal stenosis according to the European Laryngological Society classification (mean age of 6 years, range of 2-12 years). RESULTS Six patients underwent double-stage laryngotracheal reconstruction with anterior and posterior cartilage graft, and 3 patients underwent double-stage laryngotracheal reconstruction with single anterior cartilage graft. In all patients, a T-tube was used to stabilize the airway (mean time of 5.8 months, range of 5-9 months). One patient required additional dilation with bougies to obtain a viable laryngotracheal diameter. No postoperative complications were observed. One patient experienced recurrence of the stenosis 5 months after double-stage laryngotracheal reconstruction with double anterior and posterior cartilage grafts and is waiting for revision surgery. After a mean follow-up of 14 months (range of 4-36 months), 8 patients are tracheostomy-free, and all patients are feeding tube-free. CONCLUSIONS Double-stage laryngotracheal reconstruction with a single or double cartilage grafting represents a safe and effective option in the management of complete or severe laryngotracheal stenosis.
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Affiliation(s)
- Filippo Carta
- Unit of Otorhinolaryngology, Department of Surgery, Azienda Ospedaliero-Universitaria di Cagliari, University of Cagliari, Italy.
| | - Nicoletta Piras
- Unit of Otorhinolaryngology, Department of Surgery, Azienda Ospedaliero-Universitaria di Cagliari, University of Cagliari, Italy
| | - Cinzia Mariani
- Unit of Otorhinolaryngology, Department of Surgery, Azienda Ospedaliero-Universitaria di Cagliari, University of Cagliari, Italy
| | - Valeria Marrosu
- Unit of Otorhinolaryngology, Department of Surgery, Azienda Ospedaliero-Universitaria di Cagliari, University of Cagliari, Italy
| | - Melania Tatti
- Unit of Otorhinolaryngology, Department of Surgery, Azienda Ospedaliero-Universitaria di Cagliari, University of Cagliari, Italy
| | - Natalia Chuchueva
- I. M. Sechenov First Moscow State Medical University, Moscow, Russian Federation, Central State Medical Academy of Department for Presidential Affairs of the Russian Federation, Moscow, Russia.
| | - Almat Bekpanov
- UMC National Research Center for Mother and Child Health, Astana, Kazakhstan.
| | | | | | - Roberto Puxeddu
- Unit of Otorhinolaryngology, Department of Surgery, Azienda Ospedaliero-Universitaria di Cagliari, University of Cagliari, Italy
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Robinson AE, Prekker ME, Reardon RF, McHale EK, Raleigh SM, Driver BE. Emergency Airway Management in a Patient with a T-Tube Tracheal Stent. J Emerg Med 2022; 62:789-792. [PMID: 35550842 DOI: 10.1016/j.jemermed.2022.02.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Revised: 01/25/2022] [Accepted: 02/25/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND Abnormal anatomy complicates emergency airway management. In this case, we describe definitive airway management in a critically injured emergency department (ED) patient with a history of partial tracheal resection who had a Montgomery T-tube, a type of T-shaped tracheal stent, in place at the time of the motor vehicle collision. The Montgomery T-tube is not a useful artificial airway during resuscitation, as it lacks a cuff or the necessary adapter for positive pressure ventilation. CASE REPORT We describe a case of a 51-year-old man who required emergency airway management after a motor vehicle collision. The patient had a Montgomery T-tube in place, which was removed with facilitation by ketamine sedation and topical anesthesia. The patient was successfully intubated through the tracheal stoma after removal of the T-tube. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Emergency physicians must recognize the Montgomery T-tube, which resembles a standard tracheostomy tube externally, and have some understanding of how to manage a critically ill patient with this rare device in place. When a patient with a Montgomery T-tube in place requires positive pressure ventilation, the device may require emergent removal and replacement with a cuffed tracheostomy or endotracheal tube.
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Affiliation(s)
- Aaron E Robinson
- Department of Emergency Medicine, Hennepin Healthcare, Minneapolis, Minnesota.
| | - Matthew E Prekker
- Department of Emergency Medicine, Hennepin Healthcare, Minneapolis, Minnesota
| | - Robert F Reardon
- Department of Emergency Medicine, Hennepin Healthcare, Minneapolis, Minnesota
| | - Elisabeth K McHale
- Department of Emergency Medicine, Hennepin Healthcare, Minneapolis, Minnesota
| | - Sarah M Raleigh
- Department of Emergency Medicine, Hennepin Healthcare, Minneapolis, Minnesota
| | - Brian E Driver
- Department of Emergency Medicine, Hennepin Healthcare, Minneapolis, Minnesota
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D'Ambrosio PD, Cardoso PFG, Silva PLD, Fernandes PMP, Minamoto H. Management of infantile subglottic hemangioma with T-tube placement and propranolol. J Bras Pneumol 2022; 48:e20210297. [PMID: 35293485 PMCID: PMC8964104 DOI: 10.36416/1806-3756/e20210297] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Affiliation(s)
- Paula Duarte D'Ambrosio
- . Instituto do Coração, Hospital das Clinicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo (SP), Brasil
| | - Paulo F Guerreiro Cardoso
- . Instituto do Coração, Hospital das Clinicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo (SP), Brasil
| | - Priscila Loria da Silva
- . Instituto do Coração, Hospital das Clinicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo (SP), Brasil
| | - Paulo Manoel Pêgo Fernandes
- . Instituto do Coração, Hospital das Clinicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo (SP), Brasil
| | - Hélio Minamoto
- . Instituto do Coração, Hospital das Clinicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo (SP), Brasil
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Shan Q, Huang W, Wang Z, Xue Q, Shi Z, Zhou J, Wu Z, Ding X, Mao A, Shang M, Wang Z. Preliminary Experience With a Novel Metallic Segmented Transcordal Stent Modified With Three-Dimensional Printing for Inoperable Malignant Laryngotracheal Stenosis. Front Oncol 2021; 11:619781. [PMID: 34381701 PMCID: PMC8350761 DOI: 10.3389/fonc.2021.619781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Accepted: 07/05/2021] [Indexed: 11/13/2022] Open
Abstract
Background This study aims to assess the feasibility of a novel metallic segmented transcordal stent modified with three-dimensional (3D) printing for treating inoperable malignant laryngotracheal stenosis and the tolerability of the stent. Methods This was a retrospective study. The stents were individually customized with the aid of 3D printing model based on the anatomic features of each patient’s airway. The stent was composed of two separate segments that corresponded to the larynx and the upper trachea. The stents were barrel-shaped at the proximal end to prevent migration. The proximal end of the stent was located slightly above the vocal cord. The technical and clinical success of stenting procedure, patient tolerability, and stent-related complications of patients were evaluated. Results Ten patients with dyspnea caused by malignant laryngotracheal stenosis underwent implantation of such stents. Technical and clinical success of the stenting procedure were achieved in all patients. For all patients, basic communication in life could be maintained by speaking softly. During follow-up, one patient showed intolerance to the stent, and the stent was retrieved 2 weeks after stenting. Stent migration was found in one patient, and the position of the stent was readjusted. Granulation tissue proliferation was found in two patients and was treated with cryotherapy by bronchoscopy. There were no deaths associated with stenting. Conclusions The individually customized metallic segmented transcordal stent is feasible and tolerable for patients with inoperable malignant laryngotracheal stenosis. The implantation of this stent may serve as a novel alternative treatment for patients who are not suitable for surgery or tracheotomy.
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Affiliation(s)
- Qungang Shan
- Department of Radiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Wei Huang
- Department of Radiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Ziyin Wang
- Department of Radiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Qingsheng Xue
- Department of Anesthesiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Zhihong Shi
- Department of Otolaryngology & Head and Neck Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jianping Zhou
- Department of Respiratory and Critical Care Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Zhiyuan Wu
- Department of Radiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xiaoyi Ding
- Department of Radiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Aiwu Mao
- Department of Interventional Radiology, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Mingyi Shang
- Department of Interventional Radiology, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Zhongmin Wang
- Department of Radiology, RuiJin Hospital/Lu Wan Branch, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Application of Montgomery T-Tube Placement in Treating Cotton-Myer IV Subglottic Airway Atresia after Bi-Level Airway Recanalization. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2021; 2021:5517536. [PMID: 34135990 PMCID: PMC8177995 DOI: 10.1155/2021/5517536] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Revised: 04/01/2021] [Accepted: 04/20/2021] [Indexed: 11/18/2022]
Abstract
Objective The purpose of this study is to explore the effectiveness and safety of Montgomery T-tube placement in treating Cotton-Myer IV subglottic airway atresia after bi-level airway recanalization. Methods This study is a retrospective study. 11 patients who were treated for IV subglottic airway atresia between January 2017 and January 2019 in the Second Affiliated Hospital of Jiaxing University were involved in this study. The 11 patients all had undergone tracheotomies at our hospital, and they were transferred to the Department of Pulmonary and Critical Care Medicine for Montgomery T-tube placement after bi-level airway recanalization when their subglottic airway was atretic. Patients were observed for their clinical manifestations after placement. The effectiveness of T-tube placement after bi-level airway recanalization was assessed. The incidence of short-term and long-term complications after surgery was assessed. Patients were followed up for 3 to 24 months for evaluating their airway recovery. Results T-tubes were successfully placed in 11 patients. The atretic airways of all patients were recanalized after treatment. Eight patients got restoration of vocal ability, and 3 patients could only say simple words. None of the patients needed assisted oxygen inhalation. The SpO2 average level was increased from 95 ± 2% before treatment to 97 ± 3% after treatment. Patients had significant relief of cough or sputum, and they had less difficulty in dyspnea. All short- or long-term complications were self-relieved or controlled without further malignant progression after treatment by doctors. The average postoperative extubating time was (14.86 ± 3.62) months. Conclusion The application of Montgomery T-tube placement in treating Cotton-Myer IV subglottic airway atresia after bi-level airway recanalization is well effective and safe for patients, and it can be promoted in clinical treatment.
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Efficacy and Safety Profile of Montgomery T-Tube Implantation in Patients with Tracheal Stenosis. Can Respir J 2020; 2020:2379814. [PMID: 33082890 PMCID: PMC7563087 DOI: 10.1155/2020/2379814] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Accepted: 09/01/2020] [Indexed: 12/23/2022] Open
Abstract
Background Tracheal stenosis is able to lead to airway obstruction. Objective To evaluate the efficacy and safety profile of Montgomery T-tube implantation in patients with tracheal stenosis. Methods Fifty-two patients with tracheal stenosis diagnosed between 2016 and 2019 were included in this retrospective cohort study. The patients were divided into observation group (n = 25 cases) and control group (n = 27). The therapeutic effect, arterial blood gas analysis, arterial oxygen partial pressure (PaO2), arterial carbon dioxide partial pressure (PaCO2), shortness of breath score, airway diameter change, dyspnea score, quality of life, and safety were compared between the two groups before and after treatment. Results The therapeutic effect of the observation group gained better results than that of the control group (84.00% vs. 62.96%). One week after operation, the pH value, SaO2, PaCO2, shortness of breath score, airway diameter change, dyspnea score, life quality, and incidence of postoperative complications in the observation group exerted better results as compared to the control group. Conclusion The implantation of Montgomery T-tube has effective function in terms of improving the symptoms of dyspnea and the life quality of patients with safety profile in patients harboring tracheal stenosis.
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Allon R, Oren A, Wasserzug O, Fishman G, Fliss DM, Eckstein M, DeRowe A. Combined trans-stomal endotracheal approach to peri-stomal tracheal pathologies in children. Int J Pediatr Otorhinolaryngol 2020; 137:110210. [PMID: 32896340 DOI: 10.1016/j.ijporl.2020.110210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 06/16/2020] [Accepted: 06/16/2020] [Indexed: 11/29/2022]
Abstract
IMPORTANCE Peristomal pathologies in tracheostomized children are common and often difficult to treat. They may preclude decannulation even after the initial pathology that required tracheostomy had been resolved. OBJECTIVE We evaluated the safety and effectiveness of combined direct laryngoscopy and trans-stomal endotracheal surgery in the treatment of pediatric peristomal pathologies. METHODS The medical records of all children and adolescents with tracheostomies who were surgically treated for peristomal pathologies by a combined endotracheal and trans-stomal approach between January 2006 and August 2018 were retrospectively reviewed. Pathologies included stenosis, tracheomalacia, granulation tissue, and a combination of pathologies. Patient demographics and clinical details were retrieved. The primary outcome measure was successful decannulation. Secondary outcome measures were intra- and postoperative complications and number of procedures performed. RESULTS In total, 105 subjects aged 6 months to 17 years who underwent combined direct laryngoscopy and trans-stomal surgery were included. Fifty-two (49.5%) of them were successfully decannulated. The specific decannulation rates were 30.3%, 56%, and 59.6% for tracheal stenosis (TS), suprastomal granulation tissue (SSGT), and both, respectively. Trans-stomal microdebrider resection resulted in decannulation rates of 66.7% for TS and 88.8% for SSGT. Intra- and postoperative complications occurred in 4 (12.1%), 1 (4%), and 9 (20.45%) patients with TS, SSGT, and both, respectively. Older age at the time of first operation (p = .03) and tracheal stenosis (p = .02) were significantly associated with decannulation failure. CONCLUSION Combined direct laryngoscopy and trans-stomal endotracheal surgery can enable decannulation in almost 50% of children with peristomal pathologies, thus obviating open surgery. Multiple procedures may be required, depending upon the type and severity of the pathology. Complications are more common with multiple pathologies.
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Affiliation(s)
- Raviv Allon
- Pediatric Otolaryngology Unit, "Dana-Dwek" Children's Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Asaf Oren
- Pediatric Otolaryngology Unit, "Dana-Dwek" Children's Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Oshri Wasserzug
- Pediatric Otolaryngology Unit, "Dana-Dwek" Children's Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; Department of Otolaryngology, Head & Neck and Maxillofacial Surgery, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Gadi Fishman
- Pediatric Otolaryngology Unit, "Dana-Dwek" Children's Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; Department of Otolaryngology, Head & Neck and Maxillofacial Surgery, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Dan M Fliss
- Department of Otolaryngology, Head & Neck and Maxillofacial Surgery, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Margaret Eckstein
- Department of Anesthesiology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ari DeRowe
- Pediatric Otolaryngology Unit, "Dana-Dwek" Children's Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; Department of Otolaryngology, Head & Neck and Maxillofacial Surgery, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
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Aydogmus U, Kis A, Ugurlu E, Ozturk G. Superior Strategy in Benign Tracheal Stenosis Treatment: Surgery or Endoscopy? Thorac Cardiovasc Surg 2020; 69:756-763. [PMID: 32886930 DOI: 10.1055/s-0040-1715435] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Due to the variations in (laryngeal) tracheal stenosis (TS) patient groups, there is still no consensus on which patient should be treated with endoscopy or surgery. The aim of the present study was to generate an algorithm in the light of the related literature and the data obtained from a clinic where both endoscopic and surgical treatments are conducted. METHOD A retrospective analysis was performed on the data of a total of 56 patients during 2013 to 2019. A total of 38 patients were subject to surgery with 31 as a first treatment option and 7 due to the unsatisfactory results of endoscopic treatments. Endoscopic approaches were tried on a total of 29 patients with 25 as initial treatment and 4 due to postsurgical recurrence. RESULTS Symptomatic full control ratio was determined as 69% with endoscopic treatments, 89.5% in subglottic stenosis (SGS) surgery (n = 19), and 89.5% in trachea surgery (n = 19). However, success rates with no recurrence were determined, respectively, as 40.0, 36.4, and 36.4% for patients subject to dilatation, stent, or T tube treatment. Dilatation was observed to be successful in patients with stenotic segment lengths of less than 1.5 cm (p = 0.02). Failure rates increased in SGS (p = 0.03) and TS (p = 0.12) in the surgical group with increasing stenotic segment length. The presence of comorbidities was not effective on treatment success. CONCLUSION Endoscopic methods are preferred in cases of web-like stenosis. Surgical methods should first be considered for other patients and endoscopic methods should be used on patients who are not suited for surgery or in cases of postsurgical recurrence.
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Affiliation(s)
- Umit Aydogmus
- Department of Thoracic Surgery, Pamukkale University, Denizli, Turkey
| | - Argun Kis
- Department of Thoracic Surgery, Pamukkale University, Denizli, Turkey
| | - Erhan Ugurlu
- Department of Chest Disease, Pamukkale University, Denizli, Turkey
| | - Gokhan Ozturk
- Department of Thoracic Surgery, Pamukkale University, Denizli, Turkey
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Yue H, Wang T, Wang J, Han R. Anesthetic Management of Montgomery T-tube Insertion Via Rigid Bronchoscopy for Subglottic Complete Stenosis. Arch Bronconeumol 2020; 56:181-183. [DOI: 10.1016/j.arbres.2019.08.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Revised: 08/22/2019] [Accepted: 08/29/2019] [Indexed: 11/27/2022]
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Bertesteanu ȘV, Pascu P, Popescu C, Grigore R, Popescu B. Larynx stenosis; a challenge for the ENT surgeons. JOURNAL OF CLINICAL AND INVESTIGATIVE SURGERY 2018. [DOI: 10.25083/2559.5555/3.2/77.81] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Laryngo-tracheal stenosis is a complex pathology which requires multiple surgical interventions and diligence from the surgeon and patience from the patient so that normal physiology may be restored. The aim of this paper is to evaluate the factors that can influence the evolution of this pathology. It is presented a retrospective study in which 20 cases of larynx stenosis from 2008 until 2018 were evaluated. The study revealed a predominance of the pathology in men, especially from rural environment. The etiology of larynx stenosis was both iatrogenic and traumatic. Multiple surgical interventions classical and endoscopic were necessary, along with tracheostomy. In 7 cases there was the need for larynx stent to be mounted. There was no significant correlation between age, etiology and the site of stenosis and the removal of the tracheostomy. Larynx stenosis benefit in present by modern surgical techniques. Current therapeutic options include conservative therapy, endoscopic approach and external approach depending on the site, severity, morbidities of the stenosis. Even if technology is of great help in LS management of many patients, unfortunately there are still cases where therapy is very complex and with poor functional results.
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Bourinet V, Thiam K, Guinde J, Laroumagne S, Dutau H, Astoul P. [Trans-vocal cord prostheses - preliminary experience treating benign laryngotracheal stenosis in adults]. Rev Mal Respir 2018; 36:49-56. [PMID: 30337136 DOI: 10.1016/j.rmr.2018.01.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2017] [Accepted: 01/25/2018] [Indexed: 01/01/2023]
Abstract
INTRODUCTION Benign laryngotracheal stenosis is a rare pathology with multiple etiologies, the management of which is complex. This is because of the configuration and proximity of the larynx and the difficulty with surgical approaches, which are potentially mutilating, especially for the management of a benign disease. When surgery is challenging, iterative dilatations of the stricture or the fashioning of a definitive tracheotomy are therapeutic alternatives. Advances in rigid bronchoscopy and the evolution of prosthetic silicone material allow a new approach in the management of benign laryngotracheal stenosis, by placing flexible silicone prostheses which cover all the stenosis from the arytenoids to the trachea. This preliminary work aims to evaluate the feasibility, effectiveness, tolerance and complications of the implementation of this type of prosthesis. PATIENTS AND METHODS This is a retrospective single-centre study which analyzed the records of patients with symptomatic benign laryngotracheal stenosis who underwent placement of a transcordial prosthesis over a period of three years. The prosthesis used, inserted under general anesthesia during a rigid tube interventional bronchoscopy, was either a straight silicone prosthesis or a Montgomery T-tube for those with a pre-existing tracheotomy. RESULTS Six patients were included. Five are still alive, one patient died from a cause unrelated to the placement of the prosthesis. Four have no tracheostomy and two now have no transcordal prosthesis. The data collected on tolerance found, for three patients, two cases of minor aspiration and one case of transient cough. All patients had whispered voice dysphonia. We did not observe prosthesis migration or obstruction. CONCLUSION These preliminary results are encouraging. Transcordal prostheses in benign laryngotracheal stenosis have a complementary or alternative role compared to surgery with a palliative or even curative objective.
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Affiliation(s)
- V Bourinet
- Service d'oncologie thoracique, maladies de la Plèvre, pneumologie interventionnelle, hôpital Nord Aix-Marseille université, 13000 Marseille, France
| | - K Thiam
- Service d'oncologie thoracique, maladies de la Plèvre, pneumologie interventionnelle, hôpital Nord Aix-Marseille université, 13000 Marseille, France; Service de pneumo-oncologie, université Cheikh-Anta-Diop, CHU Fann, Dakar, Sénégal
| | - J Guinde
- Service d'oncologie thoracique, maladies de la Plèvre, pneumologie interventionnelle, hôpital Nord Aix-Marseille université, 13000 Marseille, France
| | - S Laroumagne
- Service d'oncologie thoracique, maladies de la Plèvre, pneumologie interventionnelle, hôpital Nord Aix-Marseille université, 13000 Marseille, France
| | - H Dutau
- Service d'oncologie thoracique, maladies de la Plèvre, pneumologie interventionnelle, hôpital Nord Aix-Marseille université, 13000 Marseille, France.
| | - P Astoul
- Service d'oncologie thoracique, maladies de la Plèvre, pneumologie interventionnelle, hôpital Nord Aix-Marseille université, 13000 Marseille, France; Aix-Marseille université, 13000 Marseille, France
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15
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Hu H, Zhang J, Wu F, Chen E. Application of the Montgomery T-tube in subglottic tracheal benign stenosis. J Thorac Dis 2018; 10:3070-3077. [PMID: 29997975 PMCID: PMC6006128 DOI: 10.21037/jtd.2018.05.140] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Accepted: 05/18/2018] [Indexed: 11/06/2022]
Affiliation(s)
- Huihui Hu
- Department of Respiratory and Critical Care Medicine, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou 310016, China
| | - Jisong Zhang
- Department of Respiratory and Critical Care Medicine, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou 310016, China
| | - Fengjie Wu
- Department of Respiratory and Critical Care Medicine, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou 310016, China
| | - Enguo Chen
- Department of Respiratory and Critical Care Medicine, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou 310016, China
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16
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Joseph ST, Tharayil J, Mihir MT, Naveen BS. Endoscope-assisted conservative resection and reconstruction in recurrent subglottic carcinoma. Head Neck 2018; 40:E36-E39. [PMID: 29405476 DOI: 10.1002/hed.25083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2017] [Revised: 10/09/2017] [Accepted: 12/20/2017] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Very few cases of conservative laryngectomy in recurrent carcinoma of subglottis postradiotherapy have been reported. Technical aspects of conservative resection and reconstruction in subglottic carcinoma have not been well described. METHODS Herein, we present a case of recurrent carcinoma of subglottis for which conservative resection with adequate margins was done with endoscope assistance and defect reconstructed by buccal mucosa, conchal cartilage, and temporoparietal free flap. The technique of resection, reconstruction, complications, postoperative outcome, and our suggestions are described. RESULTS The lesion could be removed with wide margins. Reconstruction could preserve the voice, and deglutition was unaffected. There was no donor site-related complication. Complications were a result of the choice of the stent, which included infection and difficulty in removal. CONCLUSION Selected cases of recurrent carcinoma of the subglottis can be managed by conservative resection with adequate margins and appropriate reconstruction with good functional outcomes.
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Affiliation(s)
- Shawn T Joseph
- Department of Head and Neck Surgical Oncology, VPS Lakeshore Hospital, Cochin, Kerala, India
| | - Jose Tharayil
- Department of Plastic Surgery, VPS Lakeshore Hospital, Cochin, Kerala, India
| | - Mohan T Mihir
- Department of Head and Neck Surgical Oncology, VPS Lakeshore Hospital, Cochin, Kerala, India
| | - B S Naveen
- Department of Head and Neck Surgical Oncology, VPS Lakeshore Hospital, Cochin, Kerala, India
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17
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Yang H, Chen Z, Zhou SH, Wang QY, Weng LX, Wang F, Wu TT, Zhou ML, Bao YY. Traumatic laryngotracheal stenosis treated by hyoid-sternohyoid osseomuscular flap combined with xenogenic acellular dermal matrix: A case report and literature review. J Int Med Res 2017; 45:1486-1494. [PMID: 28480810 PMCID: PMC5718716 DOI: 10.1177/0300060517705985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Objective The treatment of laryngotracheal stenosis is a major therapeutic challenge. Various treatments include observation, medical management, and surgical management. The most effective surgical management is resection and reconstruction. To the authors’ knowledge, no reports have described the use of xenogenic acellular dermal matrix (ADM) for laryngotracheal stenosis. Methods A 27-year-old man presented with hemoptysis of the neck due to a traffic accident. Emergency orotracheal intubation was performed. Tracheostomy was then performed under local anesthesia. Computed tomography revealed fractures of the right thyroid cartilage and posterior arc of the cricoid cartilage and stenosis of the subglottis and first and second tracheal rings. We used a composite hyoid–sternohyoid osseomuscular flap with xenogenic ADM and a straight silicone tube as a lumen stent to reconstruct the laryngotracheal stenosis. Results Surgical recovery was uneventful. The tracheotomy opening was changed to a metal tube 5 days postoperatively. Four months postoperatively, the silicone tube was endoscopically removed under local anesthesia. The patient was decannulated 20 days later. The patient satisfied with his voice, respiration, and deglutition at the 16-month postoperative follow-up. Conclusion The use of ADM for laryngotracheal stenosis may reduce the growth of granulation tissues and promote the repair process.
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Affiliation(s)
- Hang Yang
- 1 Department of Otorhinolaryngology, First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, China.,2 Department of Otorhinolaryngology, People's Hospital of Jiangshan City, Zhejiang Province, China
| | - Zhe Chen
- 1 Department of Otorhinolaryngology, First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Shui-Hong Zhou
- 1 Department of Otorhinolaryngology, First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Qin-Yin Wang
- 1 Department of Otorhinolaryngology, First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Li-Xia Weng
- 3 Department of Operation Room, First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Fang Wang
- 3 Department of Operation Room, First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Ting-Ting Wu
- 1 Department of Otorhinolaryngology, First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Min-Li Zhou
- 1 Department of Otorhinolaryngology, First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Yang-Yang Bao
- 1 Department of Otorhinolaryngology, First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
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18
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Nair S, Nilakantan A, Sood A, Gupta A, Gupta A. Challenges in the Management of Laryngeal Stenosis. Indian J Otolaryngol Head Neck Surg 2016; 68:294-9. [PMID: 27508129 PMCID: PMC4961642 DOI: 10.1007/s12070-015-0936-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2015] [Accepted: 12/07/2015] [Indexed: 11/24/2022] Open
Abstract
Laryngeal stenosis is one of the most complex and challenging problems in the field of head and neck surgery. The management involves a multidisciplinary approach with multiple complex procedures. In this study we discuss our experience of laryngeal stenosis with regards to patient characteristics, cause and management. A retrospective analysis of 35 patients of laryngeal stenosis treated at a tertiary care centre was evaluated. Inclusion criteria were all patients with laryngeal stenosis who required surgical intervention. Exclusion criteria were patients with associated tracheal stenosis and laryngeal stenosis due to cancer. Demographic data was recorded and findings relating to aetiology, characteristics of stenosis and the various aspects of therapeutic procedures performed are discussed with review of literature. Among 35 patients, 24 were males and 11 females of the age group 2-79 years. 2 (5.7 %) patients had supraglottic stenosis, 11 (31.4 %) had glottis stenosis, 16 (45.7 %) had subglottic stenosis and 6 (17.1 %) had combined multiple sites stenosis. Each patient underwent an average of 3.22 surgical procedures like microlaryngoscopy and excision with cold instrument, CO2 laser excision or open procedures like laryngofissure and excision and laryngoplasty. Montgomery t tube insertion was a common procedure in 17 patients (48.6 %). Of the total 35 patients with severe LS, 27 (77.1 %) patients were successfully decanulated. The results of glottic (100 %) and supraglottic stenosis (100 %) are excellent as compared to subglottic (68.8 %) and combined stenosis (50 %) of multiple sites. Laryngeal stenosis with airway compromise causes significant morbidity to the patients and is a difficult condition to treat in both adult and pediatric population. The need for multiple surgical procedures is common in the treatment of laryngeal stenosis with the t-tube being an important aid in the management of this condition. Trauma especially post intubation trauma is the commonest cause of laryngeal stenosis and the involvement of subglottis has poor outcome as compared to other subsites.
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Affiliation(s)
- Satish Nair
- Department of ENT-HNS, Army Hospital (R&R), Delhi Cantt, India
| | | | - Amit Sood
- Department of ENT-HNS, Army Hospital (R&R), Delhi Cantt, India
| | - Atul Gupta
- Department of ENT-HNS, Army Hospital (R&R), Delhi Cantt, India
| | - Abhishek Gupta
- Department of ENT-HNS, Army Hospital (R&R), Delhi Cantt, India
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Ozkul Y, Songu M, Ozturkcan S, Imre A, Erdogan N, Ates D, Ozkul Z. Is T-tube treatment effective in Meyer-Cotton grade 3 tracheal stenosis: long-term outcomes. Acta Otolaryngol 2016; 136:933-6. [PMID: 27092981 DOI: 10.3109/00016489.2016.1170877] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVES To present retrospective experience in Meyer-Cotton grade 3 tracheal stenosis of 17 patients treated by T-tube, considering the characteristics of the treated stenosis, surgical procedures performed, and post-operative outcomes and complications. METHODS All demographic and clinical data were collected retrospectively. Chest and neck computed tomography scans were performed to assess the stenosis, including length, location, and glottic involvement. The stenotic area was evaluated endoscopically according to an adapted Meyer and Cotton grading scale. RESULTS The aetiology of the tracheal stenosis was intubation-related in all cases. The duration of intubation ranged between 1 hour to 40 days. According to the Myers-Cotton classification, all patients were at stage 3. Mean length of the stenosis was 26.58 ± 12.02 (range =15-70) mm. Mean follow-up for the study group was 60.16 ± 34.10 (range =18-137) months. Two patients died during follow-up, one due to stroke, one due to chronic lymphocytic leukemia; no deaths were attributable to TS. The remaining 15 patients could be evaluated up to the present time. Post-operative decannulation was achieved in three of 15 patients (20%), and decannulation was not achieved in 12 of 15 patients (80%). CONCLUSION T-tube is not an effective treatment of tracheal stenosis.
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Affiliation(s)
- Yilmaz Ozkul
- a Department of Otorhinolaryngology , Izmir Katip Celebi University, Ataturk Training and Research Hospital , Izmir , Turkey
| | - Murat Songu
- a Department of Otorhinolaryngology , Izmir Katip Celebi University, Ataturk Training and Research Hospital , Izmir , Turkey
| | - Sedat Ozturkcan
- a Department of Otorhinolaryngology , Izmir Katip Celebi University, Ataturk Training and Research Hospital , Izmir , Turkey
| | - Abdulkadir Imre
- a Department of Otorhinolaryngology , Izmir Katip Celebi University, Ataturk Training and Research Hospital , Izmir , Turkey
| | - Nezahat Erdogan
- b Department of Radiology , Izmir Katip Celebi University, Ataturk Training and Research Hospital , Izmir , Turkey
| | - Duzgun Ates
- a Department of Otorhinolaryngology , Izmir Katip Celebi University, Ataturk Training and Research Hospital , Izmir , Turkey
| | - Zelal Ozkul
- c Department of Anaesthesia and Reanimation , Izmir Katip Celebi University, Ataturk Training and Research Hospital , Izmir , Turkey
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Schuurmans MM, Palheiros Marques M, Freitag L, Zinkernagel AS, Achermann Y. Biofilm Formation in a Permanent Tracheal Stent Implanted for Twenty-Five Years. Respiration 2015; 90:327-8. [PMID: 26351844 DOI: 10.1159/000439312] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Affiliation(s)
- Macé M Schuurmans
- Division of Pulmonology, University Hospital Zurich, Zurich, Switzerland
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Sethi S, Singh PM, Borle A. Preoperative evaluation of Montgomery tube: a stitch in time saves nine. Br J Anaesth 2014; 113:303-4. [PMID: 25038167 DOI: 10.1093/bja/aeu250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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