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Lee JE, Kim K, Kwon JH, Kim GS. Living Donor Liver Transplantation for an Infant Having Tracheostomy and Subglottic Stenosis: A Case Report. Transplant Proc 2024; 56:746-749. [PMID: 38423831 DOI: 10.1016/j.transproceed.2023.11.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Accepted: 11/26/2023] [Indexed: 03/02/2024]
Abstract
BACKGROUND It is uncommon to perform liver transplantation for patients with end-stage liver disease having tracheostomy. Usually, the tracheostomy cannula is changed to an oral endotracheal tube (ETT) before operation because ETT is easy to handle during operation. If routine oral ETT insertion is difficult, we should seek other solutions. CASE DESCRIPTION We report a successful conversion from tracheostomy tube to ETT in a patient with subglottic stenosis. The patient was an 8-month-old infant who was scheduled for living donor liver transplantation due to acute hepatic failure. The original plan was to convert the tracheostomy tube to oral ETT, which failed due to aggravation of subglottic stenosis. An otolaryngologist performed balloon dilatation surgery, and ETT was successfully intubated. Owing to a multidisciplinary approach, the surgery was successfully performed without fatal adverse events, and the patient was later discharged with a tracheostomy. CONCLUSIONS It is unusual for pediatric patients with tracheostomy tubes to undergo major surgeries like liver transplantation. We hope that this case of successful anesthetic management based on a multidisciplinary approach suggests new ideas to anesthesiologists seeking safe anesthesia.
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Affiliation(s)
- Ja Eun Lee
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Keoungah Kim
- Department of Anesthesiology and Pain Medicine, Dankook University Dental Hospital, Cheonan, Chungcheongnam-do, Republic of Korea
| | - Ji-Hye Kwon
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Gaab-Soo Kim
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
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2
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Goussard P, Eber E, Venkatakrishna S, Frigati L, Greybe L, Janson J, Schubert P, Andronikou S. Interventional bronchoscopy in pediatric pulmonary tuberculosis. Expert Rev Respir Med 2023; 17:1159-1175. [PMID: 38140708 DOI: 10.1080/17476348.2023.2299336] [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] [Received: 11/14/2023] [Accepted: 12/21/2023] [Indexed: 12/24/2023]
Abstract
INTRODUCTION Lymphobronchial tuberculosis (TB) is common in children with primary TB and enlarged lymph nodes can cause airway compression of the large airways. If not treated correctly, airway compression can result in persistent and permanent parenchymal pathology, as well as irreversible lung destruction. Bronchoscopy was originally used to collect diagnostic samples; however, its role has evolved, and it is now used as an interventional tool in the diagnosis and management of complicated airway disease. Endoscopic treatment guidelines for children with TB are scarce. AREAS COVERED The role of interventional bronchoscopy in the diagnosis and management of complicated pulmonary TB will be discussed. This review will provide practical insights into how and when to perform interventional procedures in children with complicated TB for both diagnostic and therapeutic purposes. This discussion incorporates current scientific evidence and refers to adult literature, as some of the interventions have only been done in adults but may have a role in children. Limitations and future perspectives will be examined. EXPERT OPINION Pediatric pulmonary TB lends itself to endoscopic interventions as it is a disease with a good outcome if treated correctly. However, interventions must be limited to safeguard the parenchyma and prevent permanent damage.
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Affiliation(s)
- Pierre Goussard
- Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University and Tygerberg Hospital, Cape Town, South Africa
| | - Ernst Eber
- Division of Paediatric Pulmonology and Allergology, Department of Paediatrics and Adolescent Medicine, Medical University of Graz, Graz, Austria
| | - Shyam Venkatakrishna
- Department of Pediatric Radiology, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Lisa Frigati
- Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University and Tygerberg Hospital, Cape Town, South Africa
| | - Leonore Greybe
- Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University and Tygerberg Hospital, Cape Town, South Africa
| | - Jacques Janson
- Department of Surgical Sciences, Division of Cardiothoracic Surgery, Stellenbosch University and Tygerberg Hospital, Cape Town, South Africa
| | - Pawel Schubert
- Division of Anatomical Pathology, Tygerberg Hospital, National Health Laboratory Service, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Savvas Andronikou
- Department of Pediatric Radiology, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
- Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
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3
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Goussard P, Eber E, Venkatakrishna S, Frigati L, Janson J, Schubert P, Andronikou S. Complicated intrathoracic tuberculosis: Role of therapeutic interventional bronchoscopy. Paediatr Respir Rev 2023; 45:30-44. [PMID: 36635200 DOI: 10.1016/j.prrv.2022.12.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Accepted: 12/14/2022] [Indexed: 12/23/2022]
Abstract
In recent years bronchoscopy equipment has been improved with smaller instruments and larger size working channels. This has ensured that bronchoscopy offers both therapeutic and interventional options. As the experience of paediatric interventional pulmonologists continues to grow, more interventions are being performed. There is a scarcity of published evidence in the field of interventional bronchoscopy in paediatrics. This is even more relevant for complicated pulmonary tuberculosis (PTB). Therapeutic interventional bronchoscopy procedures can be used in the management of complicated tuberculosis, including for endoscopic enucleations, closure of fistulas, dilatations of bronchial stenosis and severe haemoptysis. Endoscopic therapeutic procedures in children with complicated TB may prevent thoracotomy. If done carefully these interventional procedures have a low complication rate.
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Affiliation(s)
- Pierre Goussard
- Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg Hospital, Cape Town, South Africa.
| | - Ernst Eber
- Division of Paediatric Pulmonology and Allergology, Department of Paediatrics and Adolescent Medicine, Medical University of Graz, Graz, Austria
| | - Shyam Venkatakrishna
- Department of Pediatric Radiology, The Children's Hospital of Philadelphia, Philadelphia, PA, USA; Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Lisa Frigati
- Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg Hospital, Cape Town, South Africa
| | - Jacques Janson
- Department of Surgical Sciences, Division of Cardiothoracic Surgery, Stellenbosch University, and Tygerberg Hospital, Tygerberg, South Africa
| | - Pawel Schubert
- Division of Anatomical Pathology, Tygerberg Hospital, National Health Laboratory Service, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Savvas Andronikou
- Department of Pediatric Radiology, The Children's Hospital of Philadelphia, Philadelphia, PA, USA; Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
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4
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Zheng Y, Xu H, Li X. Management of balloon dilatation in cases of subglottic stenosis in children: success and failure. Eur Arch Otorhinolaryngol 2023; 280:2859-2864. [PMID: 36609700 DOI: 10.1007/s00405-023-07826-z] [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: 10/08/2022] [Accepted: 01/03/2023] [Indexed: 01/07/2023]
Abstract
PURPOSE To assess efficacy and prognostic factors of endoscopic balloon dilatation for the treatment of subglottic stenosis in children. METHODS A retrospective review was performed on 49 pediatric patients with subglottic stenosis treated at the Shanghai Children's Hospital between December 2017 and December 2021. Specific demographic data, type and severity of the stenosis, number of balloon dilatations and outcomes were recorded and analyzed. RESULTS Forty-nine children (30 male, 19 female) were included in the study with a median age at diagnosis of 24 (13-36.5) months, of which 7 (14.3%) had received open laryngotracheal reconstruction previously. The degree of subglottic stenosis was grade I in six patients, grade II in 16 patients, grade III in 20 patients and grade IV in seven patients. After various numbers of balloon dilatations (1-7 times), 29 patients showed a good outcome (decannulation or prevention of tracheostomy) and the success rate in that series was 59.2%. Overall, prognosis of balloon dilatation was not dependent on pathogeny (congenital or acquired) or open surgical history(P > 0.05), but rather on the severity grade of stenosis and the number of dilatations (P < 0.05). CONCLUSIONS Endoscopic balloon dilatation can be safe and effective in the treatment of subglottic stenosis in children, except for more serious cases (grade IV). Open surgery should be considered if no significant improvement is observed after dilatation, especially after three or more dilatations.
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Affiliation(s)
- Yangyang Zheng
- Department of Otolaryngology-Head and Neck Surgery, School of Medicine, Shanghai Children's Hospital, Shanghai Jiao Tong University, No. 24, Lane 1400, West Beijing Road, Shanghai, 200040, People's Republic of China
| | - Hongming Xu
- Department of Otolaryngology-Head and Neck Surgery, School of Medicine, Shanghai Children's Hospital, Shanghai Jiao Tong University, No. 24, Lane 1400, West Beijing Road, Shanghai, 200040, People's Republic of China
| | - Xiaoyan Li
- Department of Otolaryngology-Head and Neck Surgery, School of Medicine, Shanghai Children's Hospital, Shanghai Jiao Tong University, No. 24, Lane 1400, West Beijing Road, Shanghai, 200040, People's Republic of China.
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5
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Komina EI, Alkhasov AB, Rusetsky YY, Latysheva EN. [Surgical treatment of postintubation stenosis of the larynx in children]. Vestn Otorinolaringol 2023; 88:50-55. [PMID: 37450391 DOI: 10.17116/otorino20228803150] [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: 07/18/2023]
Abstract
Post-intubation laryngeal stenosis is the most common cause of upper respiratory obstruction in children. According to published data, the incidence of post-intubation stenosis ranges from 0.1 to 20%. Treatment of children with chronic laryngeal stenosis is a special branch of respiratory surgery. It remains one of the most complex and urgent problems in pediatrics, pediatric otorhinolaryngology, and pediatric surgery. Although numerous studies have described various methods for treating stenosis of the infraglottic space, there is no standard management approach. Currently, there are two main treatment methods: endoscopic interventions and open reconstructive surgery. Each method has its benefits and drawbacks. Despite the use of various techniques, the effectiveness of cicatricial laryngeal stenosis repair and decannulation in children is 63-64%, according to published data. With combined lesions of infraglottic and vocal cord parts of the larynx, especially with their cicatricial obliteration, reconstructive surgery is successful only in 50% of cases. Thus, treating children with post-intubation respiratory stenosis remains a complex problem and is a relevant direction for further research.
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Affiliation(s)
- E I Komina
- National Medical Research Center for Children's Health, Moscow, Russia
| | - A B Alkhasov
- National Medical Research Center for Children's Health, Moscow, Russia
- Pirogov Russian National Research Medical University, Moscow, Russia
| | - Yu Yu Rusetsky
- National Medical Research Center for Children's Health, Moscow, Russia
- Central State Medical Academy of the Department of Presidential Affairs of the Russian Federation, Moscow, Russia
| | - E N Latysheva
- National Medical Research Center for Children's Health, Moscow, Russia
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6
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Goussard P, Andronikou S, Fourie B, Janson JT, Schubert PT. Tuberculous bronchial stenosis: Diagnosis and role of interventional bronchoscopy. Pediatr Pulmonol 2022; 57:2445-2454. [PMID: 35775331 DOI: 10.1002/ppul.26057] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 05/10/2022] [Accepted: 06/14/2022] [Indexed: 11/08/2022]
Abstract
The reported prevalence of tuberculous bronchial stenosis in children is unknown and rarely reported in English-speaking literature. In adult patients with pulmonary tuberculosis, it varies from 40% in an autopsied series in the preantibiotic era to 10% in patients who have undergone routine bronchofibroscopy in modern times. We describe our experience of four cases of confirmed bronchial stenosis due to MTB collected between January 2000 and June 2021 in this case series descriptive study. The diagnosis of bronchial stenosis due to TB was made on flexible bronchoscopy. A TB diagnosis was made if MTB was cultured from respiratory secretions, when Ziehl-Neelsen smear or GeneXpert MTB/RIF test was positive, or if a chest radiograph revealed radiographic features typical of MTB. Bronchial stenosis due to TB is rare even if airway compression is frequently seen. Although an early diagnosis of bronchial stenosis due to TB is difficult on chest X-rays, all children in this series demonstrated parenchymal changes distal to the stenosis ranging from hyperinflation and lobar collaps to bronchiectasis. If bronchial stenosis resulting from TB disease is diagnosed early, balloon dilatation as described in this report, may be an effective and safe intervention, preventing long-term complications such as irreversible lung destruction, that may require pneumonectomy.
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Affiliation(s)
- Pierre Goussard
- Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Tygerberg Hospital, Stellenbosch University, Cape Town, South Africa
| | - Savvas Andronikou
- Department of Pediatric Radiology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.,Department of Radiology, Perelman School, of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Barend Fourie
- Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Tygerberg Hospital, Stellenbosch University, Cape Town, South Africa
| | - Jacques T Janson
- Department of Surgical Sciences, Division of Cardiothoracic Surgery, Stellenbosch University, and Tygerberg Hospital, Tygerberg, South Africa
| | - Pawel T Schubert
- Division of Anatomical Pathology, Tygerberg Hospital, National Health Laboratory Service, Faculty of Medicine and Health Science, Stellenbosch University, Cape Town, South Africa
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7
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Alshareef WA, Aldriweesh BA, Almutairi NK, Alsini AY, Zakzouk AS, Aljasser AI, Alammar AY. Adverse Respiratory Events After Pediatric Endoscopic Airway Surgeries. EAR, NOSE & THROAT JOURNAL 2022:1455613221128111. [PMID: 36112766 DOI: 10.1177/01455613221128111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2023] Open
Abstract
OBJECTIVE Perioperative risk stratification of pediatric patients undergoing airway intervention remains crucial in identifying those at a higher risk of requiring postoperative intensive care unit (ICU) care. Here we determined the likelihood of and possible risk factors for developing perioperative adverse respiratory events (PAREs) requiring ICU care after various pediatric endoscopic airway surgeries (EASs). METHODS We conducted a retrospective chart review of pediatric patients who were aged <18 years and underwent EAS between 2015 and 2021. Early postoperative adverse events within 24 h of surgery were recorded and analyzed. RESULTS Overall, 99 patients who underwent EAS were included. The age at the time of the intervention ranged from 8 months to 18 years. Fifty-eight patients, median age was 4.83 years, underwent papilloma debulking with no high likelihood of PARE in this patient subgroup (OR = 0.48; 0.16-1.44). Twenty-five patients, median age was 9.72 years, underwent balloon dilation of laryngotracheal stenosis with no increase in the likelihood of PARE in this patient population (OR = 2.02; 0.65-6.28). Early postoperative respiratory events occurred in 16 patients (16.2%). Most of these events (75%) manifested within 4 h after surgery. In a univariate analysis, intervention at the level of the subglottis or 2 or more laryngeal subsites increased the risk of PARE (OR = 6.57; 1.11-12.52 and OR = 3.73; 1.93-22.34, respectively). In a multivariate analysis, only intervention in the subglottic area maintained its effect (OR = 6.84; 1.82-25.65). CONCLUSION Respiratory adverse events following pediatric EAS are not uncommon, and the majority are encountered shortly after surgery. Intervention in the subglottic area was an independent predictor of PARE.
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Affiliation(s)
- Waleed A Alshareef
- Department of Otolaryngology-Head and Neck Surgery, King Saud University Medical City, Riyadh, Saudi Arabia
| | - Bshair A Aldriweesh
- Department of Otolaryngology-Head and Neck Surgery, King Fahad Specialist Hospital-Dammam, Dammam, Saudi Arabia
| | - Nasser K Almutairi
- Department of Otolaryngology-Head and Neck Surgery, King Saud University Medical City, Riyadh, Saudi Arabia
- Department of Otolaryngology-Head and Neck Surgery, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Albaraa Y Alsini
- Department of Otolaryngology, Head and Neck Surgery, Al-Hada Armed Forces Hospital, Taif, Saudi Arabia
| | - Abdulmajeed S Zakzouk
- Department of Otolaryngology-Head and Neck Surgery, King Saud University Medical City, Riyadh, Saudi Arabia
| | - Abdullah I Aljasser
- Department of Otolaryngology-Head and Neck Surgery, King Saud University Medical City, Riyadh, Saudi Arabia
| | - Ahmed Y Alammar
- Department of Otolaryngology-Head and Neck Surgery, King Saud University Medical City, Riyadh, Saudi Arabia
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8
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Hofmeyr R, McGuire J, Park K, Proxenos M, Peer S, Lehmann M, Lubbe D. Prospective Observational Trial of a Nonocclusive Dilatation Balloon in the Management of Tracheal Stenosis. J Cardiothorac Vasc Anesth 2022; 36:3008-3014. [PMID: 35337744 DOI: 10.1053/j.jvca.2022.02.004] [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: 12/15/2021] [Revised: 01/27/2022] [Accepted: 02/04/2022] [Indexed: 11/11/2022]
Abstract
OBJECTIVES Tracheal stenosis is a debilitating condition that often presents as an emergency and is challenging to treat. Dilatation may avoid tracheostomy or costly tracheal resection and reconstruction. Traditional dilators cause complete occlusion, preventing oxygenation and ventilation, limiting the safe duration of dilatation, and increasing the risk of hypoxic injury or barotrauma. The study authors here assessed an innovative nonocclusive tracheal dilatation balloon, which may improve patient safety by allowing continuous gas exchange. DESIGN A prospective observational study of 20 discrete dilatation procedures performed in 13 patients under general anesthesia. The primary outcomes were the ability to ventilate during dilatation and the preservation of peripheral oxygen saturation. Secondary outcomes included a measured reduction in stenosis, improvement in Cotton-Myer grading, and procedure-related adverse events. SETTING At a single university (academic) hospital. PARTICIPANTS Consenting adult patients with acquired tracheal stenosis. INTERVENTIONS Access to the airway was maintained by a rigid bronchoscope or supraglottic airway device, as deemed appropriate. Continuous conventional ventilation was provided during 3-minute balloon dilatations. MEASUREMENTS AND MAIN RESULTS Heart rate, airway pressure, end-tidal carbon dioxide partial pressure, and peripheral oxygen saturation were measured, and adverse events were recorded. Ventilation was satisfactory in all patients. Peripheral saturation remained greater than 94% in 19 of the 20 (95%) procedures. Stenosis internal diameter and grading were improved. Two patients had minor reversible adverse events (coughing and laryngospasm), which did not prevent completion of the procedure. CONCLUSIONS The authors report the first human trial of the device, in which continuous conventional ventilation could be provided during all tracheal balloon dilatation procedures. Larger trials are needed to confirm improved patient safety and comparative efficacy.
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Affiliation(s)
- Ross Hofmeyr
- Associate Department of Anaesthesia and Perioperative Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.
| | - Jessica McGuire
- Department of Otolaryngology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Kenneth Park
- (formerly) DISA Medinotec, Johannesburg, South Africa
| | | | - Shazia Peer
- Department of Otolaryngology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | | | - Darlene Lubbe
- Department of Otolaryngology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
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9
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Cantarella G, Gaffuri M, Torretta S, Neri S, Ambrosini MT, D'Onghia A, Pignataro L, Sandu K. Outcomes of balloon dilation for paediatric laryngeal stenosis. ACTA ACUST UNITED AC 2021; 40:360-367. [PMID: 33299226 PMCID: PMC7726638 DOI: 10.14639/0392-100x-n0830] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Accepted: 07/28/2020] [Indexed: 02/02/2023]
Abstract
Objective Balloon dilation (BD) is a minimally invasive endoscopic treatment for paediatric laryngeal stenosis (LS) with reduced morbidity compared to open surgery. We retrospectively describe our experience in a cohort of children with chronic LS. Methods Fourteen children (median age: 28.5; range: 2-81 months) with chronic LS (multilevel in 8) were treated with tubeless total intravenous anaesthesia under spontaneous ventilation. Results Grade III LS was preoperatively detected in 12 children; the remaining 2 had grade IV stenosis. Six had prior tracheotomy, and one received it during the first intervention. Dilation laryngoplasty was the primary treatment in 11 children and was used as an adjuvant treatment in 3 after open reconstructive surgery. The median number of dilations was 2 (range: 1-6). There were no postoperative complications. At the end of the follow-up (median: 20.5; range: 2-46 months), detectable laryngeal lumen widening and/or respiratory improvement occurred in 12 children. Two of 7 patients with tracheostomy were decannulated. Conclusions Balloon laryngoplasty is a valuable therapeutic option to improve laryngeal patency in children with chronic multilevel LS, both as a primary and secondary adjuvant treatment after reconstructive surgery.
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Affiliation(s)
- Giovanna Cantarella
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Department of Otolaryngology and Head and Neck Surgery, Milan, Italy.,Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Michele Gaffuri
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Sara Torretta
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Department of Otolaryngology and Head and Neck Surgery, Milan, Italy.,Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Simona Neri
- Unit of Pediatric Anesthesiology and Intensive Care, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Maria Teresa Ambrosini
- Unit of Pediatric Anesthesiology and Intensive Care, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Alessandra D'Onghia
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Department of Otolaryngology and Head and Neck Surgery, Milan, Italy.,Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Lorenzo Pignataro
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Department of Otolaryngology and Head and Neck Surgery, Milan, Italy.,Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Kishore Sandu
- Airway Sector; Department of Otolaryngology, Lausanne University Hospital CHUV, Switzerland
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10
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Nosair A, Singer M, Elkahely M, Abu-Gamila R, Adel W. Balloon tracheoplasty for tracheal stenosis after prolonged intubation: a simple procedure, but is it effective? THE CARDIOTHORACIC SURGEON 2021. [DOI: 10.1186/s43057-021-00052-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Tracheal stenosis following prolonged intubation is a relatively rare but serious problem. This condition is usually managed by surgical or endoscopic interventions. Bronchoscopic balloon dilatation for tracheal stenosis is considered a valuable tool used for the management of tracheal stenosis. In this article, we try to evaluate the role of balloon tracheoplasty in the management of tracheal stenosis and to assess the number of dilatation sessions usually needed as well as the short to midterm outcome.
Results
This study involved 40 patients with tracheal stenosis diagnosed by computed tomography (neck and chest) and bronchoscopy at the Security Force Hospital in Riyadh, KSA, between January 2013 and August 2018. Patients’ data were retrospectively reviewed and analyzed. Patients’ age ranged between 18 and 60 years. Thirty patients were males (75%); those patients underwent balloon tracheoplasty via dilatation of areas of narrowing using catheter balloon insufflation guided by fiber-optic bronchoscope. Ninety-five percent of the patients had initial success with acceptable dilatation of the stenotic area and improvement of the symptoms. There were no technical or major problems which resulted from the procedure, and no patient complained of severe pain or severe discomfort after the procedure. From the total of 81 BBD sessions, no in-hospital mortality is related to the procedure itself, and ICU stay ranged between 1 and 5 days post-procedure. Among those 40 patients, 16 patients (40%) needed one session, 10 patients (25%) needed two sessions, 8 patients (20%) needed three sessions, and 6 patients (15%) needed more than three sessions of balloon dilatation.
Conclusion
Balloon tracheoplasty is a simple, safe method and could be a promising and effective approach that offers immediate symptomatic relief for tracheal stenosis in cases with a history of prolonged intubation. It is worth mentioning that BBD is considered as a temporary measure, and most of the cases will need definitive or additional treatment either resection or stent placement.
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11
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Goussard P, Pohunek P, Eber E, Midulla F, Di Mattia G, Merven M, Janson JT. Pediatric bronchoscopy: recent advances and clinical challenges. Expert Rev Respir Med 2021; 15:453-475. [PMID: 33512252 DOI: 10.1080/17476348.2021.1882854] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Introduction: During the last 40 years equipment has been improved with smaller instruments and sufficient size working channels. This has ensured that bronchoscopy offers therapeutic and interventional options.Areas covered: We provide a review of recent advances and clinical challenges in pediatric bronchoscopy. This includes single-use bronchoscopes, endobronchial ultrasound, and cryoprobe. Bronchoscopy in persistent preschool wheezing and asthma is included. The indications for interventional bronchoscopy have amplified and included balloon dilatation, endoscopic intubation, the use of airway stents, whole lung lavage, closing of fistulas and air leak, as well as an update on removal of foreign bodies. Others include the use of laser and microdebrider in airway surgery. Experience with bronchoscope during the COVID-19 pandemic has been included in this review. PubMed was searched for articles on pediatric bronchoscopy, including rigid bronchoscopy as well as interventional bronchoscopy with a focus on reviewing literature in the past 5 years.Expert opinion: As the proficiency of pediatric interventional pulmonologists continues to grow more interventions are being performed. There is a scarcity of published evidence in this field. Courses for pediatric interventional bronchoscopy need to be developed. The COVID-19 experience resulted in safer bronchoscopy practice for all involved.
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Affiliation(s)
- P Goussard
- Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg Hospital, Cape Town, South Africa
| | - P Pohunek
- Division of Pediatric Respiratory Diseases, Pediatric Department, 2nd Faculty of Medicine, Charles University and University Hospital Motol, Prague, Czech Republic
| | - E Eber
- Department of Paediatrics and Adolescent Medicine, Head, Division of Paediatric Pulmonology and Allergology, Medical University of Graz, Graz, Austria
| | - F Midulla
- Department of Maternal Infantile and Urological Sciences, "Sapienza" University of Rome, Rome, Italy
| | - G Di Mattia
- Department of Maternal Infantile and Urological Sciences, "Sapienza" University of Rome, Rome, Italy
| | - M Merven
- Department Otorhinolaryngology, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg Hospital, Cape Town, South Africa
| | - J T Janson
- Department of Surgical Sciences, Division of Cardio-Thoracic Surgery, Stellenbosch University, and Tygerberg Hospital, Tygerberg, South Africa
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12
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Avelino MAG, da Silveira Botacin L, Coutinho MAC. Treatment of complex laryngotracheal stenosis in childhood–experience of a tertiary University Hospital from 2016 to 2019. ANNALS OF PEDIATRIC SURGERY 2021. [DOI: 10.1186/s43159-020-00068-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Laryngotracheal stenosis is a major cause of airway obstruction in pediatric age. The correction of such abnormality still remains a challenge, both because of anatomical issues in childhood and also due to the difficulty in having properly trained professionals and adequate hospital facilities. As treatment, many different surgical techniques are offered ranging from endoscopic and less invasive procedures to open surgeries, such as laryngotracheal reconstruction and cricotracheal resection. The treatment for complex laryngotracheal stenosis is considered successful when we have decannulation or resolution of respiratory failure with release from intensive care unit. Eighteen patients who were monitored at the pediatric otorhinolaryngology service between 2016 and 2019 were diagnosed with complex stenosis, with the collection of demographic data, comorbidities, degree of initial stenosis, post-treatment aspect, and whether or not decannulation occurred.
Results
Of the eighteen cases, three had congenital stenosis, fourteen had acquired stenosis, and one had mixed stenosis. Ages ranged from 4 months old to 15 years old. Six (33.3%) underwent endoscopic dilation procedures only, six (33.3%) underwent laryngotracheoplasty, and five (27.7%) cricotracheal resections. One patient underwent a slide tracheoplasty. Seven patients (38.8%) had to undergo more than one type of procedure to improve stenosis. Out of the eighteen patients, three of them were never tracheostomized. Of the remaining fifteen patients, fourteen (93.3%) were decannulated.
Conclusions
The success rate in decannulation or the resolution of respiratory failure with discharge from the ICU, after the procedures for correcting stenosis in childhood in our service, was 94.4%.
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Wistermayer P, McIlwain W, Escalante D, Rogers DJ. Randomized Controlled Trial of Balloon Dilation in Treatment of Subglottic Stenosis With a Rabbit Model. Otolaryngol Head Neck Surg 2020; 163:1003-1010. [PMID: 32571137 DOI: 10.1177/0194599820931486] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES Identify the effects of balloon dilation duration and topical ciprofloxacin-dexamethasone application in treatment of subglottic stenosis. STUDY DESIGN Randomized controlled trial. SETTING Animal research facility. SUBJECTS AND METHODS Forty-four rabbits underwent subglottic injury in an Institutional Animal Care and Use Committee-approved study. One week after injury, the subglottis of each rabbit was measured and treated with endoscopic balloon dilation for 2 rounds of short duration (SBD; 3 seconds), long duration (LBD; 30 seconds), or LBD with topical ciprofloxacin-dexamethasone application (LBD+C). The subglottis of each rabbit was remeasured at the study endpoint: 1 month postdilation or following development of life-threatening respiratory distress. RESULTS Of 44 rabbits, 35 (80%) survived to endoscopic balloon dilation, with 21 rabbits developing a grade III Cotton-Myer stenosis. Prior to dilation, there was no difference in stenosis rates among groups (all subjects, P = .99; grade III stenosis only, P = .52). Among grade III subjects, improvement in stenosis after dilation was -1% (SD, 21%) for SBD, 27% (SD, 38%) for LBD, and 58% (SD, 29%) for LBD+C (P = .01). Early euthanasia/death rates among grade III subjects were 85% for SBD, 63% for LBD, and 17% for LBD+C (P = .03). Time to early euthanasia/death was 5.0 days for the SBD group and 8.4 days for the LBD group (P = .04). CONCLUSION SBD was inferior to LBD or LBD+C in multiple metrics. LBD+C offered significant improvements in stenosis size and mortality over the SBD group and had the lowest rate of early mortality. Further research is needed to identify optimal balloon dilation treatment duration.
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Schweiger C, Manica D. Ongoing Laryngeal Stenosis: Conservative Management and Alternatives to Tracheostomy. Front Pediatr 2020; 8:161. [PMID: 32351919 PMCID: PMC7174582 DOI: 10.3389/fped.2020.00161] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2019] [Accepted: 03/20/2020] [Indexed: 11/30/2022] Open
Abstract
Background: Following tracheal intubation, some children may develop stridor, which is an indication of an obstructive lesion in the airway, such as an ongoing laryngeal stenosis (LS). This review focuses on evaluation of stridor and possible endoscopic predictors of progression to LS and, once post-intubation acute lesions are established, therapeutic choices to manage this disorder in avoidance of tracheostomy. Tracheostomy, due to its inherent increased morbidity, mortality and influence on social stigma, should be viewed only as a last resort. In this article, available conservative and alternative therapies for ongoing LS are thoroughly reviewed. Methods: A systematic review concerning randomized clinical trials and prospective studies on treatment modalities for LS was performed. A search strategy was developed for MEDLINE comprising terms related to disease, intervention and population. Title and abstract from captured references were peer-reviewed for eligibility. Selected studies full-texts were peer-reviewed and the results were compiled in a structured and narrative review. Stridor evaluation and post-extubation acute lesion classification were studied. Treatments such as balloon dilation, rigid dilation, corticosteroid-coated small tube intubation, and corticosteroid nebulization were described and evidence supporting their usage was discussed.
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Affiliation(s)
- Cláudia Schweiger
- Otolaryngology Department, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil.,Programa de Pós-Graduação em Saúde da Criança e do Adolescente, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Denise Manica
- Otolaryngology Department, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
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Lee JC, Kim MS, Kim DJ, Park DH, Lee IW, Roh HJ, Lee BJ, Kim YA, Ko S, Sung ES. Subglottic stenosis in children: Our experience at a pediatric tertiary center for 8 years in South Korea. Int J Pediatr Otorhinolaryngol 2019; 121:64-67. [PMID: 30875621 DOI: 10.1016/j.ijporl.2019.02.044] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2018] [Revised: 02/24/2019] [Accepted: 02/25/2019] [Indexed: 11/19/2022]
Abstract
OBJECTIVE The incidence of SGS has been reported to be less than 8% after endotracheal intubation. Therefore there is an increasing trend in the number of patients with acute acquired SGS due to mechanical ventilation in the intensive care unit. However, there have been no reports describing the treatment of SGS in children in South Korea. The objective of this study was to evaluate the management and outcomes of children with SGS at a pediatric tertiary center in South Korea over an 8-year period. METHODS All patients underwent microlaryngobronchoscopy (MLB) with bougination, incision using cold knife or laser and balloon dilatation. Data on age, sex, grade of SGS, number of management interventions, tracheostomy, comorbidities, mean follow-up period, complications, and outcome were reviewed from patient medical charts. RESULTS Twenty patients (13 [65%] males, 7 [35%] females; mean [±SD] age at the diagnostic procedure 15.26 ± 22.54 months) underwent MLB between March 2009 and December 2017. According to the Myer-Cotton scale, twelve of the 20 (60%) patients had grade III SGS, 7 (35%) had grade II and 1 (5%) had grade 1; there were no patients with grade IV SGS. Nine (45%) patients were diagnosed with acute SGS, and 11 (55%) with chronic SGS. Patients with SGS underwent MLB with interventions (mean 2.41 ± 2.23 per patient). Tracheostomy was performed in 13 of 20 (65%) patients, 2 of 9 (22.2%) with acute SGS, and 11 of 11 (100%) with chronic SGS. Two of 13 (15.3%) patients underwent successful decannulation. One of 2 (50%) patients with acute SGS underwent successful decannulation. Seven of 9 (77.7%) patients with acute SGS underwent MLB only without tracheostomy. CONCLUSIONS In patients with acute acquired SGS, the outcome was good due to the lower rate of tracheostomy and higher decannulation rate. Therefore, it is recommended that MLB with balloon laryngoplasty be performed at the earliest in patients with acute acquired SGS.
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Affiliation(s)
- Jin-Choon Lee
- Department of Otolaryngology - Head and Neck Surgery, College of Medicine and Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, South Korea
| | - Min-Sik Kim
- Department of Otolaryngology - Head and Neck Surgery, College of Medicine and Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, South Korea
| | - Dong-Jo Kim
- Department of Otolaryngology - Head and Neck Surgery, College of Medicine and Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, South Korea
| | - Da-Hee Park
- Department of Otolaryngology - Head and Neck Surgery, College of Medicine and Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, South Korea
| | - Il-Woo Lee
- Department of Otolaryngology - Head and Neck Surgery, College of Medicine and Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, South Korea
| | - Hwan-Jung Roh
- Department of Otolaryngology - Head and Neck Surgery, College of Medicine and Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, South Korea
| | - Byung-Joo Lee
- Department of Otolaryngology - Head and Neck Surgery, College of Medicine and Medical Research Institute, Pusan National University Hospital, Pusan, South Korea
| | - Young-A Kim
- Department of Pediatrics, College of Medicine, College of Medicine and Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, South Korea
| | - Sunghwa Ko
- Department of Rehabilitation, College of Medicine and Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, South Korea
| | - Eui-Suk Sung
- Department of Otolaryngology - Head and Neck Surgery, College of Medicine and Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, South Korea.
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Jiao A, Liu F, Lerner AD, Rao X, Guo Y, Meng C, Pan Y, Li G, Li Z, Wang F, Zhao J, Ma Y, Liu X, Ni X, Shen K. Effective treatment of post-intubation subglottic stenosis in children with holmium laser therapy and cryotherapy via flexible bronchoscopy. Pediatr Investig 2019; 3:9-16. [PMID: 32851282 PMCID: PMC7331425 DOI: 10.1002/ped4.12113] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Accepted: 10/08/2018] [Indexed: 12/19/2022] Open
Abstract
IMPORTANCE Post-intubation subglottic stenosis (SGS) in children can be life threatening. Definitive treatment varies and lacks a universally accepted approach. OBJECTIVE We performed a prospective study to assess the safety and feasibility of holmium laser combined with cryotherapy delivered via flexible bronchoscopy for the treatment of post-intubation SGS in children. METHODS This study involved all patients with post-intubation SGS seen at the Interventional Pulmonology Department of Beijing Children's Hospital between July 2014 and December 2016. Holmium laser treatment and cryotherapy was then performed under flexible bronchoscopy, whose parents refused to accept the alternative standard treatment of tracheotomy and balloon dilation under direct laryngoscopy. RESULTS Sixteen patients with post-intubation SGS were included in this study. Ages ranged from 2 months to 12.25 years old. According to the Cotton-Myer grading system, three cases were Grade II, 12 cases were Grade III, and one case was Grade IV. According to the McCaffrey system, eight cases were Stage 1, two cases were Stage 2, and six cases were Stage 3. The average number of procedures was 4.88. Fifteen of the 16 patients achieved clinical cure. One patient achieved clinical improvement. The average treatment course duration was 55.31 days. No severe complications were seen. Post-treatment clinical symptoms, endoscopic findings and quality of life showed marked improvement. INTERPRETATION Our study supports the conclusion that holmium laser treatment combined with cryotherapy via flexible bronchoscopy appears to be a safe and feasible treatment for post-intubation SGS in children.
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Affiliation(s)
- Anxia Jiao
- Interventional Pulmonology DepartmentBeijing Children's HospitalCapital Medical UniversityNational Center for Children's HealthBeijingChina
- China National Clinical Research Center for Respiratory DiseasesBeijingChina
| | - Fang Liu
- Interventional Pulmonology DepartmentBeijing Children's HospitalCapital Medical UniversityNational Center for Children's HealthBeijingChina
- China National Clinical Research Center for Respiratory DiseasesBeijingChina
| | - Andrew D. Lerner
- Division of Pulmonary and Critical Care MedicineJohns Hopkins University School of MedicineBaltimoreMDUSA
| | - Xiaochun Rao
- Interventional Pulmonology DepartmentBeijing Children's HospitalCapital Medical UniversityNational Center for Children's HealthBeijingChina
- China National Clinical Research Center for Respiratory DiseasesBeijingChina
| | - Yan Guo
- China National Clinical Research Center for Respiratory DiseasesBeijingChina
- Respiratory DepartmentBeijing Children's HospitalCapital Medical UniversityNational Center for Children's HealthBeijingChina
| | - Chenfang Meng
- Interventional Pulmonology DepartmentBeijing Children's HospitalCapital Medical UniversityNational Center for Children's HealthBeijingChina
- China National Clinical Research Center for Respiratory DiseasesBeijingChina
| | - Yuena Pan
- Interventional Pulmonology DepartmentBeijing Children's HospitalCapital Medical UniversityNational Center for Children's HealthBeijingChina
- China National Clinical Research Center for Respiratory DiseasesBeijingChina
| | - Gan Li
- Interventional Pulmonology DepartmentBeijing Children's HospitalCapital Medical UniversityNational Center for Children's HealthBeijingChina
- China National Clinical Research Center for Respiratory DiseasesBeijingChina
| | - Zheng Li
- Pediatric Intensive Care UnitBeijing Children's HospitalCapital Medical UniversityNational Center for Children's HealthBeijingChina
| | - Fang Wang
- Department of AnesthesiologyBeijing Children's HospitalCapital Medical UniversityNational Center for Children's HealthBeijingChina
| | - Jing Zhao
- Department of Otolaryngology, Head and Neck SurgeryBeijing Children's HospitalCapital Medical UniversityNational Center for Children's HealthBeijingChina
- Beijing Key Laboratory for Pediatric Diseases of OtolaryngologyHead and Neck SurgeryMOE Key Laboratory of Major Disease in ChildrenBeijing Pediatric Research InstituteBeijing Children's HospitalCapital Medical UniversityNational Center for Children's HealthBeijingChina
| | - Yuyan Ma
- Interventional Pulmonology DepartmentBeijing Children's HospitalCapital Medical UniversityNational Center for Children's HealthBeijingChina
- China National Clinical Research Center for Respiratory DiseasesBeijingChina
| | - Xicheng Liu
- Interventional Pulmonology DepartmentBeijing Children's HospitalCapital Medical UniversityNational Center for Children's HealthBeijingChina
- China National Clinical Research Center for Respiratory DiseasesBeijingChina
| | - Xin Ni
- Department of Otolaryngology, Head and Neck SurgeryBeijing Children's HospitalCapital Medical UniversityNational Center for Children's HealthBeijingChina
- Beijing Key Laboratory for Pediatric Diseases of OtolaryngologyHead and Neck SurgeryMOE Key Laboratory of Major Disease in ChildrenBeijing Pediatric Research InstituteBeijing Children's HospitalCapital Medical UniversityNational Center for Children's HealthBeijingChina
| | - Kunling Shen
- China National Clinical Research Center for Respiratory DiseasesBeijingChina
- Respiratory DepartmentBeijing Children's HospitalCapital Medical UniversityNational Center for Children's HealthBeijingChina
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Sekioka A, Fukumoto K, Yamoto M, Takahashi T, Nakaya K, Nomura A, Yamada Y, Urushihara N. Serial intralesional triamcinolone acetonide injections for acquired subglottic stenosis in premature infants. Pediatr Surg Int 2018; 34:1047-1052. [PMID: 30062559 DOI: 10.1007/s00383-018-4312-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/26/2018] [Indexed: 11/24/2022]
Abstract
PURPOSE Long-term intubation of premature infants sometimes induces acquired subglottic stenosis (SGS), causing glottic or supraglottic problems. These kinds of SGS often require tracheostomy and subsequently make decannulation difficult. The aim of our study was to clarify the efficacy of repeated intralesional steroid injections to the stenosis. METHODS Six children with acquired SGS, who were treated with triamcinolone acetonide injections to the subglottic space just below the vocal folds between September 2015 and December 2017 were retrospectively reviewed. RESULTS The patients' mean age was 4.3 (range 1.3-4.4) years, the mean gestational age at birth was 25 (23-28) weeks, and the mean birth weight was 591 (456-734) g. The degree of SGS was grade II in one patient and III in five patients, with both tracheostoma and glottic or supraglottic abnormalities. They generally underwent ten procedures, every 3-4 weeks. In most cases, the patency of the injected space improved by 25-220%, and the symptoms were relieved. One patient achieved decannulation, and another one underwent laryngotracheal reconstruction and decannulation. Two patients started using a speech cannula. There were no severe complications. CONCLUSION Serial intralesional steroid injections are likely to be effective in improving the patency of acquired SGS.
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Affiliation(s)
- Akinori Sekioka
- Department of Pediatric Surgery, Shizuoka Children's Hospital, 860 Urushiyama, Aoi-ku, Shizuoka City, Shizuoka Prefecture, 420-8660, Japan.
| | - Koji Fukumoto
- Department of Pediatric Surgery, Shizuoka Children's Hospital, 860 Urushiyama, Aoi-ku, Shizuoka City, Shizuoka Prefecture, 420-8660, Japan
| | - Masaya Yamoto
- Department of Pediatric Surgery, Shizuoka Children's Hospital, 860 Urushiyama, Aoi-ku, Shizuoka City, Shizuoka Prefecture, 420-8660, Japan
| | - Toshiaki Takahashi
- Department of Pediatric Surgery, Shizuoka Children's Hospital, 860 Urushiyama, Aoi-ku, Shizuoka City, Shizuoka Prefecture, 420-8660, Japan
| | - Kengo Nakaya
- Department of Pediatric Surgery, Shizuoka Children's Hospital, 860 Urushiyama, Aoi-ku, Shizuoka City, Shizuoka Prefecture, 420-8660, Japan
| | - Akiyoshi Nomura
- Department of Pediatric Surgery, Shizuoka Children's Hospital, 860 Urushiyama, Aoi-ku, Shizuoka City, Shizuoka Prefecture, 420-8660, Japan
| | - Yutaka Yamada
- Department of Pediatric Surgery, Shizuoka Children's Hospital, 860 Urushiyama, Aoi-ku, Shizuoka City, Shizuoka Prefecture, 420-8660, Japan
| | - Naoto Urushihara
- Department of Pediatric Surgery, Shizuoka Children's Hospital, 860 Urushiyama, Aoi-ku, Shizuoka City, Shizuoka Prefecture, 420-8660, Japan
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Rigid dilatation of pediatric laryngotracheal stenosis as an adequate alternative to balloon dilatation. Eur Arch Otorhinolaryngol 2018; 275:2529-2533. [PMID: 30099618 DOI: 10.1007/s00405-018-5087-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2018] [Accepted: 08/06/2018] [Indexed: 10/28/2022]
Abstract
INTRODUCTION Endoscopic balloon dilation (EBD) is the mainstay of endoscopic therapy for laryngotracheal stenosis (LTS), although there is no evidence that it achieves better results than traditional rigid laryngeal dilators. Rigid bougie dilators are less expensive and easier to use, and confer the advantage of providing tactile information about the stenosis to the surgeon. We analyzed the outcome of endoscopic rigid bougie dilatation of LTS in a large series of children and compared it to the reported results of EBD in the same setting. PATIENTS AND METHODS All cases of pediatric LTS treated by endoscopic rigid dilatation in a tertiary referral center between 2006 and 2015 were retrospectively studied. They were divided into a primary dilatation group (PDG) and a post-reconstruction dilatation group (PRG). The PDG children had no history of reconstructive airway surgery, and dilatation was the major treatment approach. The PRG children underwent dilatations after airway reconstruction surgery as part of routine postoperative management. A successful primary outcome was defined as improvement of dyspnea and achievement of a functional airway without reconstructive laryngotracheal surgery or need for a tracheostomy at final follow-up. RESULTS Sixty-two children (68 cases, mean age 5.1 years, range 0.7-17.2) underwent 156 endoscopic rigid dilatations. Successful outcome was achieved in 48 cases (70.6%), 73.0% in the PDG and 67.7% in the PRG. There were no procedure-related adverse events. CONCLUSIONS Endoscopic rigid dilatation is a relatively inexpensive and efficacious tool in endoscopic management of pediatric LTS. Its success rates are in the same range as those of EBD.
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Surgical management of children presenting with surgical-needed tracheal stenosis. Int J Pediatr Otorhinolaryngol 2018; 108:219-223. [PMID: 29605358 DOI: 10.1016/j.ijporl.2018.02.040] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2017] [Revised: 02/23/2018] [Accepted: 02/25/2018] [Indexed: 11/21/2022]
Abstract
OBJECTIVES The purpose of this work was to assess epidemiological aspects, surgical approach, morbidity and mortality rates of patients presenting with tracheal stenosis requiring surgery, and the evolution of surgical techniques over the last years. METHODS We performed a retrospective observational study from 1990 to 2017 in a pediatric tertiary-care center with needing surgery for tracheal stenosis. We analyzed clinical patients' characteristics, type of stenosis, type of surgery and follow-up. RESULTS Twenty-eight children presented with tracheal stenosis, half of them with congenital stenosis (complete tracheal rings) and the other half with acquired stenosis (neoplasic or post intubation injury). 39.3% of these stenoses were associated with a vascular ring (61.5% in case of congenital stenosis). Depending on the extent of the stenosis and its origin, the surgery could be performed endoscopically or by an external approach. Enlargement tracheoplasty with an autograft (14.3%) was replaced by slide tracheoplasty with Cardio Pulmonary By-Pass (CPBP, 28.6%) with improved results for the treatment of long segment tracheal stenosis, involving more than 30% of the tracheal length (all were congenital in our study). Slide tracheoplasty has been performed since the late 90's in our institution. 25% of children have had a resection and anastomosis of the trachea because they had a stenosis involving less than 30% of tracheal length. Endoscopic surgery was performed for membranous stenoses, which were often seen after intubation or tracheotomy (32.1% of patients). CONCLUSION Effective treatment of surgical tracheal stenosis was performed in 28 children between 1990 and 2015. Surgical techniques have evolved over time, leading to a better management of this rare and serious disease.
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Eber E, Antón-Pacheco JL, de Blic J, Doull I, Faro A, Nenna R, Nicolai T, Pohunek P, Priftis KN, Serio P, Coleman C, Masefield S, Tonia T, Midulla F. ERS statement: interventional bronchoscopy in children. Eur Respir J 2017; 50:50/6/1700901. [DOI: 10.1183/13993003.00901-2017] [Citation(s) in RCA: 58] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Accepted: 08/08/2017] [Indexed: 12/25/2022]
Abstract
Paediatric airway endoscopy is accepted as a diagnostic and therapeutic procedure, with an expanding number of indications and applications in children. The aim of this European Respiratory Society task force was to produce a statement on interventional bronchoscopy in children, describing the evidence available at present and current clinical practice, and identifying areas deserving further investigation. The multidisciplinary task force panel performed a systematic review of the literature, focusing on whole lung lavage, transbronchial and endobronchial biopsy, transbronchial needle aspiration with endobronchial ultrasound, foreign body extraction, balloon dilation and occlusion, laser-assisted procedures, usage of airway stents, microdebriders, cryotherapy, endoscopic intubation, application of drugs and other liquids, and caregiver perspectives. There is a scarcity of published evidence in this field, and in many cases the task force had to resort to the collective clinical experience of the committee to develop this statement. The highlighted gaps in knowledge underline the need for further research and serve as a call to paediatric bronchoscopists to work together in multicentre collaborations, for the benefit of children with airway disorders.
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Bitar MA, Al Barazi R, Barakeh R. Airway reconstruction: review of an approach to the advanced-stage laryngotracheal stenosis. Braz J Otorhinolaryngol 2017; 83:299-312. [PMID: 27184508 PMCID: PMC9444725 DOI: 10.1016/j.bjorl.2016.03.012] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2015] [Revised: 03/06/2016] [Accepted: 03/31/2016] [Indexed: 11/30/2022] Open
Abstract
Introduction The management of laryngotracheal stenosis is complex and is influenced by multiple factors that can affect the ultimate outcome. Advanced lesions represent a special challenge to the treating surgeon to find the best remedying technique. Objective To review the efficacy of our surgical reconstructive approach in managing advanced-stage laryngotracheal stenosis treated at a tertiary medical center. Methods A retrospective review of all patients that underwent open laryngotracheal repair/reconstruction by the senior author between 2002 and 2014. Patients with mild/moderate stenosis (e.g. stage 1 or 2), or those who had an open reconstructive procedure prior to referral, were excluded. Patients who had only endoscopic treatment (e.g. laser, balloon dilatation) and were not subjected to an open reconstructive procedure at our institution, were not included in this study. Variables studied included patient demographics, clinical presentation, etiology of the laryngotracheal pathology, the location of stenosis, the stage of stenosis, the type of corrective or reconstructive procedure performed with the type of graft used (where applicable), the type and duration of stent used, the post-reconstruction complications, and the duration of follow-up. Outcome measures included decannulation rate, total number of reconstructive surgeries needed to achieve decannulation, and the number of post-operative endoscopies needed to reach a safe patent airway. Results Twenty five patients were included, aged 0.5 months to 45 years (mean 13.5 years, median 15 years) with 16 males and 9 females. Seventeen patients (68%) were younger than 18 years. Most patients presented with stridor, failure of decannulation, or respiratory distress. Majority had acquired etiology for their stenosis with only 24% having a congenital pathology. Thirty-two reconstructive procedures were performed resulting in decannulating 24 patients (96%), with 15/17 (88%) pediatric patients and 5/8 (62.5%) adult patients requiring only a single reconstructive procedure. Cartilage grafts were mostly used in children (84% vs. 38%) and stents were mostly silicone made, followed by endotracheal tubes. The number of endoscopies required ranged from 1 to 7 (mean 3). More co-morbidities existed in young children, resulting in failure to decannulate one patient. Adult patients had more complex pathologies requiring multiple procedures to achieve decannulation, with grafting less efficacious than in younger patients. The pediatric patients had double the incidence of granulation tissue compared to adults. The decannulated patients remained asymptomatic at a mean follow-up of 50.5 months. Conclusion The review of our approach to open airway repair/reconstruction showed its efficacy in advanced-stage laryngotracheal stenosis. Good knowledge of a variety of reconstructive techniques is important to achieve good results in a variety of age groups.
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Affiliation(s)
- Mohamad Ahmad Bitar
- American University of Beirut, Faculty of Medicine and Medical Center, Department of Otolaryngology and Head & Neck Surgery, Beirut, Lebanon; American University of Beirut, Faculty of Medicine and Medical Center, Department of Pediatrics and Adolescent Medicine, Beirut, Lebanon; University of Sydney, Sydney Medical School, The Children's Hospital at Westmead, Department of ENT Surgery, Sydney, Australia; Al Jalila Children's Specialty Hospital, Department of Otolaryngology Head & Neck Surgery, Dubai, UAE.
| | - Randa Al Barazi
- American University of Beirut, Faculty of Medicine and Medical Center, Department of Otolaryngology and Head & Neck Surgery, Beirut, Lebanon
| | - Rana Barakeh
- American University of Beirut, Faculty of Medicine and Medical Center, Department of Otolaryngology and Head & Neck Surgery, Beirut, Lebanon
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Current trends of balloon laryngoplasty in Thailand. Eur Arch Otorhinolaryngol 2017; 274:2607-2611. [PMID: 28255926 DOI: 10.1007/s00405-017-4520-0] [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: 12/13/2016] [Accepted: 02/21/2017] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To describe the current trend in balloon laryngoplasty usage and experience by practicing otolaryngologists in Thailand. STUDY DESIGN Anonymous 11 question online and paper survey of otolaryngologists on their current balloon laryngoplasty practices. SUBJECTS AND METHODS Current practices and experience in balloon laryngoplasty were queried with multiple choice and open-ended questions. RESULTS Laser use is the most commonly utilized instrument to treat airway stenosis in Thailand. 86% of respondents do not have experience with balloon dilatation; yet, almost half (47.6%) report they perform a minimum of five airway surgeries per year. Most respondents had been in practice for less than 6 years (41%) and reported that they did not have exposure to balloon use during residency training. The largest barrier reported for the use of balloon instrumentation in the airway is inexperience (44.4%) followed by cost (38.3%), yet most feel that treatment in airway stenosis could benefit by usage of balloons (95.5%). CONCLUSIONS Most otolaryngologists in Thailand do not have experience with the use of balloon dilatation and lack of exposure remains the largest barrier to its use. Otolaryngologists in Thailand feel that increased usage of balloons in the airway could improve airway stenosis treatment in the country.
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Alshammari J, Alkhunaizi AA, Arafat AS. Tertiary center experience with primary endoscopic laryngoplasty in pediatric acquired subglottic stenosis and literature review. Int J Pediatr Adolesc Med 2017; 4:33-37. [PMID: 30805497 PMCID: PMC6372454 DOI: 10.1016/j.ijpam.2016.11.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2016] [Revised: 09/10/2016] [Accepted: 11/22/2016] [Indexed: 11/27/2022]
Abstract
Background and objectives To share our experience with primary endoscopic laryngoplasty in pediatric acquired subglottic stenosis and critically review the previously published studies. Setting Tertiary Referral Centers, King Abdulaziz Medical City, Riyadh, Saudi Arabia. Patients and methods A retrospective case series study was conducted, where the case notes of all pediatric patients who underwent endoscopic management as a primary surgical intervention for acquired subglottic stenosis (SGS) from 2004 to 2014 were reviewed. All patients who underwent surgical correction with primary open laryngoplasty for congenital subglottic stenosis had been excluded. Results A total of 60 patients with a workable diagnosis of subglottic stenosis were reviewed. Forty-five patients were included in the study and 15 patients were excluded because they underwent open laryngoplasty as a primary treatment modality for congenital subglottic stenosis. The majority of the patients were males 29 (64%), with 16 (36%) females. The main presentation was stridor and intercostal recession. Thirty-nine (86%) patients had subglottic stenosis due to prolonged intubation; 5 (11%) patients were idiopathic and one patient (3%) had inflammatory reasons. The site of stenosis was isolated SGS in 41 while 4 patients had glottic-subglottic stenosis (GSGS). In terms of the grade of stenosis: 13 patients had grade I; 23 had grade II and 9 had grade III. The character of stenosis was soft except in 5 patients with hard (mature) scar. The number of dilatation procedures ranged from 1 to 6 with a mean of 2. The endoscopic management was considered to be successful when the patient is completely asymptomatic after the follow up period of one year. No major complications were recorded among the patients. Thirty-seven (82.3%) patients had a benign course post endoscopic intervention without complications and 8 (17.7%) underwent a secondary open surgical management due to re-stenosis (P value < 0.01). Conclusion Our study showed that primary endoscopic management was successful in 82.3% of cases of acquired subglottic stenosis including those with high grade stenosis and long segment of more than 12 mm in terms of the craniocaudal length. CO2 laser was an important tool to convert mature hard stenotic segment into a soft one. The latter yielded to the lateral pressure created by balloon dilatation better.
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Affiliation(s)
- Jaber Alshammari
- King Saud bin Abdulaziz University for Health Sciences (KASU-HS) - Riyadh, Saudi Arabia, King Abdulaziz Medical City (KAMC) - Riyadh, Saudi Arabia, P.O.Box 22490, Riyadh 11426, Saudi Arabia
| | - Arwa A Alkhunaizi
- King Abdulaziz Medical City (KAMC) - Riyadh, Saudi Arabia, P.O.Box 22490, Riyadh 11426, Saudi Arabia
| | - Abdullah S Arafat
- King Saud bin Abdulaziz University for Health Sciences (KASU-HS) - Riyadh, Saudi Arabia, P.O.Box 3660, Riyadh 11481, Saudi Arabia
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Safe balloon sizing for endoscopic dilatation of subglottic stenosis in children. The Journal of Laryngology & Otology 2017; 131:268-272. [DOI: 10.1017/s0022215117000081] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AbstractObjectives:To describe our experience and provide guidelines for maximum safe balloon sizes according to age in children undergoing balloon dilatation.Method:A retrospective review was conducted of children undergoing balloon dilatation for subglottic stenosis in a paediatric tertiary unit between May 2006 and February 2016.Results:A total of 166 patients underwent balloon dilatation. Mean ( ± standard deviation) patient age was 4.5 ± 3.99 years. The median balloon size was 8 mm, the median balloon inflation pressure was 10 atm, and the mean balloon inflation time was 65.1 ± 18.6 seconds. No significant unexpected events occurred. The Pearson correlation co-efficient for the relationship between patient age and balloon size was 0.85 (p = 0.001), suggesting a strongly positive correlation.Conclusion:This study demonstrated that balloon dilatation is a safe procedure for airway stenosis. The results suggest using a balloon diameter that is equal to the outer diameter of the age-appropriate endotracheal tube +1 mm for the larynx and subglottis and +2 mm for the trachea.
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Abstract
PURPOSE OF REVIEW To describe the efficacy of mitomycin C in combating airway stenosis. RECENT FINDINGS Recent publications discussing mitomycin C utility have not altered the mixed results previously established by prospective trials. SUMMARY Mitomycin C has been used for the past 16 years to inhibit pediatric airway fibroblast proliferation. Its benefit remains more hypothetical than proven and its future role remains uncertain.
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Avelino M, Maunsell R, Jubé Wastowski I. Predicting outcomes of balloon laryngoplasty in children with subglottic stenosis. Int J Pediatr Otorhinolaryngol 2015; 79:532-6. [PMID: 25677564 DOI: 10.1016/j.ijporl.2015.01.022] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2014] [Revised: 01/14/2015] [Accepted: 01/19/2015] [Indexed: 11/30/2022]
Abstract
UNLABELLED The treatment of subglottic stenosis in children remains a challenge for the otolaryngologist and may involve procedures such as endoscopy, open surgery, and often both. In the recent past, high-pressure balloons have been used in endoscopic treatment due to their relative facility and high success rates. OBJECTIVE To report success rates in the treatment of acquired subglottic stenosis with balloon laryngoplasty in children and identify predictive factors for the success of the technique and its complications. METHODS Descriptive, prospective study of children who were diagnosed with acquired subglottic stenosis and underwent balloon laryngoplasty as the primary treatment. RESULTS Balloon laryngoplasty was performed in 48 children with an average age of 20.7 months: 31 presented with chronic subglottic stenosis and 17 with acute stenosis. Success rate was 100% for acute and 39% for chronic subglottic stenosis. Success was significantly associated with several factors, including recently acquired stenosis, initial grade of stenosis, younger patient age, and the absence of tracheotomy. Complications were transitory dysphagia observed in three children and a submucosal cyst in one of the patients. CONCLUSIONS Balloon laryngoplasty may be considered as a first line of treatment for acquired subglottic stenosis. In acute cases, the success rate was 100%, and even though results are less promising in chronic cases, complications were not significant and the patients can undergo open surgery without contraindications. Predictive factors of success were acute stenosis, less severe grades of stenosis, younger patient age, and the absence of tracheotomy.
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Affiliation(s)
- Melissa Avelino
- Universidade Federal de Góias-UFG, Faculdade de Medicina, Rua 235 com a Primeira Radial s/n, Setor Universitário, CEP 74605-020 Goiânia, GO, Brazil.
| | - Rebecca Maunsell
- Hospital Estadual de Sumaré, Universidade Estadual de Campinas-UNICAMP, Av da Amizade, 2400, CEP 13175-490 Sumaré, SP, Brazil.
| | - Isabela Jubé Wastowski
- Universidade Estadual de Goiás - UEG, Rua 14, n. 625, CEP 75650000 - Morrinhos, GO, Brazil.
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Maunsell R, Avelino MA. Balloon laryngoplasty for acquired subglottic stenosis in children: predictive factors for success. Braz J Otorhinolaryngol 2014; 80:409-15. [PMID: 25303816 PMCID: PMC9444630 DOI: 10.1016/j.bjorl.2014.07.012] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2013] [Accepted: 05/24/2014] [Indexed: 10/28/2022] Open
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