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Richardson CM, Walton S, Park JS, Bonilla-Velez J, Bly RA, Dahl JP, Parikh SR, Friedman S, Johnson KE. Multidisciplinary Advanced Surgical Planning for Slide Tracheoplasty Using 3D-Printed Models. Laryngoscope 2024; 134:3395-3401. [PMID: 38450727 DOI: 10.1002/lary.31327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 12/03/2023] [Accepted: 01/23/2024] [Indexed: 03/08/2024]
Abstract
OBJECTIVE The objective of this study was to develop and assess multidisciplinary advanced surgical planning (ASP) sessions using three dimensional (3D) printed models for cervicothoracic slide tracheoplasty (CST). We hypothesized that these sessions would improve surgeon confidence, streamline intraoperative planning, and highlight the utility of 3D modeling. METHODS 3D-printed patient-specific trachea models were used in pre-operative ASP sessions consisting of a multidisciplinary case discussion and hands-on slide tracheoplasty simulation. Participants completed a survey rating realism, utility, impact on the final surgical plan, and pre- and post-session confidence. Statistical analysis was performed via Wilcoxon and Kruskal-Wallis tests. RESULTS Forty-eight surveys were collected across nine sessions and 27 different physicians. On a 5-point Likert scale, models were rated as "very realistic", "very useful" (both median of 4, IQR 3-4 and 4-5, respectively). Overall confidence increased by 1.4 points (+/- 0.7, p < 0.0001), with the largest change seen in those with minimal prior slide tracheoplasty experience (p = 0.005). Participants felt that the sessions "strongly" impacted their surgical plan or anticipated performance (median 4, IQR 4-5), regardless of training level or experience. CONCLUSION 3D-printed patient-specific models were successfully implemented in ASP sessions for CST. Models were deemed very realistic and very useful by surgeons across multiple specialties and training levels. Surgical planning sessions also strongly impacted the final surgical plan and increased surgeon confidence for CST. LEVEL OF EVIDENCE 4 Laryngoscope, 134:3395-3401, 2024.
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Affiliation(s)
- Clare M Richardson
- Division of Pediatric Otolaryngology - Head & Neck Surgery, Phoenix Children's Hospital, Phoenix, Arizona, U.S.A
| | - Scott Walton
- Division of Pediatric Otolaryngology - Head & Neck Surgery, Seattle Children's Hospital, Seattle, Washington, U.S.A
- Department of Otolaryngology - Head & Neck Surgery, Madigan Army Medical Center, Tacoma, Washington, U.S.A
| | - Jason S Park
- Department of Otolaryngology-Head and Neck Surgery, Monroe Carell Jr. Children's Hospital at Vanderbilt University Medical Center, Nashville, Tennessee, U.S.A
| | - Juliana Bonilla-Velez
- Division of Pediatric Otolaryngology - Head & Neck Surgery, Seattle Children's Hospital, Seattle, Washington, U.S.A
- Department of Otolaryngology - Head & Neck Surgery, University of Washington School of Medicine, Seattle, Washington, U.S.A
| | - Randall A Bly
- Division of Pediatric Otolaryngology - Head & Neck Surgery, Seattle Children's Hospital, Seattle, Washington, U.S.A
- Department of Otolaryngology - Head & Neck Surgery, University of Washington School of Medicine, Seattle, Washington, U.S.A
| | - John P Dahl
- Division of Pediatric Otolaryngology - Head & Neck Surgery, Seattle Children's Hospital, Seattle, Washington, U.S.A
- Department of Otolaryngology - Head & Neck Surgery, University of Washington School of Medicine, Seattle, Washington, U.S.A
| | - Sanjay R Parikh
- Division of Pediatric Otolaryngology - Head & Neck Surgery, Seattle Children's Hospital, Seattle, Washington, U.S.A
- Department of Otolaryngology - Head & Neck Surgery, University of Washington School of Medicine, Seattle, Washington, U.S.A
| | - Seth Friedman
- Center for Clinical and Translational Research, Seattle Children's Hospital, Seattle, Washington, U.S.A
| | - Kaalan E Johnson
- Division of Pediatric Otolaryngology - Head & Neck Surgery, Seattle Children's Hospital, Seattle, Washington, U.S.A
- Department of Otolaryngology - Head & Neck Surgery, University of Washington School of Medicine, Seattle, Washington, U.S.A
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Siu J, Richardson CM, McMullan DM, Files M, Friedman S, Parikh S, Johnson K. Creating Patient-Specific 3D-Printed Airway Models for Slide Tracheoplasty. Laryngoscope 2024. [PMID: 38771117 DOI: 10.1002/lary.31435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Revised: 02/27/2024] [Accepted: 03/12/2024] [Indexed: 05/22/2024]
Abstract
This protocol describes the method for creating 3D-printed trachea models for use in high-fidelity simulation-based training and advanced surgical planning for pediatric patients undergoing slide tracheoplasty. The goal is to provide a template and methodology to allow for replicability and more widespread dissemination of these models to improve clinical training and patient care. Laryngoscope, 2024.
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Affiliation(s)
- Jennifer Siu
- Department of Otolaryngology-Head and Neck Surgery, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Clare M Richardson
- Division of Pediatric Otolaryngology-Head and Neck Surgery, Phoenix Children's Hospital, Phoenix, Arizona, U.S.A
| | - D Michael McMullan
- Division of Cardiac Surgery, Seattle Children's Hospital, Seattle, Washington, U.S.A
| | - Matthew Files
- Department of Cardiology, Seattle Children's Hospital, Seattle, Washington, U.S.A
| | - Seth Friedman
- Department of Continuous Improvement and Innovation, Seattle Children's Hospital, Seattle, Washington, USA
| | - Sanjay Parikh
- Division of Pediatric Otolaryngology-Head and Neck Surgery, Seattle Children's Hospital, Seattle, Washington, USA
- Department of Otolaryngology-Head and Neck Surgery, University of Washington, Seattle, Washington, USA
| | - Kaalan Johnson
- Division of Pediatric Otolaryngology-Head and Neck Surgery, Seattle Children's Hospital, Seattle, Washington, USA
- Department of Otolaryngology-Head and Neck Surgery, University of Washington, Seattle, Washington, USA
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Goussard P, Eber E, Venkatakrishna S, Janson J, Schubert P, Andronikou S. Bronchoscopy findings in children with congenital lung and lower airway abnormalities. Paediatr Respir Rev 2024; 49:43-61. [PMID: 37940462 DOI: 10.1016/j.prrv.2023.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Accepted: 10/20/2023] [Indexed: 11/10/2023]
Abstract
Congenital lung and lower airway abnormalities are rare, but they are an important differential diagnosis in children with respiratory diseases, especially if the disease is recurrent or does not resolve. The factors determining the time of presentation of congenital airway pathologies include the severity of narrowing, association with other lesions and the presence or absence of congenital heart disease (CHD). Bronchoscopy is required in these cases to assess the airway early after birth or when intubation and ventilation are difficult or not possible. Many of these conditions have associated abnormalities that must be diagnosed early, as this determines surgical interventions. It may be necessary to combine imaging and bronchoscopy findings in these children to determine the correct diagnosis as well as in operative management. Endoscopic interventional procedures may be needed in many of these conditions, ranging from intubation to balloon dilatations and aortopexy. This review will describe the bronchoscopic findings in children with congenital lung and lower airway abnormalities, illustrate how bronchoscopy can be used for diagnosis and highlight the role of interventional bronchoscopy in the management of these conditions.
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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, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Jacques Janson
- Division of Cardiothoracic Surgery, Department of Surgical Sciences, 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, 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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Dai L, Zhao L, Shen L, Pan Z, Wu C, Mo L, Wu Y. Treatment of long-segment congenital tracheal stenosis with congenital cardiovascular defects in infancy. Int J Pediatr Otorhinolaryngol 2023; 172:111691. [PMID: 37536159 DOI: 10.1016/j.ijporl.2023.111691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 07/24/2023] [Accepted: 07/29/2023] [Indexed: 08/05/2023]
Abstract
OBJECTIVES This study aims to evaluate the outcomes of simultaneous repair for infants with long-segment congenital tracheal stenosis (LSCTS) with congenital cardiovascular defects (CCD). METHODS We retrospectively reviewed the clinical data of infants aged less than 1 year with LSCTS and CCD who underwent simultaneous repair at Children's Hospital of Chongqing Medical University from January 2020 to March 2023. A systematic search of PubMed, Embase, and Cochrane Library for the relevant published studies that reported the simultaneous repair of CTS and CCD in infancy was conducted in March 2023. The inverse variance method of DerSimonian-Laird (D + L) was used for estimate synthesis. RESULTS A total of thirteen infants with a mean age of 5.6 ± 3.1 months and a mean weight of 6.4 ± 0.9 Kg underwent slide tracheoplasty with modified procedures and cardiovascular operations. LSCTS was diagnosed in all thirteen patients. Nine infants were ventilator dependent, and four patients were operated on due to persistent wheezing and recurrent respiratory infections. Seven patients underwent pulmonary artery sling repair, and six underwent atrial septal defect repair. All infants were repaired utilizing cardiopulmonary bypass (CPB) support. Significant complications were recorded in three patients. In-hospital deaths were seen in one case. The median tracheal minimum diameter of hospital survivors was significantly larger than the preoperative minimum diameter (p < 0.001). The mean follow-up duration was 17.1 ± 7.1 months. There was no late mortality during the follow-up. Twelve studies were included based on our search strategy. The pooled estimate of mortality in the literature was 10.9% (95%CI, 5.3%-17.7%, I2 = 0). The pooled estimate of airway re-interventions was 28.8% (95%CI, 14.5%-43.2%, I2 = 74%). CONCLUSIONS Simultaneous repair of LSCTS and CCD in infancy is safe and effective. Slide tracheoplasty with appropriate technical modifications may be valid for LSCTS repair without significant restenosis and reinterventions.
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Affiliation(s)
- Lurun Dai
- Department of Cardiothoracic Surgery, Children's Hospital of Chongqing Medical University, China; Ministry of Education Key Laboratory of Child Development and Disorders, China; National Clinical Research Center for Child Health and Disorders, China; China International Science and Technology Cooperation Base of Child Development and Critical Disorders, China; Chongqing Key Laboratory of Pediatrics, China; Children's Hospital of Chongqing Medical University, China
| | - Lu Zhao
- Department of Cardiothoracic Surgery, Children's Hospital of Chongqing Medical University, China; Ministry of Education Key Laboratory of Child Development and Disorders, China; National Clinical Research Center for Child Health and Disorders, China; China International Science and Technology Cooperation Base of Child Development and Critical Disorders, China; Chongqing Key Laboratory of Pediatrics, China; Children's Hospital of Chongqing Medical University, China
| | - Lianju Shen
- Ministry of Education Key Laboratory of Child Development and Disorders, China; National Clinical Research Center for Child Health and Disorders, China; China International Science and Technology Cooperation Base of Child Development and Critical Disorders, China; Chongqing Key Laboratory of Pediatrics, China; Children's Hospital of Chongqing Medical University, China
| | - Zhengxia Pan
- Department of Cardiothoracic Surgery, Children's Hospital of Chongqing Medical University, China; Ministry of Education Key Laboratory of Child Development and Disorders, China; National Clinical Research Center for Child Health and Disorders, China; China International Science and Technology Cooperation Base of Child Development and Critical Disorders, China; Chongqing Key Laboratory of Pediatrics, China; Children's Hospital of Chongqing Medical University, China
| | - Chun Wu
- Department of Cardiothoracic Surgery, Children's Hospital of Chongqing Medical University, China; Ministry of Education Key Laboratory of Child Development and Disorders, China; National Clinical Research Center for Child Health and Disorders, China; China International Science and Technology Cooperation Base of Child Development and Critical Disorders, China; Chongqing Key Laboratory of Pediatrics, China; Children's Hospital of Chongqing Medical University, China
| | - Lin Mo
- Ministry of Education Key Laboratory of Child Development and Disorders, China; National Clinical Research Center for Child Health and Disorders, China; China International Science and Technology Cooperation Base of Child Development and Critical Disorders, China; Chongqing Key Laboratory of Pediatrics, China; Children's Hospital of Chongqing Medical University, China.
| | - Yuhao Wu
- Department of Cardiothoracic Surgery, Children's Hospital of Chongqing Medical University, China; Ministry of Education Key Laboratory of Child Development and Disorders, China; National Clinical Research Center for Child Health and Disorders, China; China International Science and Technology Cooperation Base of Child Development and Critical Disorders, China; Chongqing Key Laboratory of Pediatrics, China; Children's Hospital of Chongqing Medical University, China.
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Morita K, Hatakeyama T. Clinical features of a tracheoesophageal fistula associated with complete tracheal rings. Pediatr Surg Int 2023; 39:218. [PMID: 37354332 DOI: 10.1007/s00383-023-05503-0] [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] [Accepted: 06/18/2023] [Indexed: 06/26/2023]
Abstract
PURPOSE A tracheoesophageal fistula (TEF) associated with complete tracheal rings (CTR) is extremely rare. This study aimed to elucidate the clinical features of this combination. METHODS Records of 39 patients diagnosed with TEF with or without CTR between January 2013 and February 2023 were retrospectively reviewed. Data collected included location of the TEF and CTR, esophageal gap, surgery of TEF/esophageal atresia (EA), and symptoms of CTR. RESULTS Seven patients had CTR, while 32 patients did not have CTR. TEF was frequently located higher than the T4 vertebra, and the median esophageal gap was shorter in patients with CTR than in those without (5/7 [71.4%] vs. 6/32 [18.8%], P = 0.012; 0 (range: 0-15) mm vs. 13.3 (range: 0-40) mm, P = 0.017, respectively). TEF was located just above the beginning of the CTR in all patients. All patients with CTR underwent primary esophageal anastomosis. Additionally, two patients were diagnosed with CTR before TEF/EA repair. A tracheal tube was prevented from contacting the CTR during TEF/EA repair, and respiratory insufficiency did not occur. CONCLUSIONS Our results may help pediatric surgeons in the management of TEF with CTR.
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Affiliation(s)
- Keiichi Morita
- Department of Pediatric Surgery, Kobe Children's Hospital, 1-6-7 Minatojimaminamimachi, Chuo-ku, Kobe, 650-0047, Japan.
| | - Tadashi Hatakeyama
- Department of Pediatric Surgery, Kobe Children's Hospital, 1-6-7 Minatojimaminamimachi, Chuo-ku, Kobe, 650-0047, Japan
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Zhou M, Zhong LL, Huang H, Lin L, Chen M, Ding XF. [The role of bronchoscopy in slide tracheoplasty in children]. ZHONGGUO DANG DAI ER KE ZA ZHI = CHINESE JOURNAL OF CONTEMPORARY PEDIATRICS 2023; 25:527-533. [PMID: 37272181 PMCID: PMC10247194 DOI: 10.7499/j.issn.1008-8830.2211012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Accepted: 04/10/2023] [Indexed: 06/06/2023]
Abstract
OBJECTIVES To study the role of bronchoscopy in slide tracheoplasty. METHODS A retrospective analysis was conducted on the diagnosis and treatment of four children with tracheal stenosis admitted to Hunan Provincial People's Hospital from 2017 to 2020. The role of bronchoscopy was summarized in the preoperative evaluation, intraoperative positioning and measurement, and postoperative wound evaluation and treatment during slide tracheoplasty. RESULTS Bronchoscopy evaluation before slide tracheoplasty showed that 3 of the 4 children had complete trachea rings, 2 had pulmonary artery sling, and 2 had multiple stenosis. Slide tracheoplasty was performed in the hospital on 3 children, and the midpoint of the stenosis segment was judged under bronchoscopy, and the length of the stenosis segment was measured, which assisted in the resection of the stenosis segment of the trachea. The pathogens were identified by lavage after the surgery. One child who developed scar traction 9 months after slide tracheoplasty in another hospital was improved by interventional treatment under bronchoscopy. Mucosal changes were found under bronchoscopy in 2 children 4 days after surgery, and the treatment plan was adjusted. One month after surgery, 2 children had granulation hyperplasia, which was improved by cryotherapy under bronchoscopy. One child abandoned treatment due to anastomotic necrosis and died. Three survivors were followed up for over 6 months with good prognosis, but all had tracheobronchial malacia. CONCLUSIONS Bronchoscopy can be used for the management of slide tracheoplasty in children with tracheal stenosis, which is helpful to postoperative rehabilitation and follow-up.
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Affiliation(s)
- Miao Zhou
- Children's Medical Center, Hunan Provincial People's Hospital, Changsha 410000, China
| | - Li-Li Zhong
- Children's Medical Center, Hunan Provincial People's Hospital, Changsha 410000, China
| | - Han Huang
- Children's Medical Center, Hunan Provincial People's Hospital, Changsha 410000, China
| | - Lin Lin
- Children's Medical Center, Hunan Provincial People's Hospital, Changsha 410000, China
| | - Min Chen
- Children's Medical Center, Hunan Provincial People's Hospital, Changsha 410000, China
| | - Xiao-Fang Ding
- Children's Medical Center, Hunan Provincial People's Hospital, Changsha 410000, China
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Alkhasov A, Ratnikov S, Lezhnev A, Razumovskiy A, Sergeeva I, Kuzin S, Komina E, Gusev A, Yatzik S, Romanova E, Savelieva M, Fisenko A. Sliding tracheoplasty of complete tracheal cartilage rings in children. J Pediatr Surg 2023; 58:624-628. [PMID: 36653203 DOI: 10.1016/j.jpedsurg.2022.12.022] [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: 12/07/2022] [Accepted: 12/12/2022] [Indexed: 12/24/2022]
Abstract
INTRODUCTION Complete tracheal rings are a rare malformation that occurs in 1 out of 100,000 live births. It is rare, isolated tracheal or tracheobronchial anomaly developed due to abnormal cartilage growth with formation of complete ring and often resulting in airway stenosis. Slide tracheoplasty, as it was originally described by Tsang et al. and popularized by Grillo et al., overlaps stenotic segments of trachea, shortening trachea itself, thus, doubling the circumference and diameter of the stenotic area. MATERIALS AND METHODS We have performed slide tracheoplasty in 12 children during the period of 2019-2021 in thoracic surgery department of our center. Median age was 15 ± 21,1 months (2 months-6 years),median weight - 8,04 ± 4,75 kg (3-20,7 kg),tracheal lumen varied from 2.5 to 3.0 mm, stenosis length - from 40 to 70% of the trachea length. RESULTS Slide tracheoplasty was performed using central veno-arterial extracorporeal membrane oxygenation in 7 cases and using cardiopulmonary bypass in 5 cases. Concomitant heart disease was revealed in 5 children (pulmonary artery sling in 3 cases, ventricular septal defects - 1, aberrant subclavian artery -1). 5 children underwent one-stage correction of VSD: plastic VSD -1; left pulmonary artery reimplantation - 3; subclavian artery reimplantation - 1. All patients were on mechanical ventilation for 4,3 ± 2,78 days at postoperative period. Patients were discharged 16,3 ± 5,14 days after surgery. Satisfactory result of treatment in the form of respiratory failure relief was achieved in 10 patients. It was possible to increase the trachea lumen from 1.5 to 2 times in all cases. There were 2 (16,6%) fatal cases due to sepsis and multi-organ failure development. CONCLUSIONS Children with complete tracheal rings are very complicated patients with various comorbidities. Despite the advances in medicine, sometimes it is impossible to save lives of these children. The use of extracorporeal circulation (ECMO and bypass) allows us to safely perform reconstructive surgery on the trachea and save the child from respiratory failure manifestations. If needed, simultaneous correction of heart and tracheal defects is possible. Slide tracheoplasty allows to increase trachea lumen at least in 1.5-2 times. Mechanical ventilation is an unfavorable predictive factor for the outcomes of congenital tracheal stenosis management. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Abdumanap Alkhasov
- The National Medical Research Center of Children's Health, Lomonosovskiy Prospect, 2/1, Moscow, 119991, Russia
| | - Sergey Ratnikov
- The National Medical Research Center of Children's Health, Lomonosovskiy Prospect, 2/1, Moscow, 119991, Russia
| | - Alexandr Lezhnev
- The National Medical Research Center of Children's Health, Lomonosovskiy Prospect, 2/1, Moscow, 119991, Russia
| | - Aleksandr Razumovskiy
- State Budgetary Educational Institution of Higher Professional Education, Russian National Research Medical University Named After N.I. Pirogov, Ministry of Health of Russia, Moscow, Russia
| | - Irina Sergeeva
- The National Medical Research Center of Children's Health, Lomonosovskiy Prospect, 2/1, Moscow, 119991, Russia
| | - Sergey Kuzin
- The National Medical Research Center of Children's Health, Lomonosovskiy Prospect, 2/1, Moscow, 119991, Russia
| | - Elena Komina
- The National Medical Research Center of Children's Health, Lomonosovskiy Prospect, 2/1, Moscow, 119991, Russia
| | - Aleksey Gusev
- The National Medical Research Center of Children's Health, Lomonosovskiy Prospect, 2/1, Moscow, 119991, Russia; Peoples' Friendship University of Russia (RUDN University), Miklukho-Maklaya Str. 6, Moscow, 117198, Russia.
| | - Sergey Yatzik
- The National Medical Research Center of Children's Health, Lomonosovskiy Prospect, 2/1, Moscow, 119991, Russia
| | - Ekaterina Romanova
- The National Medical Research Center of Children's Health, Lomonosovskiy Prospect, 2/1, Moscow, 119991, Russia
| | - Maria Savelieva
- The National Medical Research Center of Children's Health, Lomonosovskiy Prospect, 2/1, Moscow, 119991, Russia
| | - Andrey Fisenko
- The National Medical Research Center of Children's Health, Lomonosovskiy Prospect, 2/1, Moscow, 119991, Russia
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Slide Tracheoplasty. Otolaryngol Clin North Am 2022; 55:1253-1270. [DOI: 10.1016/j.otc.2022.07.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Smith MM, Buck LS. Update on the diagnosis and management of pediatric laryngotracheal stenosis. Expert Rev Respir Med 2022; 16:1035-1041. [DOI: 10.1080/17476348.2022.2145947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Matthew M Smith
- Division of Pediatric Otolaryngology-Head and Neck Surgery, Cincinnati Children’s Hospital Medical Center, 3333 Burnet Ave, Cincinnati, OH, 45229, USA
- Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati College of Medicine, 231 Albert Sabin Way, Cincinnati, OH, 45267, USA
| | - Lauren S Buck
- Division of Pediatric Otolaryngology-Head and Neck Surgery, Cincinnati Children’s Hospital Medical Center, 3333 Burnet Ave, Cincinnati, OH, 45229, USA
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Hysinger EB, Higano NS, Critser PJ, Woods JC. Imaging in neonatal respiratory disease. Paediatr Respir Rev 2022; 43:44-52. [PMID: 35074281 PMCID: PMC10439744 DOI: 10.1016/j.prrv.2021.12.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Accepted: 12/17/2021] [Indexed: 12/15/2022]
Abstract
The purpose of this review is to describe the current state of the art in clinical imaging for NICU patients, divided into major areas that correspond to likely phenotypes of neonatal respiratory disease: airway abnormalities, parenchymal disease, and pulmonary vascular disease. All common imaging modalities (ultrasound, X-ray, CT, and MRI) are discussed, with an emphasis on modalities that are most relevant to the individual underlying aspects of disease. Some promising aspects of dynamic and functional imaging are included, where there may be future clinical applicability.
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Affiliation(s)
- E B Hysinger
- Cincinnati Children's Hospital Medical Center, 3333 Burnett Ave, Cincinnati, OH 45229, United States.
| | - N S Higano
- Cincinnati Children's Hospital Medical Center, 3333 Burnett Ave, Cincinnati, OH 45229, United States
| | - P J Critser
- Cincinnati Children's Hospital Medical Center, 3333 Burnett Ave, Cincinnati, OH 45229, United States
| | - J C Woods
- Cincinnati Children's Hospital Medical Center, 3333 Burnett Ave, Cincinnati, OH 45229, United States
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11
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Zalzal HG, Behzadpour HK, Leonard J, Sinha P, Preciado DA. Systematic Review of Slide Tracheoplasty Outcomes. Ann Otol Rhinol Laryngol 2022; 132:558-565. [PMID: 35723210 DOI: 10.1177/00034894221104955] [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: 11/15/2022]
Abstract
OBJECTIVE To identify factors predicting success in slide tracheoplasty surgery at a regional children's hospital and compare with available published literature. MEASURES Retrospective chart review comparing demographics (age, weight) and clinical (operative and hospital course, need for additional airway intervention) factors experienced with slide tracheoplasty. Findings were compared with a systematic review of published literature. RESULTS Of the 16 tracheal stenosis patients in our cohort, 13 (81.3%) presented with an additional congenital or cardiovascular anomaly. When adjusted for cardiovascular anomalies, congenital tracheal stenosis patients had a mean age of 5.2 months (range 6 days-17 months), mean weight of 5.04 kg, and average ICU and hospital length of stay of 31.5 and 36.0 days, respectively. Tracheostomy was required for 4 patients and no early deaths were recorded. Of the 391 children in the grouped cohort, mean age and weight was older at 7.67 months and larger at 5.70 kg. Length of stay in both ICU and overall hospital course was 31.6 and 43.5 days, respectively. Mortality etiology for 44 patients was reported: 17 (38.6%) cardiac-related and 28 (63.6%) late mortalities. Our overall calculated mortality risk of 1.26 (P < .05) was lower than reported ratios of 2.0+. CONCLUSION Despite the numerous institutional studies involving tracheal stenosis, mortality and surgical challenges remain high. Future studies with the inclusion of specific perioperative data can prove to further evaluate correlations between presentation characteristics and mortality.
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Affiliation(s)
- Habib G Zalzal
- Department of Otolaryngology, Children's National Medical Center, Washington, DC, USA
| | - Hengameh K Behzadpour
- Department of Otolaryngology, Children's National Medical Center, Washington, DC, USA
| | - James Leonard
- Department of Otolaryngology, Children's National Medical Center, Washington, DC, USA
| | - Pranava Sinha
- Department of Cardiac Surgery, Children's National Medical Center, Washington, DC, USA
| | - Diego A Preciado
- Department of Otolaryngology, Children's National Medical Center, Washington, DC, USA
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12
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Bottasso-Arias N, Leesman L, Burra K, Snowball J, Shah R, Mohanakrishnan M, Xu Y, Sinner D. BMP4 and Wnt signaling interact to promote mouse tracheal mesenchyme morphogenesis. Am J Physiol Lung Cell Mol Physiol 2022; 322:L224-L242. [PMID: 34851738 PMCID: PMC8794023 DOI: 10.1152/ajplung.00255.2021] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
Tracheobronchomalacia and complete tracheal rings are congenital malformations of the trachea associated with morbidity and mortality for which the etiology remains poorly understood. Epithelial expression of Wls (a cargo receptor mediating Wnt ligand secretion) by tracheal cells is essential for patterning the embryonic mouse trachea's cartilage and muscle. RNA sequencing indicated that Wls differentially modulated the expression of BMP signaling molecules. We tested whether BMP signaling, induced by epithelial Wnt ligands, mediates cartilage formation. Deletion of Bmp4 from respiratory tract mesenchyme impaired tracheal cartilage formation that was replaced by ectopic smooth muscle, recapitulating the phenotype observed after epithelial deletion of Wls in the embryonic trachea. Ectopic muscle was caused in part by anomalous differentiation and proliferation of smooth muscle progenitors rather than tracheal cartilage progenitors. Mesenchymal deletion of Bmp4 impaired expression of Wnt/β-catenin target genes, including targets of WNT signaling: Notum and Axin2. In vitro, recombinant (r)BMP4 rescued the expression of Notum in Bmp4-deficient tracheal mesenchymal cells and induced Notum promoter activity via SMAD1/5. RNA sequencing of Bmp4-deficient tracheas identified genes essential for chondrogenesis and muscle development coregulated by BMP and WNT signaling. During tracheal morphogenesis, WNT signaling induces Bmp4 in mesenchymal progenitors to promote cartilage differentiation and restrict trachealis muscle. In turn, Bmp4 differentially regulates the expression of Wnt/β-catenin targets to attenuate mesenchymal WNT signaling and to further support chondrogenesis.
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Affiliation(s)
- Natalia Bottasso-Arias
- 1Neonatology and Pulmonary Biology Perinatal Institute, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
| | - Lauren Leesman
- 1Neonatology and Pulmonary Biology Perinatal Institute, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
| | - Kaulini Burra
- 1Neonatology and Pulmonary Biology Perinatal Institute, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
| | - John Snowball
- 1Neonatology and Pulmonary Biology Perinatal Institute, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
| | - Ronak Shah
- 1Neonatology and Pulmonary Biology Perinatal Institute, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio,2University of Cincinnati Honors Program, Cincinnati, Ohio
| | - Megha Mohanakrishnan
- 1Neonatology and Pulmonary Biology Perinatal Institute, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio,2University of Cincinnati Honors Program, Cincinnati, Ohio
| | - Yan Xu
- 1Neonatology and Pulmonary Biology Perinatal Institute, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio,3Universtiy of Cincinnati, College of Medicine, Cincinnati, Ohio
| | - Debora Sinner
- 1Neonatology and Pulmonary Biology Perinatal Institute, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio,3Universtiy of Cincinnati, College of Medicine, Cincinnati, Ohio
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13
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Alkhasov A, Razumovsky A, Gusev A, Tepaev R, Ratnikov S, Lezhnev A, Romanova E, Komina E, Saveleva M, Dyakonova E, Yatzik S. Surgical Treatment of Patients with Full Tracheal Rings: Our Experience. J Laparoendosc Adv Surg Tech A 2021; 31:1511-1515. [PMID: 34847727 DOI: 10.1089/lap.2021.0337] [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: 11/13/2022] Open
Abstract
Introduction: Complete tracheal rings are a rare pathology occurring in 1 out of 100,000 live births. It is rare isolated tracheal or tracheobronchial anomaly resulting from abnormal cartilage growth, forming a complete ring, and leading to airway stenosis. A sliding tracheoplasty, primarily described by Tsang et al. and later widely presented by Grillo et al., overlaps the tracheal stenosing segments and shortens the trachea itself, and thus increases the diameter and circumference of the stenosing area double up. Materials and Methods: We have performed four slide tracheoplasties in the period between February 2019 and December 2020 in children who underwent medical treatment in the department of thoracic surgery in our center. Median age was 10 ± 5.5 months (2 months-1 year 6 months). Median weight was 6.9 ± 1.9 kg (4.5-9 kg). Slide tracheoplasty was performed using central venoarterial extracorporeal membrane oxygenation in 3 cases and using cardiopulmonary bypass in 1 case. Results: Patients were on artificial lung ventilation for 2-6 days in the postoperative period. Patients were discharged 14-18 days after the surgery. There were no lethal outcomes in our study. Discussion: Long segment congenital tracheal stenosis is an often and serious life-threatening anatomical malformation that bounded the length of trachea >50%. There is no unique treatment strategy for patients with such pathology. Sliding tracheoplasty can be recommended for all, but not for the shortest segments of stenosis, as it creates permissible voltage fluctuations during tracheal anastomosis. Excellent results in management of such severe patients can be achieved only through the collaboration of multidisciplinary team of specialists sharing organized and consistent patient-oriented approach.
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Affiliation(s)
- Abdumanap Alkhasov
- Federal State Autonomous Institution "National Medical Research Center of Children's Health" Of the Ministry of Health of the Russian Federation, Moscow, Russian Federation
| | - Alexander Razumovsky
- State Budgetary Educational Institution of Higher Professional Education "Russian National Research Medical University named after N.I. Pirogov" Ministry of Health of Russia, Moscow, Russian Federation
| | - Alexey Gusev
- Federal State Autonomous Institution "National Medical Research Center of Children's Health" Of the Ministry of Health of the Russian Federation, Moscow, Russian Federation.,RUDN University (Peoples' Friendship University of Russia), Moscow, Russian Federation
| | - Rustem Tepaev
- Federal State Autonomous Institution "National Medical Research Center of Children's Health" Of the Ministry of Health of the Russian Federation, Moscow, Russian Federation
| | - Sergey Ratnikov
- Federal State Autonomous Institution "National Medical Research Center of Children's Health" Of the Ministry of Health of the Russian Federation, Moscow, Russian Federation
| | - Alexandr Lezhnev
- Federal State Autonomous Institution "National Medical Research Center of Children's Health" Of the Ministry of Health of the Russian Federation, Moscow, Russian Federation
| | - Ekaterina Romanova
- Federal State Autonomous Institution "National Medical Research Center of Children's Health" Of the Ministry of Health of the Russian Federation, Moscow, Russian Federation
| | - Elena Komina
- Federal State Autonomous Institution "National Medical Research Center of Children's Health" Of the Ministry of Health of the Russian Federation, Moscow, Russian Federation
| | - Maria Saveleva
- Federal State Autonomous Institution "National Medical Research Center of Children's Health" Of the Ministry of Health of the Russian Federation, Moscow, Russian Federation
| | - Elena Dyakonova
- Federal State Autonomous Institution "National Medical Research Center of Children's Health" Of the Ministry of Health of the Russian Federation, Moscow, Russian Federation
| | - Sergey Yatzik
- Federal State Autonomous Institution "National Medical Research Center of Children's Health" Of the Ministry of Health of the Russian Federation, Moscow, Russian Federation
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14
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Richardson C, Friedman SD, Park JS, Bonilla-Velez J, Dahl JP, Parikh SR, Perkins J, Johnson K. Comparison of Slide Tracheoplasty Technique on Postoperative Anatomic Outcomes in Three-Dimensional Printed Models. Laryngoscope 2021; 132:1306-1312. [PMID: 34606107 DOI: 10.1002/lary.29874] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Revised: 08/31/2021] [Accepted: 09/11/2021] [Indexed: 11/11/2022]
Abstract
OBJECTIVES/HYPOTHESIS We hypothesized that the use of three-dimensional (3D) printed tracheal models to reproducibly simulate surgical technique variations in slide tracheoplasty would demonstrate the quantitative impact of surgical variables on postoperative tracheal dimensions. STUDY DESIGN Prospective analysis of three-dimensional printed surgical simulation models. METHODS Slide tracheoplasty was performed on 3D printed long segment tracheal stenosis models with combinations of tracheal transection incision angle (90°, 45° beveled superior to inferior, 45° beveled inferior to superior) and tracheal transection location relative to the stenosis (at midpoint, 2 mm each superior and inferior to midpoint). Postoperative computed tomography (CT) scans measured changes in tracheal length, volume, and cross-sectional area compared to controls. Statistical analysis was performed using one-way analysis of variance and unpaired two-tailed t-tests. RESULTS Slide tracheoplasty yielded 27 reconstructed tracheas. On average, slide tracheoplasty reduced total tracheal length by 36%. Beveled tracheal incisions yielded 9.5% longer final tracheas than straight transection incisions (P < .0001). Cross-sectional area at the stenosis midpoint increased from 9.0 mm2 to 45 mm2 but did not vary with technique (P > .05). Total tracheal luminal volume increased from 900 mm3 to 1378 mm3 overall and was largest with beveled incisions (P = .03). More material was discarded with straight incisions compared to beveled (89 mg vs. 19 mg, P < .0001). CONCLUSIONS Beveled tracheal transection incisions resulted in increased tracheal length, longer anastomotic segments, increased volume, and reduced tissue waste as compared to straight incisions. Offsetting the incision from the midpoint of stenosis did not significantly affect reconstructed tracheal morphology. Using 3D printed models for surgical simulation can be helpful for the quantitative study of the effect isolated surgical variables on technical outcomes. LEVEL OF EVIDENCE 3 Laryngoscope, 2021.
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Affiliation(s)
- Clare Richardson
- Department of Otolaryngology - Head and Neck Surgery, Seattle Children's Hospital, Seattle, Washington, U.S.A.,Department of Otolaryngology - Head and Neck Surgery, University of Washington, Washington, District of Columbia, U.S.A
| | - Seth D Friedman
- Center for Clinical and Translational Research, Seattle Children's Hospital, Seattle, Washington, U.S.A
| | - Jason S Park
- Department of Otolaryngology - Head and Neck Surgery, Seattle Children's Hospital, Seattle, Washington, U.S.A.,Department of Otolaryngology - Head and Neck Surgery, University of Washington, Washington, District of Columbia, U.S.A
| | - Juliana Bonilla-Velez
- Department of Otolaryngology - Head and Neck Surgery, Seattle Children's Hospital, Seattle, Washington, U.S.A.,Department of Otolaryngology - Head and Neck Surgery, University of Washington, Washington, District of Columbia, U.S.A.,Center for Clinical and Translational Research, Seattle Children's Hospital, Seattle, Washington, U.S.A
| | - John P Dahl
- Department of Otolaryngology - Head and Neck Surgery, Seattle Children's Hospital, Seattle, Washington, U.S.A.,Department of Otolaryngology - Head and Neck Surgery, University of Washington, Washington, District of Columbia, U.S.A
| | - Sanjay R Parikh
- Department of Otolaryngology - Head and Neck Surgery, Seattle Children's Hospital, Seattle, Washington, U.S.A.,Department of Otolaryngology - Head and Neck Surgery, University of Washington, Washington, District of Columbia, U.S.A
| | - Jonathan Perkins
- Department of Otolaryngology - Head and Neck Surgery, Seattle Children's Hospital, Seattle, Washington, U.S.A.,Department of Otolaryngology - Head and Neck Surgery, University of Washington, Washington, District of Columbia, U.S.A
| | - Kaalan Johnson
- Department of Otolaryngology - Head and Neck Surgery, Seattle Children's Hospital, Seattle, Washington, U.S.A.,Department of Otolaryngology - Head and Neck Surgery, University of Washington, Washington, District of Columbia, U.S.A
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15
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Kennedy AA, Hart CK, de Alarcon A, Putnam PE, von Allmen D, Lehenbauer D, Bryant R, Torres-Silva C, Rutter MJ. Slide Tracheoplasty for Repair of Complex Tracheoesophageal Fistulas. Laryngoscope 2021; 132:1542-1547. [PMID: 34338338 DOI: 10.1002/lary.29785] [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: 05/04/2021] [Revised: 07/09/2021] [Accepted: 07/20/2021] [Indexed: 11/07/2022]
Abstract
OBJECTIVES/HYPOTHESIS Repair of large, recurrent, and complex tracheoesophageal fistulas (TEFs) is challenging and numerous different surgical approaches exist. These various techniques each carry a set of risks and possible complications such as fistula recurrence, tracheal stenosis or pouches, esophageal stenosis, and recurrent laryngeal nerve injury. Slide tracheoplasty is a reconstructive technique successfully used in many different airway pathologies, including TEF repair. This study examines the success, limits, and complications related to slide tracheoplasty for repair of complex TEFs. STUDY DESIGN Retrospective chart review. METHODS Patients undergoing TEF repair using a cervical or thoracic approach slide tracheoplasty, at a single institution, between July 2008 and December 2019 were retrospectively reviewed. Demographic data, comorbidities, TEF etiology and surgical history, slide tracheoplasty details and outcomes, and postoperative complication data were examined using descriptive statistics. RESULTS Twenty-six patients underwent 27 slide tracheoplasties for TEF (20 cervical approaches, 7 thoracic approaches) with a mean age of 5.2 years (IQR 0.7-7.6) at time of surgery. The most common TEF etiologies included congenital (n = 13), tracheostomy tube erosion (n = 5), and button battery ingestion (n = 4). Fistulas ranged in size from <0.5 mm to 4 cm and 59% had previous endoscopic or open repairs. There were two TEF recurrences (7.4%), one of which was successfully revised and the other which was treated with stent placement. Postoperative complications included dehiscence (3.7%), unilateral vocal fold paralysis (3.7%), and mild tracheal stenosis (18.5%). CONCLUSIONS Slide tracheoplasty is an effective surgical technique for treating complex congenital and acquired TEFs with lower rates of complications when compared to other techniques. LEVEL OF EVIDENCE IV Laryngoscope, 2021.
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Affiliation(s)
- Aimee A Kennedy
- Division of Pediatric Otolaryngology-Head and Neck Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, U.S.A
| | - Catherine K Hart
- Division of Pediatric Otolaryngology-Head and Neck Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, U.S.A.,Department of Otolaryngology Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, U.S.A.,Aerodigestive and Esophageal Center, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, U.S.A
| | - Alessandro de Alarcon
- Division of Pediatric Otolaryngology-Head and Neck Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, U.S.A.,Department of Otolaryngology Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, U.S.A.,Aerodigestive and Esophageal Center, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, U.S.A
| | - Philip E Putnam
- Aerodigestive and Esophageal Center, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, U.S.A.,Division of Gastroenterology, Nutrition and Hepatology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, U.S.A
| | - Daniel von Allmen
- Aerodigestive and Esophageal Center, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, U.S.A.,Department of Pediatric Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, U.S.A
| | - David Lehenbauer
- Department of Cardiothoracic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, U.S.A.,Department of Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, U.S.A
| | - Roosevelt Bryant
- Department of Thoracic and Cardiovascular Surgery, Phoenix Children's Hospital, Phoenix, Arizona, U.S.A
| | - Cherie Torres-Silva
- Aerodigestive and Esophageal Center, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, U.S.A.,Division of Pulmonary Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, U.S.A
| | - Michael J Rutter
- Division of Pediatric Otolaryngology-Head and Neck Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, U.S.A.,Department of Otolaryngology Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, U.S.A.,Aerodigestive and Esophageal Center, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, U.S.A
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16
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Abstract
Congenital airway anomalies (CAA) include a variety of conditions that cause respiratory distress in neonates and infants. These malformations occur at various anatomic levels and manifest in a wide spectrum of airway symptoms, with presentation significantly influenced by the level at which obstruction occurs as well as by the severity of obstruction. The prevalence of congenital airway malformations has been estimated to range between 0.2 and 1 in 10,000 live births. The most frequent CAA are laryngomalacia, bilateral vocal cord paralysis, subglottic stenosis, laryngeal webs, subglottic hemangioma, tracheomalacia, congenital tracheal stenosis, laryngotracheal cleft, and tracheal agenesis.
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Affiliation(s)
- Patricio Varela
- Program Director Pediatric Airway Unit, Mackenna Children's Hospital, University of Chile, Clínica Las Condes Medical Center. Santiago, Chile.
| | - Claudia Schweiger
- Pediatric ENT, Hospital De Clinicas de Porto Alegre, Porto Alegre, Brazil
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17
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Abstract
Acquired tracheal stenosis can result from iatrogenic injury or, less commonly, tracheal tumors. Symptoms can arise insidiously and typically include respiratory distress, sleep disordered breathing, or exercise intolerance. Diagnostic evaluation includes cross-sectional imaging and endoscopy. Various endoscopic and open procedures exist to address acquired tracheal stenosis and treatment should be tailored to the patient. Cervical slide tracheoplasty without cardiopulmonary bypass is a versatile technique that can address different types of tracheal stenosis. It allows for immediate reconstruction with vascularized tissue and continued opportunity for growth as the child ages, with high success rates with minimal morbidity.
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Affiliation(s)
- Carol Li
- Division of Pediatric Otolaryngology - Head and Neck Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA; Department of Otolaryngology - Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, OH, USA.
| | - Michael J Rutter
- Division of Pediatric Otolaryngology - Head and Neck Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA; Department of Otolaryngology - Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, OH, USA
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18
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Jeon MJ, Kim MJ, Kim JH, Park JS, Yim J, Kim M, Kwon SK, Lee S, Ko JM, Chae JH, Suh DI. Multilevel Airway Stenosis Being Bypassed by a Customized Tracheostomy Tube in an Infant with Myhre Syndrome. PEDIATRIC ALLERGY IMMUNOLOGY AND PULMONOLOGY 2021; 34:83-87. [PMID: 34143683 DOI: 10.1089/ped.2021.0029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Background: Myhre syndrome is a rare connective tissue disorder caused by heterozygous pathogenic variants in the SMAD4 gene. Although recognizing Myhre syndrome in early childhood is challenging, it is important to manage airway stenosis in patients with Myhre syndrome. Case Presentation: We report the case of a 2-month-old boy who initially presented with severe multilevel airway stenosis, dysmorphic face, and multiple abnormalities. Lung fibrosis and mild aortic valve stenosis were additionally observed on follow-up examinations. A heterozygous missense variant, c.1499T>C (p.Ile500Thr), in SMAD4 was identified through exome sequencing. Tracheostomy was performed, and the patient has maintained stable respiration through a customized tracheostomy tube with a home ventilator. Conclusions: Patients who have dysmorphic face, airway stenosis, and cardiovascular anomalies that do not fit the diagnosis of common syndromes should be evaluated for rare diseases, including Myhre syndrome. Since respiratory complications can be life threatening, early diagnosis and suitable intervention are necessary.
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Affiliation(s)
- Min Jin Jeon
- Department of Pediatrics, Seoul National University Children's Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Min Jung Kim
- Department of Pediatrics, Seoul National University Children's Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Ji Hye Kim
- Department of Pediatrics, Seoul National University Children's Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Ji Soo Park
- Department of Pediatrics, Seoul National University Children's Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Jisook Yim
- Department of Laboratory Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea.,Catholic Genetic Laboratory Center, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Myungshin Kim
- Department of Laboratory Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea.,Catholic Genetic Laboratory Center, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Seong Keun Kwon
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Soyoung Lee
- Department of Pediatrics, Seoul National University Children's Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Jung Min Ko
- Department of Pediatrics, Seoul National University Children's Hospital, Seoul National University College of Medicine, Seoul, Korea.,Rare Disease Center, Seoul National University Hospital, Seoul, Korea
| | - Jong-Hee Chae
- Department of Pediatrics, Seoul National University Children's Hospital, Seoul National University College of Medicine, Seoul, Korea.,Rare Disease Center, Seoul National University Hospital, Seoul, Korea
| | - Dong In Suh
- Department of Pediatrics, Seoul National University Children's Hospital, Seoul National University College of Medicine, Seoul, Korea
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19
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Vinh VH, Khoi NV, Quang NVD, Khanh HQ. Surgical repair for post-tuberculosis tracheobronchial stenosis. Asian Cardiovasc Thorac Ann 2020; 29:26-32. [PMID: 32996320 DOI: 10.1177/0218492320963972] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
AIM Post-tuberculosis tracheobronchial stenosis is rare but one of the most dangerous complications of tracheobronchial tuberculosis. Balloon dilatation, stent insertion, laser photoresection, argon plasma coagulation, and cryotherapy are some of the initial treatments recommended for mild to moderate cases. Here, we report a case series of patients who underwent segmental resection and end-to-end anastomosis for bronchial stenosis and a sliding technique for severe and long-segment tracheal stenosis. METHODS We retrospectively reviewed the medical records of patients with post-tuberculosis tracheobronchial stenosis operated on in our thoracic surgery department. Of the 7 cases that were treated, two had severe tracheal stenosis stretching over 50% of the tracheal length, one was operated on using resection and end-to-end anastomosis, and the other had sliding tracheoplasty. The other 5 cases of bronchial stem stenosis were treated with segmental resection and end-to-end anastomosis. RESULTS All five patients with bronchial stenosis had a good outcome; the ipsilateral lung was well ventilated and respiratory function was good. One patient with tracheal stenosis, treated with segmental resection and end-to-end anastomosis, died after the surgery, and the other patient, treated with slide tracheoplasty, had a good recovery. CONCLUSION The treatment plan for patients with post-tuberculosis tracheobronchial stenosis should be on a patient-by-patient basis. Sliding tracheoplasty can be a treatment option in patients with long-segment tracheal stenosis.
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Affiliation(s)
- Vu Huu Vinh
- Department of Thoracic Surgery, Cho Ray Hospital, Ho Chi Minh City, Vietnam
| | - Nguyen Van Khoi
- Department of Thoracic Surgery, Cho Ray Hospital, Ho Chi Minh City, Vietnam
| | | | - Huynh Quang Khanh
- Department of Thoracic Surgery, Cho Ray Hospital, Ho Chi Minh City, Vietnam
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20
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Yang CJ, Yang C, Farhat L, Gray RT, Guerrero GY, Peek GJ, Shifteh K. Bridging bronchus (pseudocarina) and left pulmonary artery sling: A case report and literature review. Int J Pediatr Otorhinolaryngol 2020; 136:110158. [PMID: 32534300 DOI: 10.1016/j.ijporl.2020.110158] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2020] [Revised: 05/08/2020] [Accepted: 05/28/2020] [Indexed: 11/28/2022]
Abstract
Congenital airway malformations can present with respiratory distress, cyanosis, and difficulty feeding in the neonate or infant. Clinical presentation may vary from asymptomatic to fatal airway obstruction. They may exist in isolation or in association with vascular rings and slings, bronchopulmonary malformations, and/or syndromes. We present an unusual case of bridging bronchus, complete bronchial rings, and left pulmonary artery sling presenting with recurrent croup, highlighting the importance of bronchoscopy and CT imaging to achieve an accurate diagnosis in patients with recurrent croup and/or respiratory failure not responding to usual treatment measures and a multidisciplinary treatment approach.
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Affiliation(s)
- Christina J Yang
- Albert Einstein School of Medicine, Yeshiva University, Bronx, NY, USA; Montefiore Medical Center, Department of Otorhinolaryngology-Head and Neck Surgery, Bronx, NY, USA.
| | - Catherina Yang
- Albert Einstein School of Medicine, Yeshiva University, Bronx, NY, USA; Montefiore Medical Center, Department of Otorhinolaryngology-Head and Neck Surgery, Bronx, NY, USA.
| | - Lara Farhat
- SUNY Downstate Health Sciences University, Department of Medicine, Division of Allergy and Immunology, Brooklyn, NY, USA.
| | - Raluca T Gray
- University of Minnesota, Department of Otolaryngology, Minneapolis, MN, USA.
| | - Giselle Y Guerrero
- Nemours Children's Hospital, Division of Pediatric Pulmonary and Sleep Medicine, Orlando, FL, USA.
| | - Giles J Peek
- University of Florida, Department of Surgery, Congenital Heart Center, Gainesville, FL, USA.
| | - Keivan Shifteh
- Albert Einstein School of Medicine, Yeshiva University, Bronx, NY, USA; Montefiore Medical Center, Department of Radiology, Bronx, NY, USA.
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21
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Smith MM, Kou YF, Schweiger C, Lehenbauer DG, de Alarcon A, Rutter MJ. Congenital Absence of Tracheal or Bronchial Rings. Otolaryngol Head Neck Surg 2020; 164:422-426. [PMID: 32838669 DOI: 10.1177/0194599820950725] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Congenital airway stenosis secondary to absent tracheal or bronchial rings is a rare congenital anomaly that is difficult to manage both clinically and surgically. This typically manifests as severe segmental tracheomalacia, and only isolated cases with short-term follow-up have been previously described. We aim to describe a series of children with absent tracheal or bronchial rings who underwent surgical management and had long-term follow-up. STUDY DESIGN Case series with chart review. SETTING Tertiary care pediatric hospital. METHODS Patients with absent tracheal or bronchial rings from 2002 to 2016. Electronic and paper medical records were queried to obtain demographics, age at diagnosis and surgery, pre- and postoperative symptoms, location of absent rings, procedure performed, length of follow-up, and adjunctive procedures performed. RESULTS Nine subjects were identified who underwent slide tracheoplasty for correction of congenital absent tracheal or bronchial rings. Age at diagnosis ranged from 10 days to 5 years of age (median, 4 weeks). Age at surgery ranged from 3 weeks to 5 years of age (median, 5 weeks). Six out of 9 subjects were extubated on postoperative day 1. Only 1 subject required additional intervention, which included balloon dilation, tracheobronchial stenting, and aortopexy to alleviate the obstruction. Mean follow-up time was 5.89 years. CONCLUSIONS This is the largest series of children with absent tracheal rings who underwent slide tracheoplasty with long-term follow-up presented to date. Slide tracheoplasty is an effective surgical intervention for the treatment of absent tracheal or bronchial rings in infants and young children.
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Affiliation(s)
- Matthew M Smith
- Division of Pediatric Otolaryngology, Head and Neck Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.,Department of Otolaryngology, Head and Neck Surgery, University of Cincinnati, Cincinnati, Ohio, USA
| | - Yann-Fuu Kou
- Division of Pediatric Otolaryngology, Head and Neck Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Claudia Schweiger
- Department of Otolaryngology, Hospital de Clinicas de Porto Alegre, Porto Alegre, Brazil
| | - David G Lehenbauer
- Department of Cardiothoracic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Alessandro de Alarcon
- Division of Pediatric Otolaryngology, Head and Neck Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.,Department of Otolaryngology, Head and Neck Surgery, University of Cincinnati, Cincinnati, Ohio, USA
| | - Michael J Rutter
- Division of Pediatric Otolaryngology, Head and Neck Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.,Department of Otolaryngology, Head and Neck Surgery, University of Cincinnati, Cincinnati, Ohio, USA
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22
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Diagnosis and management of complete tracheal rings with concurrent tracheoesophageal fistula. Int J Pediatr Otorhinolaryngol 2020; 133:109971. [PMID: 32179205 DOI: 10.1016/j.ijporl.2020.109971] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Accepted: 02/25/2020] [Indexed: 11/21/2022]
Abstract
OBJECTIVE Characterize patients with complete tracheal rings and tracheoesophageal fistula (TEF) and summarize management options. METHODS A systematic review of patients under 18 years of age with complete tracheal rings and TEF was conducted. Authors were contacted for additional patient information and new cases were added. Patients with iatrogenic TEF and tracheal stenosis due to other causes were excluded. RESULTS Sixteen patients with a median (IQR) follow-up of 10 months (3-12 months) were identified. All had a distal TEF with complete tracheal rings distal to the TEF. There were 10 (63%) type C esophageal atresia + TEF (EA/TEF), and 1 (6%) type D (5 missing data). Median (IQR) airway diameter was 2 mm (1.5-2.2 mm). Complete tracheal rings were diagnosed prior to TEF repair in 5 (31.3%) patients, after ≥1 failed extubation in 3 (12.5%) patients, and intra-operatively during respiratory distress in 1 patient. Ten patients (62.5%) were intubated with an endotracheal tube and one with a 6 Fr flexible aortic canula (5 missing data). Four patients with an endotracheal tube for TEF repair developed ventilatory problems. Complete tracheal rings were repaired in 9 (56%) patients (8 slide tracheoplasty, 1 pericardial patch) and followed conservatively in 3 (19%). One patient required tracheotomy. Four patients died. CONCLUSIONS Complete tracheal rings with concurrent TEF is a rare entity that pose challenges for ventilatory management during operative repair. Bronchoscopy prior to TEF repair is critical to allow for proper preoperative planning.
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Wilcox LJ, Schweiger C, Hart CK, de Alarcon A, Peddireddy NS, Rutter MJ. Growth and Management of Repaired Complete Tracheal Rings after Slide Tracheoplasty. Otolaryngol Head Neck Surg 2019; 161:164-170. [DOI: 10.1177/0194599819841893] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
ObjectiveThis study documents the growth and course of repaired complete tracheal rings over time after slide tracheoplasty.Study DesignCase series with review.SettingTertiary pediatric academic medical center.Subjects/MethodsMedical records of pediatric patients with confirmed tracheal rings on bronchoscopy who underwent slide tracheoplasty between January 2001 and December 2015 were reviewed. Patients who had operative notes documenting tracheal sizing over time were included. Exclusion criteria included tracheal stenosis not caused by complete tracheal rings, surgical repair prior to presentation at our institution, or lack of adequate sizing information. The postoperative follow-up was examined and airway growth over time documented.ResultsOf 197 slide tracheoplasties performed during the study time period, 139 were for complete tracheal rings, and 40 of those children met inclusion criteria. The median age at time of surgery was 7 months, and the median initial airway size was 3.9 mm (n = 34). The median growth postoperatively was 1.9 mm over a median follow-up period of 57 months (0.42 mm/year), which is similar to growth rates of unrepaired complete tracheal rings ( P = .53). Children underwent a median of 10 postoperative endoscopies, with time between endoscopies increasing further out from surgery. The most commonly performed adjunctive procedure was balloon dilation.ConclusionsThis is the first study documenting continued growth of repaired complete tracheal rings after slide tracheoplasty. Postoperative endoscopic surveillance ensures adequate growth. Intervals between airway endoscopies can be increased as the child gets older, as the airway increases in size, and as long as symptoms are minimal.
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Affiliation(s)
- Lyndy J. Wilcox
- Division of Pediatric Otolaryngology–Head and Neck Surgery, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, USA
- Division of Pediatric Otolaryngology–Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Claudia Schweiger
- Division of Pediatric Otolaryngology–Head and Neck Surgery, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, USA
| | - Catherine K. Hart
- Division of Pediatric Otolaryngology–Head and Neck Surgery, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, USA
- Aerodigestive and Esophageal Center, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, USA
- Department of Otolaryngology–Head & Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Alessandro de Alarcon
- Division of Pediatric Otolaryngology–Head and Neck Surgery, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, USA
- Aerodigestive and Esophageal Center, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, USA
- Department of Otolaryngology–Head & Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | | | - Michael J. Rutter
- Division of Pediatric Otolaryngology–Head and Neck Surgery, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, USA
- Aerodigestive and Esophageal Center, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, USA
- Department of Otolaryngology–Head & Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
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Daniero JJ, Ekbom DC, Gelbard A, Akst LM, Hillel AT. Inaugural Symposium on Advanced Surgical Techniques in Adult Airway Reconstruction: Proceedings of the North American Airway Collaborative (NoAAC). JAMA Otolaryngol Head Neck Surg 2019; 143:609-613. [PMID: 28418443 DOI: 10.1001/jamaoto.2016.4126] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Affiliation(s)
- James J Daniero
- Department of Otolaryngology-Head and Neck Surgery, University of Virginia, Charlottesville
| | - Dale C Ekbom
- Department of Otorhinolaryngology, Mayo Clinic, Rochester, Minnesota
| | - Alexander Gelbard
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University, Nashville, Tennessee
| | - Lee M Akst
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University, Baltimore, Maryland
| | - Alexander T Hillel
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University, Baltimore, Maryland
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Redmann AJ, Rutter MJ, de Alarcon A, Hart CK, Manning A, Smith M, Khosla SM. Cervical slide tracheoplasty in adults with laryngotracheal stenosis. Laryngoscope 2018; 129:818-822. [DOI: 10.1002/lary.27522] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/30/2018] [Indexed: 11/08/2022]
Affiliation(s)
- Andrew J. Redmann
- Department of Otolaryngology–Head and Neck SurgeryUniversity of Cincinnati Cincinnati Ohio U.S.A
- Division of Pediatric Otolaryngology–Head and Neck SurgeryCincinnati Children's Hospital Medical Center Cincinnati Ohio U.S.A
| | - Michael J. Rutter
- Department of Otolaryngology–Head and Neck SurgeryUniversity of Cincinnati Cincinnati Ohio U.S.A
- Division of Pediatric Otolaryngology–Head and Neck SurgeryCincinnati Children's Hospital Medical Center Cincinnati Ohio U.S.A
| | - Alessandro de Alarcon
- Department of Otolaryngology–Head and Neck SurgeryUniversity of Cincinnati Cincinnati Ohio U.S.A
- Division of Pediatric Otolaryngology–Head and Neck SurgeryCincinnati Children's Hospital Medical Center Cincinnati Ohio U.S.A
| | - Catherine K. Hart
- Department of Otolaryngology–Head and Neck SurgeryUniversity of Cincinnati Cincinnati Ohio U.S.A
- Division of Pediatric Otolaryngology–Head and Neck SurgeryCincinnati Children's Hospital Medical Center Cincinnati Ohio U.S.A
| | - Amy Manning
- Department of Otolaryngology–Head and Neck SurgeryUniversity of Cincinnati Cincinnati Ohio U.S.A
- Division of Pediatric Otolaryngology–Head and Neck SurgeryCincinnati Children's Hospital Medical Center Cincinnati Ohio U.S.A
| | - Matthew Smith
- Department of Otolaryngology–Head and Neck SurgeryUniversity of Cincinnati Cincinnati Ohio U.S.A
- Division of Pediatric Otolaryngology–Head and Neck SurgeryCincinnati Children's Hospital Medical Center Cincinnati Ohio U.S.A
| | - Sid M. Khosla
- Department of Otolaryngology–Head and Neck SurgeryUniversity of Cincinnati Cincinnati Ohio U.S.A
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Clinical outcomes after tracheoplasty in patients with congenital tracheal stenosis in 1997-2014. J Pediatr Surg 2018; 53:2140-2144. [PMID: 29370890 DOI: 10.1016/j.jpedsurg.2017.12.017] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2017] [Accepted: 12/15/2017] [Indexed: 11/21/2022]
Abstract
BACKGROUND Mortality and morbidity of congenital tracheal stenosis (CTS) remain high. The aim of this study was to determine the factors predicting 12-month survival and 2-month successful extubation after tracheoplasty in patients with CTS. METHODS Retrospective chart reviews were conducted in patients with CTS undergoing tracheoplasty at a single institution between 1997 and 2014. Patients' characteristics at disease onset and tracheoplasty were summarized. Twelve-month survival rate and 2-month extubation rate without tracheotomy after tracheoplasty were analyzed. RESULTS We reviewed 81 patients' records. Multivariate analysis for 12-month survival revealed that older age (>2 months, hazard ratio [HR]: 0.08, 95% confidence interval [CI]: 0.02-0.36) or heavier body weight (>4.4 kg, HR: 0.13, 95% CI: 0.02-0.73) at tracheoplasty was a predictive factor for survival. Body weight at tracheoplasty (>8.2 kg, HR: 3.83, 95% CI: 1.88-7.79), preoperative balloon dilatation (HR: 0.30, 95% CI: 0.12-0.78), and carina involvement (HR: 0.36, 95% CI: 0.19-0.69) were predictive factors for successful extubation. CONCLUSIONS Although CTS management is individualized, age or body weight at tracheoplasty needs to be considered and assessed for survival, as well as preoperative balloon dilatation, and carina involvement for successful extubation. LEVELS OF EVIDENCE Level III.
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Abstract
INTRODUCTION Laryngotracheal stenosis comprises a broad spectrum of congenital and acquired conditions that commonly cause pediatric airway obstruction. Although the majority of these conditions were historically managed with endoscopic dilations, the introduction of operative procedures such as laryngotracheoplasty, cricotracheal resection, and slide tracheoplasty changed the treatment paradigm. The gradual evolution of endoscopic technology enabled surgeons to perform certain procedures endoscopically that were previously only able to be performed in an open fashion. Areas covered: This review highlights the important aspects of the diagnosis, workup, and surgical treatment of pediatric laryngotracheal stenosis. Important articles describing research and techniques within pediatric airway reconstruction are summarized and included in the review. Expert commentary: The importance of the multidisciplinary concept of treating laryngotracheal stenosis is evidenced by the establishment of aerodigestive centers internationally. In order to continue successfully treating complex cases of laryngotracheal stenosis, further airway research is needed. The application and feasibility of tracheal transplantation and replacement is likely the next frontier in the treatment of laryngotracheal stenosis.
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Affiliation(s)
- Matthew M Smith
- a Division of Pediatric Otolaryngology-Head and Neck Surgery , Cincinnati Children's Hospital Medical Center , Cincinnati , OH , USA.,b Department of Otolaryngology-Head and Neck Surgery , University of Cincinnati College of Medicine , Cincinnati , OH , USA
| | - Robin T Cotton
- a Division of Pediatric Otolaryngology-Head and Neck Surgery , Cincinnati Children's Hospital Medical Center , Cincinnati , OH , USA.,b Department of Otolaryngology-Head and Neck Surgery , University of Cincinnati College of Medicine , Cincinnati , OH , USA
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Abstract
Congenital malformations of the trachea include a variety of conditions that cause respiratory distress in neonates and infants. A number of anomalies are self-limiting while others are life-threatening and require immediate therapy. The prevalence of congenital airway malformations has been estimated to range between 0.2 and 1 in 10,000 live births. The most frequent congenital tracheal malformations are: tracheomalacia, congenital tracheal stenosis, laryngotracheal cleft and tracheal agenesis. The management of congenital tracheal malformations is complex and requires an individualized approach delivered by a multidiscipilinary team within centralized units with the necessary expertise.
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Affiliation(s)
- Patricio Varela
- Program Director Pediatric Airway Unit, Mackenna Children's Hospital, Clínica Las Condes Medical Center, University of Chile, Santiago, Chile.
| | - Michelle Torre
- Director Pediatric Airway Unit, Gaslinni Institute, Genoa, Italy
| | - Claudia Schweiger
- Pediatric Otolaryngology and Head and Neck Surgeon, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - Hiroki Nakamura
- National Children's Research Centre, Our Lady's Children's Hospital, Dublin, Ireland
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Gandhi H, Naidu TVK, Mishra A, Garg P, Surti J, Trivedi V, Acharya H. Management of a case of double aortic arch with tracheal compression complicated with postoperative tracheal restenosis. Ann Card Anaesth 2018; 20:362-364. [PMID: 28701608 PMCID: PMC5535584 DOI: 10.4103/aca.aca_95_16] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Tracheal stenosis in association with the double aortic arch (DAA) is uncommon; however, it carries a high risk of morbidity, mortality, and restenosis. Although surgery is the mainstay of managing a case of the DAA with tracheal stenosis, management of tracheal restenosis requires a multidisciplinary approach. In this case report, we present our successful experience in managing a child of DAA with tracheal stenosis who developed tracheal restenosis after sliding tracheoplasty of trachea.
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Affiliation(s)
- Hemang Gandhi
- Department of Cardaic Anesthesia, U. N. Mehta Institute of Cardiology and Research Center (Affiliated to BJ Medical College), Ahmedabad, Gujarat, India
| | - T Vikram Kumar Naidu
- Department of Cardaic Anesthesia, U. N. Mehta Institute of Cardiology and Research Center (Affiliated to BJ Medical College), Ahmedabad, Gujarat, India
| | - Amit Mishra
- Department of Cardiovascular Thoracic Surgery, U. N. Mehta Institute of Cardiology and Research Center (Affiliated to BJ Medical College), Ahmedabad, Gujarat, India
| | - Pankaj Garg
- Department of Cardiovascular Thoracic Surgery, U. N. Mehta Institute of Cardiology and Research Center (Affiliated to BJ Medical College), Ahmedabad, Gujarat, India
| | - Jigar Surti
- Department of Cardaic Anesthesia, U. N. Mehta Institute of Cardiology and Research Center (Affiliated to BJ Medical College), Ahmedabad, Gujarat, India
| | - Visharad Trivedi
- Department of Cardaic Anesthesia, U. N. Mehta Institute of Cardiology and Research Center (Affiliated to BJ Medical College), Ahmedabad, Gujarat, India
| | - Himanshu Acharya
- Department of Research, U. N. Mehta Institute of Cardiology and Research Center (Affiliated to BJ Medical College), Ahmedabad, Gujarat, India
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Sidell DR, Hart CK, Tabangin ME, Bryant R, Rutter MJ, Manning PB, Meinzen-Derr J, Balakrishnan K, Yang C, de Alarcon A. Revision thoracic slide tracheoplasty: Outcomes following unsuccessful tracheal reconstruction. Laryngoscope 2018; 128:2181-2186. [DOI: 10.1002/lary.27145] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Revised: 01/04/2018] [Accepted: 01/25/2018] [Indexed: 11/08/2022]
Affiliation(s)
- Douglas R. Sidell
- Department of Otolaryngology-Head and Neck Surgery; Stanford University; Stanford California
| | - Catherine K. Hart
- Division of Pediatric Otolaryngology-Head and Neck Surgery; Cincinnati Children's Hospital Medical Center; Cincinnati Ohio
- Department of Otolaryngology-Head and Neck Surgery; University of Cincinnati College of Medicine; Cincinnati Ohio
| | - Meredith E. Tabangin
- Division of Pediatric Otolaryngology-Head and Neck Surgery; Cincinnati Children's Hospital Medical Center; Cincinnati Ohio
- Division of Biostatistics and Epidemiology; Cincinnati Children's Hospital Medical Center; Cincinnati Ohio
| | - Roosevelt Bryant
- Division of Cardiothoracic Surgery; Cincinnati Children's Hospital Medical Center; Cincinnati Ohio
| | - Michael J. Rutter
- Department of Otolaryngology-Head and Neck Surgery; Stanford University; Stanford California
- Department of Otolaryngology-Head and Neck Surgery; University of Cincinnati College of Medicine; Cincinnati Ohio
| | - Peter B. Manning
- Division of Cardiothoracic Surgery, Section of Pediatric Cardiothoracic Surgery; Washington University School of Medicine/St. Louis Children's Hospital; St. Louis Missouri
| | - Jareen Meinzen-Derr
- Division of Biostatistics and Epidemiology; Cincinnati Children's Hospital Medical Center; Cincinnati Ohio
| | - Karthik Balakrishnan
- Department of Otorhinolaryngology; Mayo Clinic College of Medicine; Rochester Minnesota
| | - Christina Yang
- Department of Otorhinolaryngology-Head and Neck Surgery; Montefiore Medical Center; Bronx New York U.S.A
| | - Alessandro de Alarcon
- Division of Pediatric Otolaryngology-Head and Neck Surgery; Cincinnati Children's Hospital Medical Center; Cincinnati Ohio
- Department of Otolaryngology-Head and Neck Surgery; University of Cincinnati College of Medicine; Cincinnati Ohio
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31
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Resheidat A, Kelly T, Mossad E. Incidental Diagnosis of Congenital Tracheal Stenosis in Children With Congenital Heart Disease Presenting for Cardiac Surgery. J Cardiothorac Vasc Anesth 2018; 33:781-784. [PMID: 29753667 DOI: 10.1053/j.jvca.2018.04.027] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2018] [Indexed: 11/11/2022]
Affiliation(s)
- Ashraf Resheidat
- Department of Pediatric Anesthesia, Baylor College of Medicine, Houston, TX
| | - Tamra Kelly
- Department of Pediatric Anesthesia, Baylor College of Medicine, Houston, TX
| | - Emad Mossad
- Department of Pediatric Anesthesia, Baylor College of Medicine, Houston, TX.
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32
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Wilcox LJ, Hart CK, de Alarcon A, Schweiger C, Peddireddy NS, Tabangin M, Rutter MJ. Unrepaired Complete Tracheal Rings: Natural History and Management Considerations. Otolaryngol Head Neck Surg 2018; 158:729-735. [DOI: 10.1177/0194599817751889] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objectives To document the natural growth pattern of unrepaired complete tracheal rings (UCTRs) and describe the patient population managed conservatively. Study Design Case series with chart review. Setting Tertiary pediatric academic center. Subjects/Methods Medical records of patients with confirmed complete tracheal rings on bronchoscopy from 1993 to 2017 were reviewed. Patients aged 0 to 18 who had documented tracheal sizing over time and did not require surgical intervention were included. Exclusion criteria included tracheal stenosis not caused by complete tracheal rings. Comorbidities and airway characteristics were documented in addition to endoscopic findings. These were compared with children requiring surgical repair. Results In total, 149 patients with complete tracheal rings were identified. Twenty-five had UCTRs for an overall 16.8% rate of conservative management. Nineteen patients met inclusion criteria and underwent a total of 90 microlaryngoscopy and bronchoscopies (MLBs) with sizing. The growth of the UCTRs over time, based on MLB sizing, was chronicled. The median airway growth noted was 0.38 mm/y. A moderately strong positive correlation was seen between age and airway size ( rs = 0.72, P < .0001). Children with UCTRs were less likely to have long-segment involvement than those who required repair (92%, P = .024). Conclusions A select group of children with complete tracheal rings can be managed expectantly without surgical intervention. Conservative management may be less successful in children with long-segment complete tracheal rings. Airway growth does occur in this population and can be monitored over time. Having a standardized method for sizing UCTRs allows for more effective communication between providers and assurance of continued growth of the airway while following these patients.
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Affiliation(s)
- Lyndy J. Wilcox
- Division of Pediatric Otolaryngology–Head and Neck Surgery, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, USA
| | - Catherine K. Hart
- Division of Pediatric Otolaryngology–Head and Neck Surgery, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, USA
- Aerodigestive and Esophageal Center, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, USA
- Department of Otolaryngology–Head & Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Alessandro de Alarcon
- Division of Pediatric Otolaryngology–Head and Neck Surgery, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, USA
- Aerodigestive and Esophageal Center, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, USA
- Department of Otolaryngology–Head & Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Claudia Schweiger
- Division of Pediatric Otolaryngology–Head and Neck Surgery, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, USA
| | | | - Meredith Tabangin
- Division of Biostatistics and Epidemiology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, USA
| | - Michael J. Rutter
- Division of Pediatric Otolaryngology–Head and Neck Surgery, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, USA
- Aerodigestive and Esophageal Center, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, USA
- Department of Otolaryngology–Head & Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
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33
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Wineland AM, Turpin B, Gupta A, de Alarcon A. Ewing Sarcoma in the cervical trachea of a pediatric patient: A case report and review of the literature. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2018. [DOI: 10.1016/j.epsc.2017.09.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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Ohno M, Fuchimoto Y, Hsu HC, Higuchi M, Komura M, Yamaoka T, Umezawa A, Enosawa S, Kuroda T. Airway reconstruction using decellularized tracheal allografts in a porcine model. Pediatr Surg Int 2017; 33:1065-1071. [PMID: 28819688 DOI: 10.1007/s00383-017-4138-8] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/01/2017] [Indexed: 10/19/2022]
Abstract
PURPOSE Tracheal cartilage reconstruction is an essential approach for the treatment of tracheal congenital abnormalities or injury. Here, we evaluated the use of allogeneic decellularized tracheas as novel support scaffolds. METHODS Six weaned pigs (4-week-old domestic males) were transplanted with allogeneic tracheal graft patches (three decellularized and three fresh tracheal scaffolds) onto artificial defects (approximately 15 × 15 mm). After 11 weeks, the tracheas were evaluated by bronchoscopy and histological studies. RESULTS No pigs displayed airway symptoms during the observation period. Tracheal lumen restored by fresh graft patches showed more advanced narrowing than that treated with decellularized grafts by bronchoscopy. Histologically, fresh grafts induced typical cellular rejection; this was decreased with decellularized grafts. In addition, immunohistochemistry demonstrated regenerating foci of recipient cartilage along the adjacent surface of decellularized tracheal grafts. CONCLUSION Decellularized allogeneic tracheal scaffolds could be effective materials for restoring impaired trachea.
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Affiliation(s)
- Michinobu Ohno
- Division of Surgery, Department of Surgical Specialties, National Center for Child Health and Development, Tokyo, Japan
| | - Yasushi Fuchimoto
- Department of Pediatric Surgery, Graduate School of Medicine, Keio University, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan.
| | - Huai-Che Hsu
- Division for Advanced Medical Sciences, National Center for Child Health and Development, Tokyo, Japan
| | - Masataka Higuchi
- Division of Pulmonology, Department of Medical Specialties, National Center for Child Health and Development, Tokyo, Japan
| | - Makoto Komura
- Department of Pediatric Surgery, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Tetsuji Yamaoka
- Department of Biomedical Engineering, National Cerebral and Cardiovascular Center Research Institute, Suita, Japan
| | - Akihiro Umezawa
- Department of Reproductive Biology, National Center for Child Health and Development, Tokyo, Japan
| | - Shin Enosawa
- Division for Advanced Medical Sciences, National Center for Child Health and Development, Tokyo, Japan
| | - Tatsuo Kuroda
- Department of Pediatric Surgery, Graduate School of Medicine, Keio University, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
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Wineland AM, Thomsen JR, Landry A, Benscoter D, Rutter M. Segmental deficiency of cervical tracheal rings masquerading as complete tracheal rings: A case report and literature review. Int J Pediatr Otorhinolaryngol 2017; 101:246-248. [PMID: 28964303 DOI: 10.1016/j.ijporl.2017.08.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2017] [Revised: 08/01/2017] [Accepted: 08/04/2017] [Indexed: 10/19/2022]
Abstract
Congenital deficiency of distal tracheal rings is a rare anomaly and has been previously reported in the literature. Here we report the first case deficient tracheal rings confined to the cervical trachea. Patient was transferred to our institution for management of what was initial thought to be complete tracheal rings. The patient was successfully managed with a tracheal resection and short segment cervical slide tracheoplasty. Presentation, surgical approach, histological findings, and literature review are described.
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Affiliation(s)
- Andre M Wineland
- University of Cincinnati School of Medicine, Department of Otolaryngology - Head & Neck Surgery, Division of Pediatric Otolaryngology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - James R Thomsen
- Pediatric Ear, Nose and Throat of Atlanta, Atlanta, GA 30342, USA
| | - April Landry
- Emory University School of Medicine, Department of Otolaryngology - Head and Neck Surgery, Division of Pediatric Otolaryngology, Atlanta, GA 30342, USA
| | - Dan Benscoter
- Cincinnati Children's Hospital Medical Center, Division of Pulmonary and Sleep Medicine, Cincinnati, OH, USA
| | - Michael Rutter
- University of Cincinnati School of Medicine, Department of Otolaryngology - Head & Neck Surgery, Division of Pediatric Otolaryngology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
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Zhang H, Wang S, Lu Z, Zhu L, Du X, Wang H, Xu Z. Slide tracheoplasty in 81 children: Improved outcomes with modified surgical technique and optimal surgical age. Medicine (Baltimore) 2017; 96:e8013. [PMID: 28930836 PMCID: PMC5617703 DOI: 10.1097/md.0000000000008013] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
The aim of this study was to evaluate the surgical outcome of slide tracheoplasty.Eighty-one patients who underwent slide tracheoplasty were retrospectively reviewed. Before and after operation, all patients were examined by computed tomography (CT) and bronchoscopy regularly.There were 8 deaths and the mortality was 9.9%. They all died of respiratory failure associated with the formation of granulation tissue in the airway postoperatively. The mortality was 15.8% from 2009 to 2012 and decreased to 8.1% from 2013 to 2016. The mortality of patients aged 10 to 24 months was 5.7%, which was significantly lower than those younger than 10 months and those older than 24 months. After surgery, 11 patients had granulation tissue growing at anastomosis edges and 8 of them died eventually. Twenty patients had mucosa varus at the site of anastomosis which mainly happened in the early time. Between different time periods and different age groups, there was significant difference in the incidence of granulation tissue and mucosa varus (P < .01). Clinical symptoms of tracheal stenosis disappeared and the results of CT were satisfactory after operation.Slide tracheoplasty is an effective surgical method for congenital tracheal stenosis associated with congenital heart disease. With the continuous improvement of surgical technique, the mortality has been reduced and the incidence of granulation tissue and mucosa varus also has been reduced. The period of 10 to 24 months of age is the optimal cure time.
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37
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Abstract
The management of pediatric airway pathology can be challenging and requires a dedicated team, consisting of thoracic surgeons, phoniatricians, logopedics, pediatricians and anesthetists. It necessitates a tailored treatment approach for each individual patient in order to address the minor variances that exist between cases. The majority of pediatric airway problems are a sequela of prematurity and prolonged post-partal intubation/tracheostomy. Surgical repair is often complicated by additional malformation or severe comorbidities. This comprehensive review should give an overview on most common airway problems in neonates and children as well as available surgical techniques.
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Affiliation(s)
- Konrad Hoetzenecker
- Department of Thoracic Surgery, Medical University of Vienna, Vienna, Austria
| | - Thomas Schweiger
- Department of Thoracic Surgery, Medical University of Vienna, Vienna, Austria
| | | | - Walter Klepetko
- Department of Thoracic Surgery, Medical University of Vienna, Vienna, Austria
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Schweiger C, Cohen AP, Rutter MJ. Tracheal and bronchial stenoses and other obstructive conditions. J Thorac Dis 2016; 8:3369-3378. [PMID: 28066618 DOI: 10.21037/jtd.2016.11.74] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Although tracheal stenosis and bronchial stenosis are relatively rare in the pediatric population, they are both associated with significant morbidity and mortality. While most cases of congenital tracheal stenosis in children present as complete tracheal rings (CTRs), other congenital tracheal obstructions are also encountered in clinical practice. In addition, acquired obstructive tracheal conditions stemming from endotracheal trauma or previous surgical interventions may occur. Many affected children also have associated cardiovascular malformations, further complicating their management. Optimal management of children with tracheal or bronchial stenoses requires comprehensive diagnostic evaluation and optimization prior to surgery. Slide tracheoplasty has been the operative intervention of choice in the treatment of the majority of these children.
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Affiliation(s)
- Claudia Schweiger
- Division of Pediatric Otolaryngology-Head and Neck Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Aliza P Cohen
- Division of Pediatric Otolaryngology-Head and Neck Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Michael J Rutter
- Division of Pediatric Otolaryngology-Head and Neck Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA; ; Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, OH, USA
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Chao YC, Peng CC, Lee KS, Lin SM, Chen MR. The association of congenital tracheobronchial stenosis and cardiovascular anomalies. Int J Pediatr Otorhinolaryngol 2016; 83:1-6. [PMID: 26968043 DOI: 10.1016/j.ijporl.2016.01.024] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2015] [Revised: 01/12/2016] [Accepted: 01/15/2016] [Indexed: 10/22/2022]
Abstract
OBJECTIVES Congenital tracheobronchial stenosis (CTBS) is a rare disorder characterized by the presence of focal or diffuse complete tracheal or bronchial cartilage rings resulting in a fixed lumen narrowing. The aim of this study was to expose the association of various cardiovascular (CV) anomalies with various types of CTBS. METHODS A retrospective review of 58 patients who had bronchoscopically proven CTBS between 1997 and 2011 was conducted. Totally, 48 cases who had received echocardiography, computed tomography and other examinations including cardiac catheterization were enrolled. There were 33 boys and 15 girls, and the median age of diagnosis was 4 months (0-44 months). The image findings of associated CV anomalies were reviewed and analyzed, along with the clinical manifestations and patients' outcome. RESULTS There were 14 generalized hypoplasia (29.2%), 10 funnel type (20.8%), 15 segmental type (31.3%), and 9 isolated bronchial stenosis cases (18.7%). Among 48 cases of CTBS, 32 patients (66.7%) had various CV anomalies including atrial septal defect (n=9), pulmonary artery sling (n=7), ventricular septal defect (n=7), patent ductus arteriosus (n=6), tetralogy of Fallot (n=3), peripheral pulmonary stenosis (n=3), etc. No significant difference existed in the incidence and types of comorbid CV anomalies among 4 types of CTBS, except that funnel type had significantly higher comorbidity of pulmonary artery sling (50%, p<0.01). CONCLUSION Patients with CTBS had high incidence of various associated CV anomalies. Isolated bronchial stenosis had similar high comorbidity of CV anomalies as did the 3 classical categories of congenital tracheal stenosis. The higher comorbidity of pulmonary artery sling in patients with funnel CTBS might be related to its gradual caudal narrowing of the trachea.
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Affiliation(s)
- Yen-Chun Chao
- Department of Pediatrics, Mackay Children's Hospital, Taipei, Taiwan
| | - Chun-Chin Peng
- Department of Pediatrics, Mackay Children's Hospital, Taipei, Taiwan
| | - Kuo-Sheng Lee
- Department of Otorhinolaryngolaryngology, Mackay Memorial Hospital, Taipei, Taiwan
| | - Shan-Miao Lin
- Department of Pediatrics, Mackay Memorial Hospital, Taipei, Taiwan
| | - Ming-Ren Chen
- Department of Pediatrics, Mackay Children's Hospital, Taipei, Taiwan; Mackay Junior College of Medicine, Nursing, and Management, Taipei, Taiwan; Mackay Medical College, Taipei, Taiwan.
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Hart CK, Rutter MJ. Tracheobronchial issues in congenital heart disease. Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu 2015; 18:57-61. [PMID: 25939844 DOI: 10.1053/j.pcsu.2014.12.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2014] [Accepted: 12/04/2014] [Indexed: 06/04/2023]
Abstract
In children with congenital heart disease, tracheobronchial compromise is uncommon but potentially life-threatening. Airway lesions in these patients may be congenital or acquired, and may be stenotic, compressive, or malacic in nature. We present an overview of the etiologies of tracheobronchial lesions typically seen in children with congenital heart disease and review management options for these lesions.
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Affiliation(s)
- Catherine K Hart
- Division of Pediatric Otolaryngology-Head and Neck Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Michael J Rutter
- Division of Pediatric Otolaryngology-Head and Neck Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, OH.
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Ono S, Maeda K, Baba K, Usui Y, Tsuji Y, Kawahara I, Fukuta A, Sekine S. Balloon tracheoplasty as initial treatment for neonates with symptomatic congenital tracheal stenosis. Pediatr Surg Int 2014; 30:957-60. [PMID: 25064230 DOI: 10.1007/s00383-014-3571-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/15/2014] [Indexed: 12/19/2022]
Abstract
Neonates with congenital tracheal stenosis (CTS) sometimes develop respiratory distress and may be difficult to intubate. We used balloon tracheoplasty with a rigid bronchoscope for emergency airway management in neonates with symptomatic CTS. Herein, we describe the balloon tracheoplasty procedure and the early outcomes following its use as the initial treatment of neonatal symptomatic CTS. We performed a retrospective analysis of five neonates with CTS who were initially treated with balloon tracheoplasty at our institution from January 2010 to December 2013. Five patients with a mean birthweight of 2,117 g were treated during the study period. Of these, four developed respiratory distress after birth, and all patients had difficult intubations. In all five patients, definitive diagnosis of CTS was made by rigid bronchoscopy and 3-dimensional reconstruction scan. A total of nine balloon dilatations were performed in five patients. Following balloon tracheoplasty, two patients were extubated, one was extubated after resection and end-to-end anastomosis following initial balloon dilatation, and one remained hospitalized with tracheostomy for tracheomalacia. The remaining patient died from tracheal bleeding associated with congenital heart disease. Although our sample size was small, balloon tracheoplasty is a potentially effective initial treatment for selected cases with neonatal symptomatic CTS.
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Affiliation(s)
- Shigeru Ono
- Division of Pediatric Surgery, Department of Surgery, Jichi Medical University School of Medicine, 3311-1 Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan,
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Provenzano MJ, Rutter MJ, von Allmen D, Manning PB, Paul Boesch R, Putnam PE, Black AP, de Alarcon A. Slide tracheoplasty for the treatment of tracheoesophogeal fistulas. J Pediatr Surg 2014; 49:910-4. [PMID: 24888833 DOI: 10.1016/j.jpedsurg.2014.01.022] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2014] [Accepted: 01/27/2014] [Indexed: 11/29/2022]
Abstract
PURPOSE The purpose of this study is to determine the surgical outcome of slide tracheoplasty for the treatment of tracheoesophageal (TE) fistula in pediatric patients. METHODS After internal review board approval, the charts of pediatric patients (0-18years old) who had undergone slide tracheoplasty for tracheoesophageal fistula were retrospectively reviewed. Patient information and surgical outcomes were reviewed. RESULTS Nine patients underwent slide tracheoplasty for correction of TE fistula. In five patients the original TE fistula was congenital. Other causes included battery ingestion, tracheostomy tube complications, foreign body erosion, and an iatrogenic injury. The average age at repair was 48±64 months (range: 1-190). Seven patients had undergone previous TEF repair either open or endoscopically. There were no recurrences after repair. Two patients had sternal periosteum interposed between the esophagus and trachea. There were no TEF recurrences. A single patient had dehiscence of the tracheal anastomosis and underwent a second procedure. CONCLUSION Slide tracheoplasty is an effective method to treat complex TE fistulas. The procedure was not associated with any recurrences. This is the first description of a novel, effective, and safe method to treat TE fistulas.
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Affiliation(s)
- Matthew J Provenzano
- Division of Pediatric Otolaryngology - Head and Neck Surgery, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH 45229-3026
| | - Michael J Rutter
- Division of Pediatric Otolaryngology - Head and Neck Surgery, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH 45229-3026.
| | - Daniel von Allmen
- Division of General and Thoracic Surgery, Division of Pediatric Surgery, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH 45229-3026
| | - Peter B Manning
- The Heart Center: Cardiology Cardiothoracic Surgery, St. Louis Children's Hospital, One Children's Place, Suite 5S50, Saint Louis, MO 63110
| | - R Paul Boesch
- Pediatric and Adolescent Medicine, Mayo Clinic, 201W Center St, Rochester, MN 55902
| | - Philip E Putnam
- Division of Gastroenterology, Hepatology and Nutrition, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH 45229-3026
| | - Angela P Black
- Division of Pediatric Otolaryngology - Head and Neck Surgery, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH 45229-3026
| | - Alessandro de Alarcon
- Division of Pediatric Otolaryngology - Head and Neck Surgery, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH 45229-3026
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Chung SR, Yang JH, Jun TG, Kim WS, Kim YH, Kang IS, Huh J, Song JY, Cho J. Clinical outcomes of slide tracheoplasty in congenital tracheal stenosis†. Eur J Cardiothorac Surg 2014; 47:537-42; discussion 542. [DOI: 10.1093/ejcts/ezu196] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Yokoi A, Nakao M, Bitoh Y, Arai H, Oshima Y, Nishijima E. Treatment of postoperative tracheal granulation tissue with inhaled budesonide in congenital tracheal stenosis. J Pediatr Surg 2014; 49:293-5; discussion 295. [PMID: 24528970 DOI: 10.1016/j.jpedsurg.2013.11.041] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2013] [Accepted: 11/10/2013] [Indexed: 10/26/2022]
Abstract
PURPOSE Tracheal obstruction by granulation tissue can compromise the postoperative course in congenital tracheal stenosis (CTS). Balloon dilatation and stenting may be required. Budesonide is a corticosteroid with topical anti-inflammatory effects. In 2008, we used inhaled budesonide for treatment of postoperative granulation tissue for the first time in CTS, resulting in significant improvement. The aim of this study was to evaluate the efficacy of inhaled budesonide for treatment of postoperative granulation tissue in CTS. METHODS Retrospective chart review was conducted. From 2004 through 2011, we performed 39 tracheoplasties. Forced stenting ± balloon dilatation (S/B) was required when airway obstruction with tissue granulation was life-threatening. We compared the requirement for S/B between the early group without budesonide (2004-Nov. 2008, Early) and the late group with budesonide (Dec. 2008-2011, Late). Statistical analysis was performed using Fisher's Exact test. RESULTS Eleven of 22 in Early and 8 of 17 in Late were successfully extubated, never having had life-threatening tissue granulation. The remaining patients in each group (11 in Early and 9 in Late) required tracheostomies due to postoperative complication. Ten in Early and 5 in Late with tracheostomies developed granulation tissue. Of these patients, the 10 in Early required S/B, while none of the 5 in Late required S/B (P=.0003). Bronchoscopy demonstrated significant regression of granulation tissue in all cases treated with inhaled budesonide. CONCLUSION Inhaled budesonide is effective for treatment of tracheal granulation tissue in patients with tracheostomies after repair of CTS.
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Affiliation(s)
- Akiko Yokoi
- Department of Pediatric Surgery, Kobe Children's Hospital, Kobe, Japan.
| | - Makoto Nakao
- Department of Pediatric Surgery, Kobe Children's Hospital, Kobe, Japan
| | - Yuko Bitoh
- Department of Pediatric Surgery, Kobe Children's Hospital, Kobe, Japan
| | - Hiroshi Arai
- Department of Pediatric Surgery, Kobe Children's Hospital, Kobe, Japan
| | - Yoshihiro Oshima
- Department of Cardiovascular Surgery, Kobe Children's Hospital, Kobe, Japan
| | - Eiji Nishijima
- Department of Pediatric Surgery, Kobe Children's Hospital, Kobe, Japan
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Fandiño M, Kozak FK, Verchere C, Campbell A. Modified slide tracheoplasty in a newborn with bronchial and carinal stenosis. Int J Pediatr Otorhinolaryngol 2013; 77:2075-80. [PMID: 24139586 DOI: 10.1016/j.ijporl.2013.09.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2013] [Revised: 09/02/2013] [Accepted: 09/04/2013] [Indexed: 10/26/2022]
Abstract
Congenital tracheal stenosis (CTS) is a life-threatening condition that is associated with significant morbidity and mortality particularly when symptomatic presentation occurs in the newborn period. The most challenging form of CTS is long segment congenital tracheal stenosis (LSCTS) with compromise of the carina and main stem bronchi. We report the case of a newborn with severe distal tracheal stenosis with carinal and main stem bronchial involvement who was managed successfully with a modified slide and autologous rib graft tracheoplasty. The patient was discharged from hospital without ventilator support or oxygen requirement at 2 months of age. The details of this case and the description of the surgical procedure are presented and the related literature is reviewed.
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Affiliation(s)
- Marcela Fandiño
- Department of Surgery, Division of Pediatric Otolaryngology, BC Children's Hospital, University of British Columbia, Vancouver, BC, Canada.
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Maeda K, Ono S, Baba K. Management of laryngotracheal stenosis in infants and children: the role of re-do surgery in cases of severe subglottic stenosis. Pediatr Surg Int 2013; 29:1001-6. [PMID: 23979403 DOI: 10.1007/s00383-013-3397-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Although many advances have improved the treatment of congenital and acquired laryngotracheal stenosis in children over the past two decades, the therapeutic decision-making process remains challenging for pediatric surgeons and otolaryngologists. Severe subglottic stenosis is a complex laryngeal injury that necessitates multiple airway procedures, and the approach depends on the exact nature of the cicatricial lesion and its effect on the vocal cord mobility. Therefore, it is imperative that the pediatric surgeons and otolaryngologists dealing with this situation should be well trained in endoscopy and laser treatment, in addition to open surgical intervention. Open re-do surgery remains the best choice in cases of severe congenital stenosis, glottic immobility, or after two to three endoscopic procedures have been performed without any significant improvement.
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Affiliation(s)
- Kosaku Maeda
- Division of Pediatric Surgery, Department of Surgery, Jichi Medical University School of Medicine, 3311-1, Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan,
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Yong MS, d'Udekem Y, Robertson CF, Butt W, Brizard CP, Konstantinov IE. Tracheal repair in children: reduction of mortality with advent of slide tracheoplasty. ANZ J Surg 2013; 84:748-54. [DOI: 10.1111/ans.12132] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/13/2013] [Indexed: 12/01/2022]
Affiliation(s)
- Matthew S. Yong
- Department of Cardiothoracic Surgery; Royal Children's Hospital; Melbourne Victoria Australia
- The University of Melbourne; Melbourne Victoria Australia
- Murdoch Children's Research Institute; Melbourne Victoria Australia
| | - Yves d'Udekem
- Department of Cardiothoracic Surgery; Royal Children's Hospital; Melbourne Victoria Australia
- The University of Melbourne; Melbourne Victoria Australia
- Murdoch Children's Research Institute; Melbourne Victoria Australia
| | - Colin F. Robertson
- Department of Respiratory Medicine; Royal Children's Hospital; Melbourne Victoria Australia
- The University of Melbourne; Melbourne Victoria Australia
- Murdoch Children's Research Institute; Melbourne Victoria Australia
| | - Warwick Butt
- Department of Intensive Care; Royal Children's Hospital; Melbourne Victoria Australia
- The University of Melbourne; Melbourne Victoria Australia
- Murdoch Children's Research Institute; Melbourne Victoria Australia
| | - Christian P. Brizard
- Department of Cardiothoracic Surgery; Royal Children's Hospital; Melbourne Victoria Australia
- The University of Melbourne; Melbourne Victoria Australia
- Murdoch Children's Research Institute; Melbourne Victoria Australia
| | - Igor E. Konstantinov
- Department of Cardiothoracic Surgery; Royal Children's Hospital; Melbourne Victoria Australia
- The University of Melbourne; Melbourne Victoria Australia
- Murdoch Children's Research Institute; Melbourne Victoria Australia
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Multisystem Disease and Pediatric Laryngotracheal Reconstruction. Otolaryngol Clin North Am 2012; 45:643-51, viii. [DOI: 10.1016/j.otc.2012.03.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Valencia D, Overman D, Tibesar R, Lander T, Moga F, Sidman J. Surgical management of distal tracheal stenosis in children. Laryngoscope 2011; 121:2665-71. [DOI: 10.1002/lary.22355] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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