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Siddiqui KM, Baig UA, Yousuf MS. Single stage cricoid split laryngoplasty with costochondral rib grafting is a novel approach to treat subglottic stenosis in a paediatric patient: A case report. Int J Surg Case Rep 2024; 121:109952. [PMID: 38943940 PMCID: PMC11261409 DOI: 10.1016/j.ijscr.2024.109952] [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: 05/17/2024] [Revised: 06/20/2024] [Accepted: 06/25/2024] [Indexed: 07/01/2024] Open
Abstract
INTRODUCTION AND IMPORTANCE Subglottic stenosis (SGS) appears to be a commonly encountered condition in the paediatric age group. Single stage cricoid split laryngoplasty with costochondral rib grafting in paediatric patients is a unique, innovative, and advanced operation in nature. Morbidity and mortality rates can be minimized with early diagnosis and prompt treatment. PRESENTATION OF CASE Presenting the case of a 13-month-old child diagnosed with Grade II SGS who was managed for cricoid split laryngoplasty with a costochondral rib graft. It was a unique strategy for providing infants and neonates with symptomatic SGS with a safe and efficient substitute for long-term tracheostomy. When healing was completed, the patient regained the function of their airway. The approach was successful, and preventable to long-term tracheostomy. DISCUSSION Performing this procedure early in children has shown higher rates of success and it is safe and effective. Further extensive research and studies need to be conducted in this domain, and every patient's status should be reviewed time and again to tend to their specific needs, and the choice of procedure should be made optimally based on clinical evaluations. CONCLUSION Successful management of a 13-month-old child with Grade II subglottic stenosis through cricoid split laryngoplasty with costochondral rib grafting is a challenging and novel approach to treating single-stage SGS.
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Affiliation(s)
| | - Umair Aftab Baig
- Department of Anaesthesiology, Aga Khan University, Karachi, Sindh, Pakistan
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Blumenthal D, Leonard JA, Behzadpour H, Zalzal G, Preciado D. Recalcitrant Stenosis Following Pediatric LTR: Contributing Factors and Clinical Impact. Otolaryngol Head Neck Surg 2024; 171:247-253. [PMID: 38482949 DOI: 10.1002/ohn.696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Revised: 01/09/2024] [Accepted: 02/05/2024] [Indexed: 06/28/2024]
Abstract
OBJECTIVES Laryngotracheal reconstruction (LTR) has revolutionized the management of pediatric subglottic stenosis (SGS). However, postoperative stenosis remains a difficult hurdle to overcome. Our goal is to determine the clinical impact of recalcitrant stenosis after LTR and the factors contributing to postoperative stenosis. STUDY DESIGN Retrospective review of 181 open LTR patients between 2008 and 2021. SETTING Stand-alone tertiary children's hospital. METHODS Recalcitrant stenosis was defined as new or worsening stenosis despite open LTR. Fisher's exact and Mann-Whitney tests were used to detect differences in categorical and continuous clinical data between patients with and without treatment-resistant stenosis. Time-to-decannulation analysis of both groups was performed using Kaplan-Meier analysis and evaluated with log-rank and Cox proportional hazards regression. Multivariate logistical regression was used to assess the validity of associations found in univariate analysis. RESULTS As expected, the 27 patients with postoperative stenosis were less likely to be decannulated (P < .001, Fisher's Exact), more likely to require a postoperative tracheostomy (P < .001, Fisher's Exact) or revision LTR (P < .001, Fisher's Exact) and had prolonged time to decannulation (P < .001, Log-rank). Children with Grade IV SGS (P = .004, Fisher's Exact), and those with longer suprastomal stent duration (P = .03, Fisher's Exact) were more likely to suffer from recalcitrant stenosis. Stent duration longer than 4 weeks (P = .01) contributed to refractory stenosis when controlling for all aforementioned variables using multivariable logistic regression. Interposition grafts had a protective effect (P = .005). CONCLUSION Maintaining suprastomal stents over 4 weeks after LTR increases the risk for postoperative stenosis and its sequelae. LEVEL OF EVIDENCE: 4
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Affiliation(s)
- Daniel Blumenthal
- Department of Pediatric Otolaryngology, Children's National Hospital, Washington, USA
- Department of Otolaryngology-Head and Neck Surgery, Medstar Georgetown University Hospital, Washington, USA
| | - James A Leonard
- Department of Pediatric Otolaryngology, Children's National Hospital, Washington, USA
- Department of Otolaryngology-Head and Neck Surgery, Medstar Georgetown University Hospital, Washington, USA
| | - Hengameh Behzadpour
- Department of Pediatric Otolaryngology, Children's National Hospital, Washington, USA
| | - George Zalzal
- Department of Pediatric Otolaryngology, Children's National Hospital, Washington, USA
| | - Diego Preciado
- Department of Pediatric Otolaryngology, Children's National Hospital, Washington, USA
- George Washington University School of Medicine, Washington, USA
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Wang L, Ren P, Cui PC, Liang LP, Zhao QQ, Zhao DQ. Swallowing rehabilitation of patients undergoing T-tube implantation for the treatment of laryngotracheal stenosis. Head Neck 2024. [PMID: 38943309 DOI: 10.1002/hed.27848] [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: 11/26/2023] [Revised: 06/03/2024] [Accepted: 06/08/2024] [Indexed: 07/01/2024] Open
Abstract
OBJECTIVE Patients with laryngotracheal stenosis (LTS) often have dysphagia after laryngotracheal reconstruction with T-tube insertion, which affects the quality of life. The purpose of this study is to observe the effect of swallowing rehabilitation therapy on the improvement of quality of life in patients of otolaryngology-head and neck surgery with dysphagia undergoing T-tube implantation treatment through longitudinal study. METHODS Thirty-eight patients with LTS who experienced dysphagia after laryngotracheal reconstruction and T-tube implantation were recruited. All patients received swallowing rehabilitation therapy. The assessment of swallowing function was performed using the 10-item Eating Assessment Tool (EAT-10), the 30 mL water swallow test (WST), and flexible endoscopic evaluation of swallow (FEES). RESULTS After swallowing rehabilitation therapy, timing of swallowing, grade of dysphagia, performance on FEES and 30 mL WST, and EAT-10 score all improved. Thirty-eight patients successfully transitioned to oral feeding and were able to remove their nasogastric tubes without experiencing any complications, including aspiration pneumonia. CONCLUSION For patients with LTS who experienced dysphagia after laryngotracheal reconstruction and T-tube implantation, swallowing rehabilitation therapy could improve swallowing function of the patients, so as to reduce the potential harm caused by the pain and complications of surgery experienced by patients.
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Affiliation(s)
- Lu Wang
- Department of Otolaryngology - Head and Neck Surgery, The Second Affiliated Hospital of the Air Force Medical University, Xi'an, China
| | - Pan Ren
- Department of Otolaryngology - Head and Neck Surgery, The Second Affiliated Hospital of the Air Force Medical University, Xi'an, China
| | - Peng-Cheng Cui
- Department of Otolaryngology - Head and Neck Surgery, The Second Affiliated Hospital of the Air Force Medical University, Xi'an, China
| | - Le-Ping Liang
- Department of Otolaryngology - Head and Neck Surgery, The Second Affiliated Hospital of the Air Force Medical University, Xi'an, China
| | - Qian-Qian Zhao
- Department of Otolaryngology - Head and Neck Surgery, The Second Affiliated Hospital of the Air Force Medical University, Xi'an, China
| | - Da-Qing Zhao
- Department of Otolaryngology - Head and Neck Surgery, The Second Affiliated Hospital of the Air Force Medical University, Xi'an, China
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Mafla L, So RJ, Collins SL, Chan-Li Y, Lina I, Motz KM, Hillel AT. An Ovine Model Yields Histology and Gene Expression Changes Consistent with Laryngotracheal Stenosis. Laryngoscope 2024. [PMID: 38738796 DOI: 10.1002/lary.31499] [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: 02/08/2024] [Revised: 04/06/2024] [Accepted: 04/24/2024] [Indexed: 05/14/2024]
Abstract
OBJECTIVES Animal models for laryngotracheal stenosis (LTS) are critical to understand underlying mechanisms and study new therapies. Current animal models for LTS are limited by small airway sizes compared to human. The objective of this study was to develop and validate a novel, large animal ovine model for LTS. METHODS Sheep underwent either bleomycin-coated polypropylene brush injury to the subglottis (n = 6) or airway stent placement (n = 2) via suspension microlaryngoscopy. Laryngotracheal complexes were harvested 4 weeks following injury or stent placement. For the airway injury group, biopsies (n = 3 at each site) were collected of tracheal scar and distal normal regions, and analyzed for fibrotic gene expression. Lamina propria (LP) thickness was compared between injured and normal areas of trachea. RESULTS No mortality occurred in sheep undergoing airway injury or stent placement. There was no migration of tracheal stents. After protocol optimization, LP thickness was significantly increased in injured trachea (Sheep #3: 529.0 vs. 850.8 um; Sheep #4: 933.0 vs. 1693.2 um; Sheep #5: 743.7 vs. 1378.4 um; Sheep #6: 305.7 vs. 2257.6 um). A significant 62-fold, 20-fold, 16-fold, 16-fold, and 9-fold change of COL1, COL3, COL5, FN1, and TGFB1 was observed in injured scar specimen relative to unaffected airway, respectively. CONCLUSION An ovine LTS model produces histologic and transcriptional changes consistent with fibrosis seen in human LTS. Airway stent placement in this model is safe and feasible. This large airway model is a reliable and reproducible method to assess the efficacy of novel LTS therapies prior to clinical translation. LEVEL OF EVIDENCE N/A Laryngoscope, 2024.
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Affiliation(s)
- Laura Mafla
- Department of Otolaryngology - Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, U.S.A
| | - Raymond J So
- Department of Otolaryngology - Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, U.S.A
| | - Samuel L Collins
- Department of Otolaryngology - Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, U.S.A
| | - Yee Chan-Li
- Department of Otolaryngology - Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, U.S.A
| | - Ioan Lina
- Department of Otolaryngology - Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, U.S.A
| | - Kevin M Motz
- Department of Otolaryngology - Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, U.S.A
| | - Alexander T Hillel
- Department of Otolaryngology - Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, U.S.A
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Viaud-Murat EM, Bahra L, Redmann AJ, Buck LS, Carratola M. Ethics in Practice: Laryngotracheoplasty Versus Tracheostomy in a Patient With Severe Hydranencephaly. Otolaryngol Head Neck Surg 2024; 170:1474-1477. [PMID: 38353287 DOI: 10.1002/ohn.680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Revised: 11/21/2023] [Accepted: 12/01/2023] [Indexed: 04/30/2024]
Affiliation(s)
| | - Luka Bahra
- Department of Otolaryngology, University of Colorado Anschutz Medical Campuus, Parker, Colorado, USA
| | - Andrew J Redmann
- Department of Otolaryngology, Head and Neck Surgery, University of Minnesota, Minneapolis, Minnesota, USA
| | - Lauren S Buck
- Department of Otolaryngology, Head and Neck Surgery, Louisiana State University Health Sciences Center, Our Lady of the Lake Children's Hospital, Baton Rouge, Louisiana, USA
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Lee JE, Kim K, Kwon JH, Kim GS. Living Donor Liver Transplantation for an Infant Having Tracheostomy and Subglottic Stenosis: A Case Report. Transplant Proc 2024; 56:746-749. [PMID: 38423831 DOI: 10.1016/j.transproceed.2023.11.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Accepted: 11/26/2023] [Indexed: 03/02/2024]
Abstract
BACKGROUND It is uncommon to perform liver transplantation for patients with end-stage liver disease having tracheostomy. Usually, the tracheostomy cannula is changed to an oral endotracheal tube (ETT) before operation because ETT is easy to handle during operation. If routine oral ETT insertion is difficult, we should seek other solutions. CASE DESCRIPTION We report a successful conversion from tracheostomy tube to ETT in a patient with subglottic stenosis. The patient was an 8-month-old infant who was scheduled for living donor liver transplantation due to acute hepatic failure. The original plan was to convert the tracheostomy tube to oral ETT, which failed due to aggravation of subglottic stenosis. An otolaryngologist performed balloon dilatation surgery, and ETT was successfully intubated. Owing to a multidisciplinary approach, the surgery was successfully performed without fatal adverse events, and the patient was later discharged with a tracheostomy. CONCLUSIONS It is unusual for pediatric patients with tracheostomy tubes to undergo major surgeries like liver transplantation. We hope that this case of successful anesthetic management based on a multidisciplinary approach suggests new ideas to anesthesiologists seeking safe anesthesia.
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Affiliation(s)
- Ja Eun Lee
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Keoungah Kim
- Department of Anesthesiology and Pain Medicine, Dankook University Dental Hospital, Cheonan, Chungcheongnam-do, Republic of Korea
| | - Ji-Hye Kwon
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Gaab-Soo Kim
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
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Skaribas EE, Leming AB, Allen DZ, Yuksel S. Management of pediatric choanal atresia restenosis and subglottic stenosis using steroid-eluting stents. Int J Pediatr Otorhinolaryngol 2024; 178:111897. [PMID: 38367603 DOI: 10.1016/j.ijporl.2024.111897] [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: 08/16/2023] [Revised: 02/09/2024] [Accepted: 02/13/2024] [Indexed: 02/19/2024]
Abstract
OBJECTIVES To depict the novel use of steroid-eluting stents in the treatment of choanal atresia (CA) restenosis and subglottic stenosis (SGS). METHODS A retrospective chart review of three pediatric patients, one with CA and two with SGS, treated with mometasone furoate eluting mini stents (PROPEL) was performed. Patients were evaluated for restenosis and adverse events between one to twelve months postoperatively. RESULTS Postoperatively, patient one with CA showed no signs of restenosis and required no further intervention. Patient two with SGS demonstrated an open subglottic lumen with no signs of restenosis as well as improved phonation following his planned serial procedures. Post-operatively, patient three with SGS exhibited no restenosis of the subglottic lumen, tolerated intermittent tracheostomy capping, and demonstrated improved phonation. CONCLUSION In this case series, we outline successful treatments for the management of CA restenosis and SGS with mometasone furoate-eluting stents. To our knowledge, this is the first reported application of this treatment in pediatric patients with CA restenosis and the second reported application in pediatric patients with SGS.
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Affiliation(s)
- Elena E Skaribas
- McGovern Medical School, University of Texas Health Science Center, 6431 Fannin St., Houston, TX, 77030, USA.
| | - Amy B Leming
- Department of Otorhinolaryngology-Head and Neck Surgery, McGovern Medical School, 6400 Fannin St. #2700, Houston, TX, 77030, USA
| | - David Z Allen
- Department of Otorhinolaryngology-Head and Neck Surgery, McGovern Medical School, 6400 Fannin St. #2700, Houston, TX, 77030, USA
| | - Sancak Yuksel
- Department of Otorhinolaryngology-Head and Neck Surgery, McGovern Medical School, 6400 Fannin St. #2700, Houston, TX, 77030, USA
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Gehret PM, Dumas AA, Jacobs IN, Gottardi R. A Pilot Study of Decellularized Cartilage for Laryngotracheal Reconstruction in a Neonatal Pig Model. Laryngoscope 2024; 134:807-814. [PMID: 37658705 PMCID: PMC11046979 DOI: 10.1002/lary.31017] [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: 02/11/2023] [Revised: 06/30/2023] [Accepted: 08/03/2023] [Indexed: 09/03/2023]
Abstract
OBJECTIVE Severe subglottic stenosis develops as a response to intubation in 1% of the >200,000 neonatal intensive care unit infants per year and may require laryngotracheal reconstruction (LTR) with autologous hyaline cartilage. Although effective, LTR is limited by comorbidities, severity of stenosis, and graft integration. In children, there is a significant incidence of restenosis requiring revision surgery. Tissue engineering has been proposed to develop alterative grafting options to improve outcomes and eliminate donor-site morbidity. Our objective is to engineer a decellularized, channel-laden xenogeneic cartilage graft, that we deployed in a proof-of-concept, neonatal porcine LTR model. METHODS Meniscal porcine cartilage was freeze-thawed and washed with pepsin/elastase to decellularize and create microchannels. A 6 × 10-mm decellularized cartilage graft was then implanted in 4 infant pigs in an anterior cricoid split. Airway patency and host response were monitored endoscopically until sacrifice at 12 weeks, when the construct phenotype, cricoid expansion, mechanics, and histomorphometry were evaluated. RESULTS The selective digestion of meniscal components yielded decellularized cartilage with cell-size channels. After LTR with decellularized meniscus, neonatal pigs were monitored via periodic endoscopy observing re-epithelization, integration, and neocartilage formation. At 12 weeks, the graft appeared integrated and exhibited airway expansion of 4 mm in micro-CT and endoscopy. Micro-CT revealed a larger lumen compared with age-matched controls. Finally, histology showed significant neocartilage formation. CONCLUSION Our neonatal porcine LTR model with a decellularized cartilage graft is a novel approach to tissue engineered pediatric LTR. This pilot study sets the stage for "off-the-shelf" graft procurement and future optimization of MEND for LTR. LEVEL OF EVIDENCE NA Laryngoscope, 134:807-814, 2024.
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Affiliation(s)
- Paul M Gehret
- Department of Surgery, Division of Otolaryngology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, U.S.A
- Department of Bioengineering, School of Engineering and Applied Science, University of Pennsylvania, Philadelphia, Pennsylvania, U.S.A
| | - Alexandra A Dumas
- Department of Surgery, Division of Otolaryngology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, U.S.A
- Department of Bioengineering, School of Engineering and Applied Science, University of Pennsylvania, Philadelphia, Pennsylvania, U.S.A
| | - Ian N Jacobs
- Department of Surgery, Division of Otolaryngology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, U.S.A
- Department of Otorhinolaryngology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, U.S.A
| | - Riccardo Gottardi
- Department of Surgery, Division of Otolaryngology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, U.S.A
- Department of Bioengineering, School of Engineering and Applied Science, University of Pennsylvania, Philadelphia, Pennsylvania, U.S.A
- Department of Otorhinolaryngology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, U.S.A
- Department of Pediatrics, Division of Pulmonary and Sleep Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, U.S.A
- Department of Orthopaedic Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, United States
- Ri.MED Foundation, Palermo, Italy
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Huang R, Chen S, Song X, Zheng H. Inhalation of Carboxymethyl Chitosan Alleviates Posttraumatic Tracheal Fibrosis. Ann Otol Rhinol Laryngol 2024; 133:50-57. [PMID: 37394747 DOI: 10.1177/00034894231181749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/04/2023]
Abstract
OBJECTIVES The present study was performed to determine whether the inhalation of carboxymethyl (CM)-chitosan can alleviate tracheal fibrosis in a rabbit model. METHODS We designed a rabbit model of tracheal stenosis involving electrocoagulation with a spherical electrode. Twenty New Zealand white rabbits were randomly divided into experimental and control groups (10 animals each). Tracheal damage was successfully established by electrocoagulation in all animals. The experimental group was given CM-chitosan (inhalation for 28 days), while the control group inhaled saline. The effects of CM-chitosan inhalation on tracheal fibrosis were analyzed. Laryngoscopy was performed to evaluate and grade tracheal granulation, while tracheal fibrosis was evaluated by histological examination. The effects of CM-chitosan inhalation on the tracheal mucosa were examined by scanning electron microscopy (SEM), and hydroxyproline content in tracheal scar tissue was determined by enzyme-linked immunosorbent assay (ELISA). RESULTS Laryngoscopy showed that the tracheal cross-sectional area was smaller in the experimental than control group. The amounts of loose connective tissue and damaged cartilage, as well as the severity of collagen and fibrosis, decreased following inhalation of CM-chitosan. According to the ELISA, the experimental group had low levels of hydroxyproline in the tracheal scar tissue. CONCLUSION The findings presented here showed that inhalation of CM-chitosan mitigated posttraumatic tracheal fibrosis in a rabbit model, thus suggesting a potential new treatment for tracheal stenosis.
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Affiliation(s)
- Rushi Huang
- Department of Otorhinolaryngology-Head and Neck Surgery, The First Affiliated Hospital of Naval Medical University, Shanghai, China
| | - Shicai Chen
- Department of Otorhinolaryngology-Head and Neck Surgery, The First Affiliated Hospital of Naval Medical University, Shanghai, China
| | - Xianmin Song
- Department of Otorhinolaryngology-Head and Neck Surgery, The First Affiliated Hospital of Naval Medical University, Shanghai, China
| | - Hongliang Zheng
- Department of Otorhinolaryngology-Head and Neck Surgery, The First Affiliated Hospital of Naval Medical University, Shanghai, China
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Alshareef W, Almutairi N, Sindi A, Almakoshi L, Zakzouk A, Aljasser A, Alammar A. Spirometry in laryngotracheal stenosis: a systematic review and meta-analysis. Eur Arch Otorhinolaryngol 2023; 280:4783-4792. [PMID: 37522909 DOI: 10.1007/s00405-023-08159-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Accepted: 07/25/2023] [Indexed: 08/01/2023]
Abstract
PURPOSE This study aimed to assess the changes in spirometry parameters or indices after relieving laryngotracheal stenosis (LTS) in adult patients. METHODS A systematic review and meta-analysis of studies from PubMed, Scopus, Web of Science, Cochrane Library, and EBSCO databases was conducted for assessing changes in spirometry values after endoscopic balloon dilatation of LTS in adults. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed. Relevant data, such as changes in mean spirometry values between preoperative and postoperative interventions, and findings of receiver operating characteristic curve analyses for predicting the need for surgical intervention, were extracted. RESULTS Ten studies including 330 patients overall met the inclusion criteria. Significant improvements were observed from preoperative to postoperative mean values of different spirometry parameters and indices. The overall mean differences in peak expiratory flow (ΔPEF), expiratory disproportion index (ΔEDI), and peak inspiratory flow (ΔPIF) were 2.26 L/s (95% CI 2.14-2.38), 27.94 s (95% CI 26.36-29.52), and 1.21 L/s (95% CI 0.95-1.47), respectively. ΔPEF and ΔPIF values increased, while ΔEDI decreased. In predicting the need for surgical intervention, EDI had the highest sensitivity (88%), and forced expiratory volume per second/forced vital capacity had the highest specificity (85%). CONCLUSION Spirometry is a valuable tool for assessing patients with LTS. PEF, EDI, and PIF were the most commonly reported spirometry parameters that significantly improved after airway stenosis was relieved.
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Affiliation(s)
- Waleed Alshareef
- Department of Otolaryngology-Head and Neck Surgery, King Saud University Medical City, Riyadh, Saudi Arabia.
- Department of Otolaryngology-Head and Neck Surgery, Maternity and Children Hospital, Makkah, Saudi Arabia.
| | - Nasser Almutairi
- Department of Otolaryngology-Head and Neck Surgery, King Saud University Medical City, Riyadh, Saudi Arabia
- Department of Otolaryngology-Head and Neck Surgery, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Abdullah Sindi
- Department of Otolaryngology-Head and Neck Surgery, King Saud University Medical City, Riyadh, Saudi Arabia
| | - Latifah Almakoshi
- Department of Otolaryngology-Head and Neck Surgery, King Saud University Medical City, Riyadh, Saudi Arabia
| | - Abdulmajeed Zakzouk
- Department of Otolaryngology-Head and Neck Surgery, King Saud University Medical City, Riyadh, Saudi Arabia
| | - Abdullah Aljasser
- Department of Otolaryngology-Head and Neck Surgery, King Saud University Medical City, Riyadh, Saudi Arabia
| | - Ahmed Alammar
- Department of Otolaryngology-Head and Neck Surgery, King Saud University Medical City, Riyadh, Saudi Arabia
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Lee AJ, Prager JD, Mandler TN, Chatterjee D, Wine TM, Janosy NR. Anesthesia for laryngotracheal reconstruction in children: A narrative review. Paediatr Anaesth 2023; 33:883-893. [PMID: 37408495 DOI: 10.1111/pan.14716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2023] [Revised: 05/16/2023] [Accepted: 06/06/2023] [Indexed: 07/07/2023]
Abstract
Laryngotracheal stenosis, congenital or acquired, is a common cause of pediatric airway obstruction. Acquired subglottic stenosis frequently results from prolonged neonatal intubation. The clinical presentation of subglottic stenosis is variable, ranging from biphasic stridor and frequent upper respiratory infections to acute airway compromise. Optimal patient care requires clinical coordination within a multidisciplinary subspecialty team. Medical management includes optimizing respiratory status, gastroesophageal reflux, speech, feeding, nutrition therapies, and providing psychosocial support. If surgical intervention is required, the otolaryngologist, anesthesiologist, and perioperative team must collaborate closely to ensure successful operative outcomes. This narrative review of laryngotracheal stenosis will discuss the pathophysiology, clinical evaluation, medical management, and surgical interventions, and focus on the perioperative anesthetic considerations for children undergoing laryngotracheal reconstruction.
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Affiliation(s)
- Amy J Lee
- Department of Anesthesiology, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Jeremy D Prager
- Department of Otolaryngology, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Tessa N Mandler
- Department of Anesthesiology, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Debnath Chatterjee
- Department of Anesthesiology, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Todd M Wine
- Department of Otolaryngology, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Norah R Janosy
- Department of Anesthesiology, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, Colorado, USA
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Fiz I, Filauro M, Sampieri C, Ioppi A, Vallin A, Fiz F, Koelmel JC, Lancini D, Piazza C, Sittel C, Peretti G. Analysis of Complications in (Crico-) Tracheal Resection Anastomosis in Adults: A Multicenter Study. Laryngoscope 2023; 133:2910-2919. [PMID: 36883671 DOI: 10.1002/lary.30635] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2022] [Revised: 02/09/2023] [Accepted: 02/09/2023] [Indexed: 03/09/2023]
Abstract
OBJECTIVES The gold standard treatments for advanced laryngotracheal stenosis (LTS) are represented by partial crico-tracheal (PCTRA) or tracheal resection and anastomosis (TRA). These procedures are potentially burdened by high postoperative complication rates. We investigated the impact of the most common stenosis and patient-related characteristics on the onset of complications in a multicentric cohort. METHODS We retrospectively analyzed patients who underwent PCTRA or TRA for LTS of different etiologies in three referral centers. We tested the effectiveness of these procedures, the impact of complications on the outcomes, and identified factors causing postoperative complications. RESULTS A total of 267 patients were included in the study (130 females; mean age, 51.46 ± 17.64 years). The overall decannulation rate was 96.4%. Altogether, 102 (38.2%) patients presented at least one complication, whereas 12 (4.5%) had two or more. The only independent predictor of post-surgical complications was the presence of systemic comorbidities (p = 0.043). Patients experiencing complications needed additional surgery more frequently (70.1% vs. 29.9%, p < 0.001), and had a longer duration of hospitalization (20 ± 10.9 vs. 11.3 ± 4.1 days, p < 0.001). Six of 102 (5.9%) patients with complications had restenosis, although this event did not occur among patients without complications. CONCLUSION PCTRA and TRA have an excellent success rate even when performed for high-grade LTS. However, a significant percentage of patients may experience complications associated with a longer duration of hospitalization or the need for additional surgeries. The presence of medical comorbidities was independently related to an increased risk of complications. LEVEL OF EVIDENCE 4 Laryngoscope, 133:2910-2919, 2023.
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Affiliation(s)
- Ivana Fiz
- Department of Otorhinolaryngology, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Marta Filauro
- Unit of Otorhinolaryngology-Head and Neck Surgery, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
- Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, Genoa, Italy
| | - Claudio Sampieri
- Unit of Otorhinolaryngology-Head and Neck Surgery, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
- Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, Genoa, Italy
| | - Alessandro Ioppi
- Unit of Otorhinolaryngology-Head and Neck Surgery, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
- Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, Genoa, Italy
| | - Alberto Vallin
- Unit of Otorhinolaryngology-Head and Neck Surgery, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
- Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, Genoa, Italy
| | - Francesco Fiz
- Nuclear Medicine Department, Ente Ospedaliero "Ospedali Galliera", Genoa, Italy
- Department of Nuclear Medicine and Clinical Molecular Imaging, University Hospital, Tübingen, Germany
| | - Jan Costantin Koelmel
- Department of Otorhinolaryngology-Head and Neck Surgery, Klinikum Stuttgart, Stuttgart, Germany
| | - Davide Lancini
- Unit of Otorhinolaryngology-Head and Neck Surgery, ASST Spedali Civili of Brescia, Brescia, Italy
- Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Cesare Piazza
- Unit of Otorhinolaryngology-Head and Neck Surgery, ASST Spedali Civili of Brescia, Brescia, Italy
- Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Christian Sittel
- Department of Otorhinolaryngology-Head and Neck Surgery, Klinikum Stuttgart, Stuttgart, Germany
| | - Giorgio Peretti
- Unit of Otorhinolaryngology-Head and Neck Surgery, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
- Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, Genoa, Italy
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13
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Demott C, Jones MR, Chesney CD, Grunlan MA. Adhesive Hydrogel Building Blocks to Reconstruct Complex Cartilage Tissues. ACS Biomater Sci Eng 2023; 9:1952-1960. [PMID: 36881710 PMCID: PMC10848198 DOI: 10.1021/acsbiomaterials.2c01438] [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: 12/02/2022] [Accepted: 02/14/2023] [Indexed: 03/09/2023]
Abstract
Cartilage has an intrinsically low healing capacity, thereby requiring surgical intervention. However, limitations of biological grafting and existing synthetic replacements have prompted the need to produce cartilage-mimetic substitutes. Cartilage tissues perform critical functions that include load bearing and weight distribution, as well as articulation. These are characterized by a range of high moduli (≥1 MPa) as well as high hydration (60-80%). Additionally, cartilage tissues display spatial heterogeneity, resulting in regional differences in stiffness that are paramount to biomechanical performance. Thus, cartilage substitutes would ideally recapitulate both local and regional properties. Toward this goal, triple network (TN) hydrogels were prepared with cartilage-like hydration and moduli as well as adhesivity to one another. TNs were formed with either an anionic or cationic 3rd network, resulting in adhesion upon contact due to electrostatic attractive forces. With the increased concentration of the 3rd network, robust adhesivity was achieved as characterized by shear strengths of ∼80 kPa. The utility of TN hydrogels to form cartilage-like constructs was exemplified in the case of an intervertebral disc (IVD) having two discrete but connected zones. Overall, these adhesive TN hydrogels represent a potential strategy to prepare cartilage substitutes with native-like regional properties.
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Affiliation(s)
- Connor
J. Demott
- Department
of Biomedical Engineering, Texas A&M
University, College
Station, Texas 77843-3003, United States
| | - McKenzie R. Jones
- Department
of Biomedical Engineering, Texas A&M
University, College
Station, Texas 77843-3003, United States
| | - Caleb D. Chesney
- Department
of Biomedical Engineering, Texas A&M
University, College
Station, Texas 77843-3003, United States
| | - Melissa A. Grunlan
- Department
of Biomedical Engineering, Texas A&M
University, College
Station, Texas 77843-3003, United States
- Department
of Materials Science & Engineering, Texas A&M University, College
Station, Texas 77843-3003, United States
- Department
of Chemistry, Texas A&M University, College Station, Texas 77843-3003, United States
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14
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Baguant A, Aboussouan MP, Castellanos PF, Atallah I. Decannulation of Tracheostomy-Dependent Patients: Results and Review of Techniques of Reconstructive Transoral Laser Microsurgery. Ann Otol Rhinol Laryngol 2023; 132:361-370. [PMID: 35686520 DOI: 10.1177/00034894221097183] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVES This study aims to demonstrate the benefit of reconstructive transoral laser microsurgery (R-TLM) in decannulation of tracheostomy-dependent patients with airway obstruction. METHODS A consecutive series of tracheostomy-dependent patients who underwent R-TLM using multiple techniques described in our previous works, were reviewed for outcomes especially for decannulation. Full airway examination was essential to determine the anatomical and functional sites of obstruction to establish the surgical plan including R-TLM techniques needed to improve airway prior to permanent decannulation. RESULTS Twenty-two patients were treated. Eighteen subjects were successfully decannulated. Single or multiple R-TLM surgical technique(s) was/were performed during the same surgery to treat upper airway stenosis at the level of the hypopharynx, larynx, and trachea. The mean number of surgeries per patient was 2.1. Patients were followed up for at least 12 months. CONCLUSION R-TLM combines different surgical techniques which can be used individually or combined in a stepwise surgical plan for permanent decannulation of tracheostomy-dependent patients with a previous history of decannulation failure secondary to airway obstruction. Accurate preoperative examination gives valuable information about airway and allows establishing a stepwise surgical plan that may need multiple surgeries for full permanent decannulation of these patients.
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Affiliation(s)
- Ashley Baguant
- Otolaryngology-Head & Neck Surgery Department, Grenoble Alpes University Hospital, Grenoble, France
| | - Marie-Pierre Aboussouan
- Department of Anesthesiology and Intensive Care Medicine, Grenoble Alpes University Hospital, Grenoble, France
| | | | - Ihab Atallah
- Otolaryngology-Head & Neck Surgery Department, Grenoble Alpes University Hospital, Grenoble, France.,School of Medicine, Grenoble Alpes University, Domaine de la Merci, Grenoble, France
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15
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Lava CX, Martin TS, Leonard JA, Blumenthal DL, Scriven‐Weiner K, Chu E, Harley EH. Complications associated with costal cartilage harvest in pediatric laryngotracheal reconstruction. Laryngoscope Investig Otolaryngol 2023; 8:584-590. [PMID: 37090864 PMCID: PMC10116967 DOI: 10.1002/lio2.1028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Accepted: 01/23/2023] [Indexed: 03/08/2023] Open
Abstract
Objective We aimed to determine the rate of complications associated with autologous costal cartilage graft harvest for pediatric laryngotracheal reconstruction (LTR). Secondarily, we sought to identify risk factors associated with the harvest of autologous costal cartilage, as well as evaluate management strategies. Data Sources An electronic database search of Ovid MEDLINE, Ovid EMBASE, and PubMed was completed for articles pertaining to complications in autologous costal cartilage harvest for pediatric LTR. Review Methods This systematic review adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines. The study characteristics, operative information, and patient demographics were collected. The data concerning postoperative complications, risk factors, and management strategies were collected and analyzed for patterns. Results A total of 31 manuscripts representing 745 patients were included for analysis. The reported donor site complications included pneumothorax (n = 13, 1.74%), pleural tear (n = 5, 0.67%), infection (n = 8, 1.07%), and scar-related problems (n = 2, 0.26%). There were no reported cases of seroma, persistent pain, or chest wall deformity. Only five studies discussed the management of donor site complications, with intervention in 11 (39.28%) patients including chest tube drainage and steroid injection. Conclusion There is significant variability in the literature regarding complication rates in autologous costal cartilage harvest for pediatric LTR. The incidence of major postoperative complications is low and supports the use of autologous costal cartilage as graft material for pediatric LTR. Level of Evidence NA.
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Affiliation(s)
| | | | - James A. Leonard
- MedStar Georgetown University Hospital Department of Otolaryngology – Head and Neck Surgery Washington DC USA
| | - Daniel L. Blumenthal
- MedStar Georgetown University Hospital Department of Otolaryngology – Head and Neck Surgery Washington DC USA
| | - Kelly Scriven‐Weiner
- MedStar Georgetown University Hospital Department of Otolaryngology – Head and Neck Surgery Washington DC USA
| | - Eugenia Chu
- MedStar Georgetown University Hospital Department of Otolaryngology – Head and Neck Surgery Washington DC USA
| | - Earl H. Harley
- MedStar Georgetown University Hospital Department of Otolaryngology – Head and Neck Surgery Washington DC USA
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16
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Tang X, Yang Y, Zhang Z, Sun R. Immediate extubation after single-stage laryngotracheal reconstruction for subglottic stenosis in children. Eur Arch Otorhinolaryngol 2023; 280:2897-2904. [PMID: 36729155 PMCID: PMC10175422 DOI: 10.1007/s00405-023-07858-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Accepted: 01/20/2023] [Indexed: 02/03/2023]
Abstract
PURPOSE To evaluate the feasibility and clarify the appropriate indications for extubation immediately after single-stage laryngotracheal reconstruction (SS-LTR) in pediatric subglottic stenosis (SGS). METHODS A retrospective study was performed from July 2017 to July 2022. All patients underwent SS-LTR with anterior costal cartilage graft. Information such as demographics, comorbidities, history of intubation or tracheostomy, Classification and grading of airway stenosis, the operation-specific decannulation rate and overall decannulation rate were analyzed. RESULTS Twenty-two patients with simple SGS were identified. The median age at SS-LTR was 19 months (IQR = 18.5 months). Fourteen patients (63.6%) were intubated prior to the presentation of symptoms. Fourteen patients (63.6%) required preoperative tracheostomy to maintain a secure airway. Eight patients (36.4%) had congenital SGS, 10 patients (45.5%) had acquired SGS, and 4 patients (18.2%) had mixed SGS. Three patients had Grade II stenosis. Nineteen patients had Grade III stenosis. Comorbidities were found in 10 patients (45.5%). Major comorbidities were pneumonia. Congenital airway anomalies were found in 6 patients (27.3%). After anesthesia, all 22 patients were successfully extubated and returned to the general ward. Twenty patients had a satisfactory airway after SS-LTR. Two patients required reintubation or tracheostomy after operation. Operation-specific decannulation rate was 90.9%. The overall decannulation rate is 100%. CONCLUSION SS-LTR with anterior costal cartilage graft is an effective method to treat simple SGS ranging from Grades I to III in children. Extubation immediately after surgery is safe and feasible.
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Affiliation(s)
- XinYe Tang
- Department of Otolaryngology, Children's Hospital of Chongqing Medical University, Chongqing, China.,Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China.,National Clinical Research Center for Child Health and Disorders (Chongqing), Chongqing, China.,China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing, China
| | - Yang Yang
- Department of Otolaryngology, Children's Hospital of Chongqing Medical University, Chongqing, China.,Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China.,National Clinical Research Center for Child Health and Disorders (Chongqing), Chongqing, China.,China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing, China
| | - ZhiHai Zhang
- Department of Otolaryngology, Children's Hospital of Chongqing Medical University, Chongqing, China.,Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China.,National Clinical Research Center for Child Health and Disorders (Chongqing), Chongqing, China.,China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing, China
| | - Rong Sun
- Department of Physical Examination, The First Affiliated Hospital of Chongqing Medical University, No. 1, Youyi Road, Yuzhong District, Chongqing, 400016, China.
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17
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Teplitzky TB, Kou YF, Bozkanat KM, Johnson RF, Chorney SR. Pathogenic bacteria in bronchoalveolar lavage cultures and pediatric laryngotracheal reconstruction outcomes. Pediatr Pulmonol 2023; 58:1438-1443. [PMID: 36721379 DOI: 10.1002/ppul.26338] [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: 11/07/2022] [Revised: 01/07/2023] [Accepted: 01/27/2023] [Indexed: 02/02/2023]
Abstract
OBJECTIVE The primary objective was to determine if treating pathogenic bacteria in bronchoalveolar lavage (BAL) cultures improves outcomes after pediatric double stage laryngotracheal reconstruction (dsLTR). STUDY DESIGN Case series with chart review. SETTING Tertiary children's hospital. METHODS All children (<18 years) obtaining flexible bronchoscopy with BAL cultures before dsLTR between 2016 and 2022 were included. Cultures identified abnormal bacterial growth or normal respiratory flora. Thirty-day postoperative surgical site or lung infections were captured and tracheostomy decannulation rates were obtained for children with at least 12 months of follow-up. RESULTS Twenty-seven children obtained presurgical BAL cultures before dsLTR. Median age at reconstruction was 2.9 years (interquartile range: 2.3-3.5) and 89% (24/27) had high grade subglottic stenosis. Positive cultures were obtained in 56% of children (N = 15) with Pseudomonas aeruginosa (40%, 6/15) and methicillin-resistant Staphylococcus aureus (33%, 5/15) the most frequent organisms. All children with positive cultures were treated based on culture and sensitivity data. Postoperative infections developed in 22% (6/27) of children with equal distribution of surgical site and respiratory infections among children with pathogenic bacteria and normal respiratory flora. At 12 months after surgery, the decannulation rate was no different between those treated and not treated for a presurgical positive BAL culture (47% vs. 58%, p = 0.70). CONCLUSION Pathogenic bacteria are common in BAL cultures from tracheostomy-dependent children before dsLTR. Treatment keeps respiratory infections and decannulation rates similar to children with negative cultures, suggesting continued benefit of flexible bronchoscopy and BAL in preparation for these surgeries.
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Affiliation(s)
- Taylor B Teplitzky
- Department of Otolaryngology-Head and Neck Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Yann-Fuu Kou
- Department of Otolaryngology-Head and Neck Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA.,Department of Pediatric Otolaryngology, Children's Medical Center Dallas, Dallas, Texas, USA
| | - Kubra M Bozkanat
- Department of Pediatrics, Division of Pediatric Pulmonology and Sleep Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Romaine F Johnson
- Department of Otolaryngology-Head and Neck Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA.,Department of Pediatric Otolaryngology, Children's Medical Center Dallas, Dallas, Texas, USA
| | - Stephen R Chorney
- Department of Otolaryngology-Head and Neck Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA.,Department of Pediatric Otolaryngology, Children's Medical Center Dallas, Dallas, Texas, USA
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18
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Zheng Y, Xu H, Li X. Management of balloon dilatation in cases of subglottic stenosis in children: success and failure. Eur Arch Otorhinolaryngol 2023; 280:2859-2864. [PMID: 36609700 DOI: 10.1007/s00405-023-07826-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2022] [Accepted: 01/03/2023] [Indexed: 01/07/2023]
Abstract
PURPOSE To assess efficacy and prognostic factors of endoscopic balloon dilatation for the treatment of subglottic stenosis in children. METHODS A retrospective review was performed on 49 pediatric patients with subglottic stenosis treated at the Shanghai Children's Hospital between December 2017 and December 2021. Specific demographic data, type and severity of the stenosis, number of balloon dilatations and outcomes were recorded and analyzed. RESULTS Forty-nine children (30 male, 19 female) were included in the study with a median age at diagnosis of 24 (13-36.5) months, of which 7 (14.3%) had received open laryngotracheal reconstruction previously. The degree of subglottic stenosis was grade I in six patients, grade II in 16 patients, grade III in 20 patients and grade IV in seven patients. After various numbers of balloon dilatations (1-7 times), 29 patients showed a good outcome (decannulation or prevention of tracheostomy) and the success rate in that series was 59.2%. Overall, prognosis of balloon dilatation was not dependent on pathogeny (congenital or acquired) or open surgical history(P > 0.05), but rather on the severity grade of stenosis and the number of dilatations (P < 0.05). CONCLUSIONS Endoscopic balloon dilatation can be safe and effective in the treatment of subglottic stenosis in children, except for more serious cases (grade IV). Open surgery should be considered if no significant improvement is observed after dilatation, especially after three or more dilatations.
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Affiliation(s)
- Yangyang Zheng
- Department of Otolaryngology-Head and Neck Surgery, School of Medicine, Shanghai Children's Hospital, Shanghai Jiao Tong University, No. 24, Lane 1400, West Beijing Road, Shanghai, 200040, People's Republic of China
| | - Hongming Xu
- Department of Otolaryngology-Head and Neck Surgery, School of Medicine, Shanghai Children's Hospital, Shanghai Jiao Tong University, No. 24, Lane 1400, West Beijing Road, Shanghai, 200040, People's Republic of China
| | - Xiaoyan Li
- Department of Otolaryngology-Head and Neck Surgery, School of Medicine, Shanghai Children's Hospital, Shanghai Jiao Tong University, No. 24, Lane 1400, West Beijing Road, Shanghai, 200040, People's Republic of China.
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19
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Kirasirova EA, Yumatova DA, Mamedov RF, Lafutkina NV, Rezakov RA, Mironova DA. [The use of platelet-rich plasma in the treatment of cicatricial stenosis of the larynx and cervical trachea]. Vestn Otorinolaringol 2023; 88:73-80. [PMID: 37767594 DOI: 10.17116/otorino20228804173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/29/2023]
Abstract
Despite the technical achievements of recent years in medicine, the problem of frequent recurrent stricture formation of the lumen of larynx and cervical trachea remains urgent. The etiology and pathogenesis of development of scar stenosis of the larynx and trachea were considered, and the analysis of the drugs' use for topical therapy in the comprehensive treatment of this pathology was conducted in the presented review. Special attention was paid to plasma enriched with platelets, its use in otorhinolaryngology, in particular in the treatment of laryngeal diseases. Positive and negative sides of the adjuvant therapy use have been identified. The search for means helping to prevent recurrent stricture formation of laryngeal lumen and cervical trachea determines the interest of the considered problem.
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Affiliation(s)
- E A Kirasirova
- Pirogov Russian National Research Medical University, Moscow, Russia
- Sverzhevsky Research Clinical Institute for Otolaryngology, Moscow, Russia
| | - D A Yumatova
- Pirogov Russian National Research Medical University, Moscow, Russia
| | - R F Mamedov
- Sverzhevsky Research Clinical Institute for Otolaryngology, Moscow, Russia
| | - N V Lafutkina
- Sverzhevsky Research Clinical Institute for Otolaryngology, Moscow, Russia
| | - R A Rezakov
- Sverzhevsky Research Clinical Institute for Otolaryngology, Moscow, Russia
| | - D A Mironova
- Sverzhevsky Research Clinical Institute for Otolaryngology, Moscow, Russia
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20
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Demott CJ, Grunlan MA. Emerging polymeric material strategies for cartilage repair. J Mater Chem B 2022; 10:9578-9589. [PMID: 36373438 DOI: 10.1039/d2tb02005j] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Cartilage is found throughout the body, serving an array of essential functions. Owing to the limited healing capacity of cartilage, damage or degeneration is often permanent and so requires clinical intervention. Established surgical techniques generally rely on biological grafting. However, recent advances in polymeric materials provide an encouraging alternative to overcome limits of auto- and allografts. For regenerative engineering of cartilage, a polymeric scaffold ideally supports and instructs tissue regeneration while also providing mechanical integrity. Scaffolds direct regeneration via chemical and mechanical cues, as well as delivery and support of exogenous cells and bioactive factors. Advanced polymeric scaffolds aim to direct regeneration locally, replicating the heterogeneities of native tissues. Alternatively, new cartilage-mimetic hydrogels have potential to serve as synthetic cartilage replacements. Prepared as multi-network or composite hydrogels, the most promising candidates have simultaneously realized the hydration, mechanical, and tribological properties of native cartilage. Collectively, the recent rise in polymers for cartilage regeneration and replacement proposes a changing paradigm, with a new generation of materials paving the way for improved clinical outcomes.
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Affiliation(s)
- Connor J Demott
- Department of Biomedical Engineering, Texas A&M University, College Station, TX 77843-3003, USA
| | - Melissa A Grunlan
- Department of Biomedical Engineering, Texas A&M University, College Station, TX 77843-3003, USA.,Department of Materials Science & Engineering, Texas A&M University, College Station, TX 77843-3003, USA.,Department of Chemistry, Texas A&M University, College Station, TX 77843-3003, USA.
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21
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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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22
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Demott CJ, Jones MR, Chesney CD, Yeisley DJ, Culibrk RA, Hahn MS, Grunlan MA. Ultra-High Modulus Hydrogels Mimicking Cartilage of the Human Body. Macromol Biosci 2022; 22:e2200283. [PMID: 36040017 DOI: 10.1002/mabi.202200283] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Revised: 08/12/2022] [Indexed: 12/25/2022]
Abstract
The human body is comprised of numerous types of cartilage with a range of high moduli, despite their high hydration. Owing to the limitations of cartilage tissue healing and biological grafting procedures, synthetic replacements have emerged but are limited by poorly matched moduli. While conventional hydrogels can achieve similar hydration to cartilage tissues, their moduli are substantially inferior. Herein, triple network (TN) hydrogels are prepared to synergistically leverage intra-network electrostatic repulsive and hydrophobic interactions, as well as inter-network electrostatic attractive interactions. They are comprised of an anionic 1st network, a neutral 2nd network (capable of hydrophobic associations), and a cationic 3rd network. Collectively, these interactions act synergistically as effective, yet dynamic crosslinks. By tuning the concentration of the cationic 3rd network, these TN hydrogels achieve high moduli of ≈1.5 to ≈3.5 MPa without diminishing cartilage-like water contents (≈80%), strengths, or toughness values. This unprecedented combination of properties poises these TN hydrogels as cartilage substitutes in applications spanning articulating joints, intervertebral discs (IVDs), trachea, and temporomandibular joint disc (TMJ).
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Affiliation(s)
- Connor J Demott
- Department of Biomedical Engineering, Texas A&M University, College Station, TX, 77843-3003, USA
| | - McKenzie R Jones
- Department of Biomedical Engineering, Texas A&M University, College Station, TX, 77843-3003, USA
| | - Caleb D Chesney
- Department of Biomedical Engineering, Texas A&M University, College Station, TX, 77843-3003, USA
| | - Daniel J Yeisley
- Department of Biomedical Engineering, Rensselaer Polytechnic Institute, Troy, NY, 12180-3590, USA
| | - Robert A Culibrk
- Department of Biomedical Engineering, Rensselaer Polytechnic Institute, Troy, NY, 12180-3590, USA
| | - Mariah S Hahn
- Department of Biomedical Engineering, Rensselaer Polytechnic Institute, Troy, NY, 12180-3590, USA
| | - Melissa A Grunlan
- Department of Biomedical Engineering, Department of Materials Science & Engineering, and Department of Chemistry, Texas A&M University, College Station, TX, 77843-3003, USA
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23
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Shakrawal N, Patro SK, Soni K, Kaushal D, Choudhury B, Goyal A. Our Experience with Laryngotracheal Trauma (LTT) in a Tertiary Care Centre of Western Rajasthan. Indian J Otolaryngol Head Neck Surg 2022; 74:375-382. [PMID: 36213471 PMCID: PMC9535059 DOI: 10.1007/s12070-021-02820-5] [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: 05/13/2021] [Accepted: 08/15/2021] [Indexed: 10/20/2022] Open
Abstract
LTT is a life-threatening incident that is fortunately rare. The presenting symptoms might not correlate with the intensity of trauma and range from mild endolaryngeal edema to complete laryngotracheal transection. An early diagnosis and timely intervention is required for successful outcomes and minimizing complications. This retrospective audit was performed on 18 patients of LTT who presented to the emergency from January 2017 to December 2019. The history, clinical presentation, examination findings, degree and nature of trauma, diagnostic modalities, medical and surgical management, and outcomes were analyzed. A total of 13 males and 5 females were included in this audit, with a mean age of 38.7 years. The most common cause was accidental in 77.7% patients. 61.5% of patients presented with Schaefer grade 3 and higher. Out of which 46% underwent emergent neck exploration and repair. 27.7% (5/18) presented with sequelae which were managed either by T- tube stenting, endoscopic dilatation by coblation, or laryngotracheal resection (LTR) and end-to-end anastomosis (EEA). Out of 14 surgically reconstructed airways, successful decannulation was achieved in 57.1% (8) patients. High clinical suspicion, early referral with emergent intervention is paramount for successful outcomes, fewer recurrences, and reduction of hospital's and patient's financial burden as timely planning and intervention can ensure successful decannulation of around two thirds of the higher grades (grade 3-5) of laryngotracheal traumatic injuries. Early airway establishment is the most critical goal. Definitive treatment protocols are needed in this field which warrants further formulation of multicentric studies and audits.
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Affiliation(s)
- Neha Shakrawal
- Dept of Oto-Rhino-Laryngology, AIIMS, Jodhpur, India
- Dept of Oto-Rhino-Laryngology, SNMC, Jodhpur, India
| | - Sourabha K. Patro
- Dept of Oto-Rhino-Laryngology, AIIMS, Jodhpur, India
- Dept of Otolaryngology & Head and Neck Surgery, PGIMER, Sector-12, Chandigarh, 160012 India
| | - Kapil Soni
- Dept of Oto-Rhino-Laryngology, AIIMS, Jodhpur, India
| | - Darwin Kaushal
- Dept of Oto-Rhino-Laryngology, AIIMS, Jodhpur, India
- Dept of Oto-Rhino-Laryngology, AIIMS, Bilaspur, India
| | | | - Amit Goyal
- Dept of Oto-Rhino-Laryngology, AIIMS, Jodhpur, India
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Md JNG, Ransom M, Kaspar A, Wilcox LJ, Whigham AS, Engelstad HJ. Neonatal Laryngotracheal Anomalies. Neoreviews 2022; 23:e613-e624. [PMID: 36047759 DOI: 10.1542/neo.23-9-e613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Respiratory distress in the neonate is one of the most common reasons for referral to a tertiary NICU, accounting for more than 20% of admissions. (1) The cause of respiratory distress can range from parenchymal lung disease to anomalies of any portion of the neonatal airway including the nose, pharynx, larynx, trachea, or bronchi. This review will focus on airway anomalies at or immediately below the level of the larynx. Although rare, those with such congenital or acquired laryngotracheal anomalies often require urgent evaluation and surgical intervention. This review describes 1) the pathophysiology associated with congenital and acquired laryngotracheal deformities in the neonate, 2) the clinical presentation and diagnostic evaluation of these anomalies, and 3) the current medical and surgical strategies available in the NICU and after discharge.
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Affiliation(s)
- Jean-Nicolas Gallant Md
- Division of Pediatric Otolaryngology, Department of Otolaryngology-Head and Neck Surgery, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, TN
| | - Meaghan Ransom
- Division of Neonatology, Department of Pediatrics, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, TN
| | - Ashley Kaspar
- Department of Therapy and Rehabilitation, Dell Children's Medical Center, Austin, TX
| | - Lyndy J Wilcox
- Division of Pediatric Otolaryngology, Department of Otolaryngology-Head and Neck Surgery, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, TN
| | - Amy S Whigham
- Division of Pediatric Otolaryngology, Department of Otolaryngology-Head and Neck Surgery, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, TN
| | - Holly J Engelstad
- Division of Neonatology, Department of Pediatrics, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, TN
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Miller EJ, Huning EYS. Subglottic tracheal stenosis complicating pregnancy: A case report. Obstet Med 2022; 15:205-207. [PMID: 36262817 PMCID: PMC9574454 DOI: 10.1177/1753495x21990220] [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: 07/27/2020] [Revised: 11/22/2020] [Accepted: 12/30/2020] [Indexed: 09/03/2023] Open
Abstract
The case presented details an uncommon case of subglottic tracheal stenosis exacerbated by pregnancy. We outine the multidisciplinary management involved and the outcomes for the pregnancy. The case serves as a reminder that shortness of breath in pregnancy has a broad differential diagnosis, and stridor is always abnormal.
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Johnson RF, Teplitzky T, Wynings EM, Kou Y, Chorney SR. Surgical site infections after pediatric open airway reconstruction—A National Surgical Quality Improvement Program‐Pediatric analysis. Laryngoscope Investig Otolaryngol 2022; 7:1618-1625. [PMID: 36258868 PMCID: PMC9575049 DOI: 10.1002/lio2.895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Revised: 06/08/2022] [Accepted: 08/06/2022] [Indexed: 12/04/2022] Open
Abstract
Objectives To determine the rate of surgical site infections (SSI) after pediatric open airway reconstruction using a nationwide database. Study Design Cross‐sectional study of the American College of Surgeons National Surgical Quality Improvement Program‐Pediatric (ACS NSQIP‐P) Database. Methods The ACS NSQIP‐P was queried for open airway surgeries between 2013 and 2019 determining postoperative SSI and wound dehiscence with a random sample of non‐airway cases serving as a control group. Results A total of 637 laryngotracheoplasties (LTP), 411 tracheal resections (TR) and 2100 control procedures were included. LTP and TR were both performed on younger children with more comorbidities than control surgeries (p < .05). Postoperative wound complications occurred more often after airway reconstructions than non‐airway cases (6.4% vs. 2.9%, p < .001). Compared to non‐airway procedures, LTP (OR: 2.42, 95% CI: 1.62–3.61) and TR (OR: 2.07, 95% CI: 1.28–3.66) developed increased SSI. Multiple logistic regression identified dirty or infected wounds (OR: 4.61, p < .001, 95% CI: 2.35–9.03) and American Society of Anesthesiologists (ASA) Class IV (OR: 3.19, p = .02, 95% CI: 1.12–8.39) as the strongest predictors of SSI after airway reconstruction. Conclusions SSI after pediatric airway reconstruction occur in 6% of cases and are increased in infected wounds and ASA Class IV surgeries. Recognizing common factors for these complications provide reliable benchmarking to design surgical quality improvement initiatives. Level of Evidence 4.
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Affiliation(s)
- Romaine F. Johnson
- Department of Otolaryngology–Head & Neck Surgery University of Texas Southwestern Medical Center Dallas Texas USA
- Department of Pediatric Otolaryngology Children's Medical Center Dallas Dallas Texas USA
| | - Taylor Teplitzky
- Department of Otolaryngology–Head & Neck Surgery University of Texas Southwestern Medical Center Dallas Texas USA
| | - Erin M. Wynings
- Department of Otolaryngology–Head & Neck Surgery University of Texas Southwestern Medical Center Dallas Texas USA
| | - Yann‐Fuu Kou
- Department of Otolaryngology–Head & Neck Surgery University of Texas Southwestern Medical Center Dallas Texas USA
- Department of Pediatric Otolaryngology Children's Medical Center Dallas Dallas Texas USA
| | - Stephen R. Chorney
- Department of Otolaryngology–Head & Neck Surgery University of Texas Southwestern Medical Center Dallas Texas USA
- Department of Pediatric Otolaryngology Children's Medical Center Dallas Dallas Texas USA
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McCormick ME. Trends in Subglottic Stenosis Management: Resource Utilization and Pediatric Otolaryngology Training. Laryngoscope 2022; 132 Suppl 5:S1-S9. [DOI: 10.1002/lary.28927] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Revised: 06/13/2020] [Accepted: 06/17/2020] [Indexed: 01/22/2023]
Affiliation(s)
- Michael E. McCormick
- Department of Otolaryngology Medical College of Wisconsin Milwaukee Wisconsin U.S.A
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Tuzuner A, Bas C, Jafarov S, Bahcecitapar M, Aydin E. Respiratory problems and associated factors following endoscopic balloon dilatation procedure in children with acquired subglottic stenosıs. Eur Arch Otorhinolaryngol 2022; 279:2493-2500. [PMID: 35037169 DOI: 10.1007/s00405-021-07208-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Accepted: 11/26/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Endoscopic balloon dilatation (EBD) offers a safe and non-invasive surgical option for the treatment of subglottic stenosis. Patient selection is important to achieve good results and to detect which patients are more prone to the development of complications. The aim of this study was to determine predictors of postoperative problems and early complications in primary EBD surgeries. METHODS A retrospective analysis was made of patients with acquired subglottic stenosis who were operated on with the EBD technique between January 2010 and December 2019 in the Otolaryngology-Head and Neck Surgery Department of Baskent University Hospital. Demographic data including the age and sex of the patients were collected together with etiology, presence of chromosomal or craniofacial anomaly (C/CA), duration of prolonged intubation (DPI), and extubation dilatation timeframe (EDT). Intra and postoperative follow-up data were recorded of the need for intubation or tracheotomy, development of desaturation, and grade and type of stenosis. RESULTS The male to female ratio was 2:1. The patients comprised 42 males and 22 females with a mean age of 296.52 ± 551.93 days. The cause of prolonged intubation was surgery for congenital heart disease in 50 (78.1%) patients and prematurity in 14 (21.9%). The type of lesion was acute granulation in 44 (72.1%) and chronic granulation in 17 (27.9%) patients. C/CA was determined in 13 patients, the mean grade of stenosis was 76.33 ± 15.21%, mean DPI was 25.25 ± 35.49 days, and mean EDT was calculated as 78.23 ± 373.82 days. Desaturation following endoscopic balloon dilatation developed in 26 (40.6%), orotracheal intubation was required in 10 (15.6%), tracheotomy in 10 (15.6%), and cardiopulmonary arrest occurred in 4 (6.25%). Prematurity, a longer duration of preoperative intubation, longer time from extubation to dilatation, older age, and higher grade of stenosis were determined as factors associated with postoperative early respiratory complications. CONCLUSION EBD indication should be carefully considered in children with acquired subglottic stenosis. To achieve better results and minimise complications, EBD should be performed without delay.
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Affiliation(s)
- Arzu Tuzuner
- Department of Otolaryngology, Baskent University School of Medicine, Yukarı Bahçelievler, No:, 77. Sk. No:11, Çankaya, 06490, Ankara, Turkey
| | - Ceren Bas
- Department of Otolaryngology, Baskent University School of Medicine, Yukarı Bahçelievler, No:, 77. Sk. No:11, Çankaya, 06490, Ankara, Turkey.
| | - Sabuhi Jafarov
- Department of Otolaryngology, Baskent University School of Medicine, Yukarı Bahçelievler, No:, 77. Sk. No:11, Çankaya, 06490, Ankara, Turkey
| | - Melike Bahcecitapar
- Department of Statistics, School of Science, Hacettepe University, Ankara, Turkey
| | - Erdinc Aydin
- Department of Otolaryngology, Baskent University School of Medicine, Yukarı Bahçelievler, No:, 77. Sk. No:11, Çankaya, 06490, Ankara, Turkey
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Cantarella G, Gaffuri M, Torretta S, Neri S, Ambrosini MT, D'Onghia A, Pignataro L, Sandu K. Outcomes of balloon dilation for paediatric laryngeal stenosis. ACTA ACUST UNITED AC 2021; 40:360-367. [PMID: 33299226 PMCID: PMC7726638 DOI: 10.14639/0392-100x-n0830] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Accepted: 07/28/2020] [Indexed: 02/02/2023]
Abstract
Objective Balloon dilation (BD) is a minimally invasive endoscopic treatment for paediatric laryngeal stenosis (LS) with reduced morbidity compared to open surgery. We retrospectively describe our experience in a cohort of children with chronic LS. Methods Fourteen children (median age: 28.5; range: 2-81 months) with chronic LS (multilevel in 8) were treated with tubeless total intravenous anaesthesia under spontaneous ventilation. Results Grade III LS was preoperatively detected in 12 children; the remaining 2 had grade IV stenosis. Six had prior tracheotomy, and one received it during the first intervention. Dilation laryngoplasty was the primary treatment in 11 children and was used as an adjuvant treatment in 3 after open reconstructive surgery. The median number of dilations was 2 (range: 1-6). There were no postoperative complications. At the end of the follow-up (median: 20.5; range: 2-46 months), detectable laryngeal lumen widening and/or respiratory improvement occurred in 12 children. Two of 7 patients with tracheostomy were decannulated. Conclusions Balloon laryngoplasty is a valuable therapeutic option to improve laryngeal patency in children with chronic multilevel LS, both as a primary and secondary adjuvant treatment after reconstructive surgery.
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Affiliation(s)
- Giovanna Cantarella
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Department of Otolaryngology and Head and Neck Surgery, Milan, Italy.,Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Michele Gaffuri
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Sara Torretta
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Department of Otolaryngology and Head and Neck Surgery, Milan, Italy.,Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Simona Neri
- Unit of Pediatric Anesthesiology and Intensive Care, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Maria Teresa Ambrosini
- Unit of Pediatric Anesthesiology and Intensive Care, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Alessandra D'Onghia
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Department of Otolaryngology and Head and Neck Surgery, Milan, Italy.,Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Lorenzo Pignataro
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Department of Otolaryngology and Head and Neck Surgery, Milan, Italy.,Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Kishore Sandu
- Airway Sector; Department of Otolaryngology, Lausanne University Hospital CHUV, Switzerland
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Fehervari M, Patel S, Towning R, Haire K, Al Yaghchi C, Sabharwal A, Sandhu G, Efthimiou E. Management of Laryngotracheal Stenosis in Obesity. Is This Another Co-morbidity that Can Be Improved with Weight Loss Following Bariatric Surgery? Obes Surg 2021; 31:4815-4820. [PMID: 34389931 PMCID: PMC8490261 DOI: 10.1007/s11695-021-05647-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 07/29/2021] [Accepted: 07/30/2021] [Indexed: 11/26/2022]
Abstract
PURPOSE Bariatric surgery improves several obesity-related comorbidities. Laryngotracheal stenosis is a rare condition that is usually managed with repeated endoscopic airway interventions and reconstructive airway surgery. The outcome of these definitive operations is worse in individuals with obesity. There are no studies investigating the effect of weight loss following bariatric surgery in the management of laryngotracheal stenosis. MATERIALS AND METHODS In an observational study, consecutive patients with a BMI over 35 kg/m2 and laryngotracheal stenosis were prospectively recruited to a bariatric and airway stenosis database in two tertiary care centres. Patients were treated with laparoscopic Roux-en-Y gastric bypass or sleeve gastrectomy and control subjects were managed conservatively. RESULTS A total of eleven patients with an initial body mass index of 43 kg/m2 (37-45) were enrolled to this study. Six patients underwent bariatric surgery and five subjects were treated conservatively. After 12 months, the total weight loss of patients undergoing bariatric surgery was 19.4% (14-24%) whilst 2.3% (1-3%) in the control group. The annual number of endoscopic airway interventions following bariatric surgery reduced (p = 0.002). Higher weight loss in patients led to less frequent interventions compared to control subjects (p = 0.004). Patients undergoing laryngotracheal reconstruction following bariatric surgery needed less endoscopic intervention, an annual average of 1.9 interventions before vs 0.5 intervention after. Conservatively managed control subjects required more frequent endoscopic intervention, 1.8 before vs 3.4 after airway reconstruction. CONCLUSION Bariatric surgery reduced the number of endoscopic airway interventions and enabled patients to undergo successful definitive airway reconstructive surgery.
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Affiliation(s)
- Matyas Fehervari
- Chelsea and Westminster Hospital, London, UK.
- Imperial College London, London, UK.
| | | | - Rebecca Towning
- National Centre for Airway Reconstruction, Imperial College Healthcare NHS Trust, London, UK
| | - Kevin Haire
- Chelsea and Westminster Hospital, London, UK
| | - Chadwan Al Yaghchi
- National Centre for Airway Reconstruction, Imperial College Healthcare NHS Trust, London, UK
| | | | - Guri Sandhu
- Imperial College London, London, UK
- National Centre for Airway Reconstruction, Imperial College Healthcare NHS Trust, London, UK
| | - Evangelos Efthimiou
- Chelsea and Westminster Hospital, London, UK
- Imperial College London, London, UK
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Shan Q, Huang W, Wang Z, Xue Q, Shi Z, Zhou J, Wu Z, Ding X, Mao A, Shang M, Wang Z. Preliminary Experience With a Novel Metallic Segmented Transcordal Stent Modified With Three-Dimensional Printing for Inoperable Malignant Laryngotracheal Stenosis. Front Oncol 2021; 11:619781. [PMID: 34381701 PMCID: PMC8350761 DOI: 10.3389/fonc.2021.619781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Accepted: 07/05/2021] [Indexed: 11/13/2022] Open
Abstract
Background This study aims to assess the feasibility of a novel metallic segmented transcordal stent modified with three-dimensional (3D) printing for treating inoperable malignant laryngotracheal stenosis and the tolerability of the stent. Methods This was a retrospective study. The stents were individually customized with the aid of 3D printing model based on the anatomic features of each patient’s airway. The stent was composed of two separate segments that corresponded to the larynx and the upper trachea. The stents were barrel-shaped at the proximal end to prevent migration. The proximal end of the stent was located slightly above the vocal cord. The technical and clinical success of stenting procedure, patient tolerability, and stent-related complications of patients were evaluated. Results Ten patients with dyspnea caused by malignant laryngotracheal stenosis underwent implantation of such stents. Technical and clinical success of the stenting procedure were achieved in all patients. For all patients, basic communication in life could be maintained by speaking softly. During follow-up, one patient showed intolerance to the stent, and the stent was retrieved 2 weeks after stenting. Stent migration was found in one patient, and the position of the stent was readjusted. Granulation tissue proliferation was found in two patients and was treated with cryotherapy by bronchoscopy. There were no deaths associated with stenting. Conclusions The individually customized metallic segmented transcordal stent is feasible and tolerable for patients with inoperable malignant laryngotracheal stenosis. The implantation of this stent may serve as a novel alternative treatment for patients who are not suitable for surgery or tracheotomy.
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Affiliation(s)
- Qungang Shan
- Department of Radiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Wei Huang
- Department of Radiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Ziyin Wang
- Department of Radiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Qingsheng Xue
- Department of Anesthesiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Zhihong Shi
- Department of Otolaryngology & Head and Neck Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jianping Zhou
- Department of Respiratory and Critical Care Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Zhiyuan Wu
- Department of Radiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xiaoyi Ding
- Department of Radiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Aiwu Mao
- Department of Interventional Radiology, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Mingyi Shang
- Department of Interventional Radiology, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Zhongmin Wang
- Department of Radiology, RuiJin Hospital/Lu Wan Branch, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Pediatric Open Airway Reconstruction. CURRENT OTORHINOLARYNGOLOGY REPORTS 2021. [DOI: 10.1007/s40136-020-00317-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Önder Şahin S, Şahin Yılmaz A, Gergin Ö, Yılmaz B. Balloon Laryngoplasty for Pediatric Subglottic Stenosis: A 5-year Experience. Turk Arch Otorhinolaryngol 2020; 58:208-213. [PMID: 33554194 DOI: 10.5152/tao.2020.5795] [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] [Received: 07/19/2020] [Accepted: 08/25/2020] [Indexed: 11/22/2022] Open
Abstract
Objective The objective of this study was to present our experience and evaluate our results of endoscopic balloon laryngoplasty (BL) in children with subglottic stenosis (SGS) at a pediatric tertiary center over a 5-year period. Methods This study reviewed 41 pediatric patients diagnosed with acquired SGS who had undergone BL as the primary course of treatment. Cases were analyzed for details including patient demographics, SGS grade and length, timing and the type of surgery, presence of tracheostomy, comorbidities, postoperative management, complications and outcomes of balloon dilatation. Results Forty-one children (22 girls and 19 boys) who had undergone BL at a mean age of 26 months (range, 1 month to 14 years) were included in the study. Nineteen (46.3%) were diagnosed with acute SGS (12 thin stenosis, 7 thick stenosis) and 22 (53.7%) with chronic SGS (9 thin stenosis, 13 thick stenosis). The success rate of BL was 100% in patients with acute and chronic thin membranous stenosis. The effectiveness of BL was significantly higher in patients with acute thick stenosis than in patients with chronic thick stenosis (p=0.016). Conclusion This study confirms that BL in patients presenting with acquired SGS with thin membranous stenosis, regardless of whether acute or chronic, can have a good prognosis. However, the results are less promising in cases of chronic thick stenosis.
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Affiliation(s)
- Serap Önder Şahin
- Department of Otolaryngology, University of Health Sciences, Ümraniye Training and Research Hospital, İstanbul, Turkey
| | - Aslı Şahin Yılmaz
- Department of Otolaryngology, University of Health Sciences, Ümraniye Training and Research Hospital, İstanbul, Turkey
| | - Özgül Gergin
- Department of Otolaryngology, Medipol University Hospital, İstanbul, Turkey
| | - Begüm Yılmaz
- Department of Otolaryngology, University of Health Sciences, Ümraniye Training and Research Hospital, İstanbul, Turkey
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Stramiello JA, Mohammadzadeh A, Ryan J, Brigger MT. The role of bioresorbable intraluminal airway stents in pediatric tracheobronchial obstruction: A systematic review. Int J Pediatr Otorhinolaryngol 2020; 139:110405. [PMID: 33017664 DOI: 10.1016/j.ijporl.2020.110405] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2020] [Revised: 08/24/2020] [Accepted: 09/23/2020] [Indexed: 12/20/2022]
Abstract
INTRODUCTION Tracheal stenosis and tracheobronchomalacia are complicated, patient-specific diseases that can be treated with intraluminal stenting. Most commonly, silicone and metal stents are utilized, however, they pose significant early and late morbidity and are further complicated by growth of the airway in the pediatric population. Given recent improvements in materials science, there is a growing body of evidence suggesting a strong role for bioresorbable intraluminal stents in treating pediatric tracheobronchial obstruction. METHODS A PubMed.gov literature search was performed on December 3, 2019 and May 15, 2020, and a 2-researcher systematic review was performed following the PRISMA criteria. The following search query was utilized: (((((((bioresorbable) OR bioabsorbable) OR resorbable) OR absorbable) OR biodegradable AND airway) OR trachea) AND stent. A pooled statistical analysis was performed on all reported pediatric patients using SPSS software. RESULTS 1369 publications were screened and 26 articles with original data were identified. Materials used included polydioxanone (PDO), poly-l-lactic acid (PLLA), polyglycolic acid/poly-l-lactide co-polymer with Proglactin 910 (Vicryl®-PDS®), polycaprolactone (PCL), magnesium alloys, and co-polymers in varying proportions. Twelve articles presented data on human subjects, 8 of which were case series and case reports on pediatric populations using polydioxanone (PDO) stents. Pooled statistical analysis demonstrated an average age of 19 months (range 0.25-144), 56.5% associated with a cardiovascular anomaly, and overall complication rate of 21.7%, with a stent fragment foreign body being the most common (8.7%), followed by significant granulation tissue (4.3%), stent migration (4.3%), and local stenosis (4.3%). Comparative analysis demonstrated short-term improvement (up to 1 month) has a statistically significant association with tracheobronchomalacia versus tracheal stenosis on chi-squared test (p = 0.001). The remaining analyses did not yield statistical significance. CONCLUSION The reported application of bioresorbable materials as intraluminal airway stents is positive. All comparative animal studies report biocompatibility and fewer morbidities compared to metal and silicone stents, however, in human studies there are concerns over the short interval of degradation and the potential for obstructive foreign bodies in poorly seated stents. Overall, there are clear, reproducible advantages to bioresorbable intraluminal stents in pediatric airway obstruction, as well as common pitfalls, that warrant further research.
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Affiliation(s)
- Joshua A Stramiello
- Division of Otolaryngology-Head & Neck Surgery, Department of Surgery, University of California San Diego, 200 W Arbor Dr. MC8895, San Diego, CA, 92103, USA
| | - Amir Mohammadzadeh
- UC San Diego School of Medicine, University of California San Diego, 9500 Gilman Dr., La Jolla, CA, 92093, USA
| | - Justin Ryan
- 3D Innovations Lab, Rady Children's Hospital, San Diego, CA, 3020 Children's Way MC5166, San Diego, CA, 92123, USA
| | - Matthew T Brigger
- Division of Otolaryngology-Head & Neck Surgery, Department of Surgery, University of California San Diego, 200 W Arbor Dr. MC8895, San Diego, CA, 92103, USA; Division of Pediatric Otolaryngology, Department of Surgery, Rady Children's Hospital, San Diego, CA, 3020 Children's Way, San Diego, CA, 92123, USA.
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Stramiello JA, Saddawi-Konefka R, Ryan J, Brigger MT. The role of 3D printing in pediatric airway obstruction: A systematic review. Int J Pediatr Otorhinolaryngol 2020; 132:109923. [PMID: 32035351 DOI: 10.1016/j.ijporl.2020.109923] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Revised: 01/30/2020] [Accepted: 01/30/2020] [Indexed: 02/09/2023]
Abstract
BACKGROUND Tracheomalacia and tracheal stenosis are complicated, patient-specific diseases that require a multidisciplinary approach to diagnose and treat. Surgical interventions such as aortopexy, slide tracheoplasty, and stents potentially have high rates of morbidity. Given the emergence of three-dimensional (3D) printing as a versatile adjunct in managing complex pathology, there is a growing body of evidence that there is a strong role for 3D printing in both surgical planning and implant creation for pediatric airway obstruction. METHODS A structured PubMed.gov literature search was utilized, and a two-researcher systematic review was performed following the PRISMA criteria. The following search query was utilized: (((((3D printing) OR three-dimensional printing) OR 3D printed) OR three-dimensional printed) AND trachea) OR airway. RESULTS Over 23,000 publications were screened. Eight literature reviews and thirty-seven original papers met inclusion criteria. Of the thirty-seven original papers, eleven discussed 3D printing for surgical planning and twenty-six discussed 3D printing implants for interventions. CONCLUSION The reported application of 3D printing for management of pediatric airway obstruction is emerging with positive and broad applications. 3D printing for surgical planning not only improves pre-operative assessment of surgical approach and stent customization, but also helps facilitate patient/family education. 3D printing for custom implantable interventions is focused on bioresorbable external airway splints and biological grafts, with both animal studies and human case reports showing good results in improving symptoms.
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Affiliation(s)
- Joshua A Stramiello
- Division of Otolaryngology-Head & Neck Surgery, Department of Surgery, University of California San Diego, 200 W Arbor Dr. MC8895, San Diego, CA 92103, USA.
| | - Robert Saddawi-Konefka
- Division of Otolaryngology-Head & Neck Surgery, Department of Surgery, University of California San Diego, 200 W Arbor Dr. MC8895, San Diego, CA 92103, USA
| | - Justin Ryan
- 3D Innovations Lab, Rady Children's Hospital, 3020 Children's Way MC5166, San Diego, CA, 92123, USA
| | - Matthew T Brigger
- Division of Otolaryngology-Head & Neck Surgery, Department of Surgery, University of California San Diego, 200 W Arbor Dr. MC8895, San Diego, CA 92103, USA; Division of Pediatric Otolaryngology, Department of Surgery, Rady Children's Hospital, 3020 Children's Way, San Diego, CA, 92123, USA
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Li XZ, Wang ZC, Qiu Y, Ma SX, Meng LB, Wu WH, Zhang P, Yang W, Song WP, Huang L. Bioinformatics analysis and verification of gene targets for benign tracheal stenosis. Mol Genet Genomic Med 2020; 8:e1245. [PMID: 32309912 PMCID: PMC7284051 DOI: 10.1002/mgg3.1245] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2020] [Revised: 03/10/2020] [Accepted: 03/20/2020] [Indexed: 12/15/2022] Open
Abstract
Background Tracheal injury could cause intratracheal scar hyperplasia which in turn causes benign tracheal stenosis (TS). With the increasing use of mechanical ventilation and ventilator, the incidence of TS is increasing. However, the molecular mechanisms of TS have not been elucidated. It is significant to further explore the molecular mechanisms of TS. Methods The repeatability of public data was verified. Differently expressed genes (DEGs) and most significant genes were identified between TS and normal samples. Enrichment analysis of Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) were analyzed. The comparative toxicogenomics database were analyzed. TS patients were recruited and RT‐qPCR were performed to verify the most significant genes. Results There exist strong correlations among samples of TS and normal group. There was a total of 194 DEGs, including 61 downregulated DEGs and 133 upregulated DEGs. GO were significantly enriched in mitotic nuclear division, cell cycle, and cell division. Analysis of KEGG indicated that the top pathways were cell cycle, and p53 pathway. MKI67(OMIM:176741), CCNB1(OMIM:123836), and CCNB2(OMIM:602755) were identified as the most significant genes of TS, and validated by the clinical samples. Conclusion Bioinformatics methods might be useful method to explore the mechanisms of TS. In addition, MKI67, CCNB1, and CCNB2 might be the most significant genes of TS.
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Affiliation(s)
- Xu-Ze Li
- Department of Anesthesiology, The Second Hospital of Hebei Medical University, Shijiazhuang, China
| | - Zi-Chen Wang
- Department of Anesthesiology, The Second Hospital of Hebei Medical University, Shijiazhuang, China
| | - Yong Qiu
- Anesthesiology Department, Beijing Hospital, National Center of Gerontology, Beijing, P. R. China
| | - Shu-Xian Ma
- Department of Anesthesiology, The Second Hospital of Hebei Medical University, Shijiazhuang, China
| | - Ling-Bing Meng
- Neurology Department, Beijing Hospital, National Center of Gerontology, Beijing, P. R. China
| | - Wen-Hao Wu
- Department of Anesthesiology, The Second Hospital of Hebei Medical University, Shijiazhuang, China
| | - Pei Zhang
- Department of Anesthesiology, The Second Hospital of Hebei Medical University, Shijiazhuang, China
| | - Wei Yang
- Shandong Weigao Group National Engineering Lab, Weihai, China
| | - Wen-Ping Song
- Shandong Weigao Group National Engineering Lab, Weihai, China
| | - Lining Huang
- Department of Anesthesiology, The Second Hospital of Hebei Medical University, Shijiazhuang, China
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Challenging tracheal resection anastomosis: Case series. Auris Nasus Larynx 2020; 47:616-623. [PMID: 32035696 DOI: 10.1016/j.anl.2020.01.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Revised: 12/21/2019] [Accepted: 01/21/2020] [Indexed: 12/20/2022]
Abstract
OBJECTIVES This study was conducted to review our experience in Otorhinolaryngology Department, Mansoura University Hospitals, Egypt, in the last 2 years in the management of high-risk patients who underwent cricotracheal resection due to different pathologies. METHODS This case series included nine patients with severe, grade III or IV subglottic / cervical tracheal stenosis. These patients were considered high risk patients due to unusual pathology / etiology of stenosis or associated surgical field morbidity. Four patients had recurrent stenosis after previous unsuccessful cricotracheal resection, three patients had subglottic stenosis due to external neck trauma which compromised the surgical field. One patient had upper tracheal neoplasm, and in 1 patient there was upper tracheal stenosis associated with tracheo-esophageal fistula. RESULTS Successful decannulation was achieved in all patients (n = 9) without any reported major intraoperative or postoperative compilations. CONCLUSION Cases of subglottic / upper tracheal stenosis due to uncommon pathologies like neoplastic lesions, external neck trauma compromising the surgical field and revision cricotracheal resection, can be successfully managed by cricotracheal resection. However, a highly skilled team, well familiar with these surgeries, is mandatory to achieve an optimum outcome.
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Gao B, Jing H, Gao M, Wang S, Fu W, Zhang X, He X, Zheng J. Long-segmental tracheal reconstruction in rabbits with pedicled Tissue-engineered trachea based on a 3D-printed scaffold. Acta Biomater 2019; 97:177-186. [PMID: 31352107 DOI: 10.1016/j.actbio.2019.07.043] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2019] [Revised: 07/20/2019] [Accepted: 07/24/2019] [Indexed: 12/13/2022]
Abstract
Long-segmental tracheal defects constitute an intractable clinical problem, due to the lack of satisfactory tracheal substitutes for surgical reconstruction. Tissue engineered artificial substitutes could represent a promising approach to tackle this challenge. In our current study, tissue-engineered trachea, based on a 3D-printed poly (l-lactic acid) (PLLA) scaffold with similar morphology to the native trachea of rabbits, was used for segmental tracheal reconstruction. The 3D-printed scaffolds were seeded with chondrocytes obtained from autologous auricula, dynamically pre-cultured in vitro for 2 weeks, and pre-vascularized in vivo for another 2 weeks to generate an integrated segmental trachea organoid unit. Then, segmental tracheal defects in rabbits were restored by transplanting the engineered tracheal substitute with pedicled muscular flaps. We found that the combination of in vitro pre-culture and in vivo pre-vascularization successfully generated a segmental tracheal substitute with bionic structure and mechanical properties similar to the native trachea of rabbits. Moreover, the stable blood supply provided by the pedicled muscular flaps facilitated the survival of chondrocytes and accelerated epithelialization, thereby improving the survival rate. The segmental trachea substitute engineered by a 3D-printed scaffold, in vitro pre-culture, and in vivo pre-vascularization enhanced survival in an early stage post-operation, presenting a promising approach for surgical reconstruction of long segmental tracheal defects. STATEMENT OF SIGNIFICANCE: We found that the combination of in vitro pre-culture and in vivo pre-vascularization successfully generated a segmental tracheal substitute with bionic structure and mechanical properties similar to the native trachea of rabbits. Moreover, the stable blood supply provided by the pedicled muscular flaps facilitated the survival of chondrocytes and accelerated epithelialization, thereby improving the survival rate of the rabbits. The segmental trachea substitute engineered by a 3D-printed scaffold, in vitro pre-culture, and in vivo pre-vascularization enhanced survival in an early stage post-operation, presenting a promising approach for surgical reconstruction of long segmental tracheal defects.
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Affiliation(s)
- Botao Gao
- Department of Cardiothoracic Surgery, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, 1678 Dongfang Road, Shanghai 200127, People's Republic of China
| | - Hui Jing
- Department of Cardiothoracic Surgery, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, 1678 Dongfang Road, Shanghai 200127, People's Republic of China
| | - Manchen Gao
- Department of Cardiothoracic Surgery, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, 1678 Dongfang Road, Shanghai 200127, People's Republic of China; Department of Pediatric Cardiac Surgery, National Center for Cardiovascular Disease and Fuwai Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, 167 Beilishi Road, Xicheng, Beijing 100037, People's Republic of China
| | - Shoubao Wang
- Department of Cardiothoracic Surgery, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, 1678 Dongfang Road, Shanghai 200127, People's Republic of China; Department of Plastic and Reconstrucive Surgery, Shanghai 9th People's Hospital, 639 Zhi Zao Ju Road, Shanghai 200011, People's Republic of China
| | - Wei Fu
- Department of Cardiothoracic Surgery, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, 1678 Dongfang Road, Shanghai 200127, People's Republic of China; Institute of Pediatric Translational Medicine, Shanghai Children's Medical Center, Shanghai Jiaotong University School of Medicine, 1678 Dong Fang Road, Shanghai 200127, People's Republic of China
| | - Xiaoyang Zhang
- Department of Cardiothoracic Surgery, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, 1678 Dongfang Road, Shanghai 200127, People's Republic of China
| | - Xiaomin He
- Department of Cardiothoracic Surgery, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, 1678 Dongfang Road, Shanghai 200127, People's Republic of China
| | - Jinghao Zheng
- Department of Cardiothoracic Surgery, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, 1678 Dongfang Road, Shanghai 200127, People's Republic of China.
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Kylat RI. Tracheal Stenosis and Congenital Heart Disease in Trisomy 21. CHILDREN-BASEL 2019; 6:children6090098. [PMID: 31487969 PMCID: PMC6769800 DOI: 10.3390/children6090098] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Revised: 08/28/2019] [Accepted: 09/02/2019] [Indexed: 01/13/2023]
Abstract
Tracheal rings (TR) are rare, congenital cartilaginous defect of the upper airway and are usually due to complete or near complete circumferential cartilaginous tracheal rings, with variable degrees of tracheal stenosis (TS) and shortening. Chromosomal anomalies like trisomy 21 are characteristically associated with a wide range of upper airway anomalies including TS and congenital heart disease (CHD). However, the overall prevalence of severe forms of TS is rare and reported in 1.2% of all CHD patients. Herein, we present a rare association of severe TS due to complete tracheal rings in a trisomy 21 patient with CHD and the challenges in the management.
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Affiliation(s)
- Ranjit I Kylat
- Department of Pediatrics, University of Arizona, College of Medicine, Tucson, AZ 85724, USA.
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Albrecht NM, Ostrower S. Case report of a laryngotracheal reconstruction with anterior and posterior costal cartilage graft and stent placement - Surgical technique. Int J Surg Case Rep 2019; 58:145-152. [PMID: 31039513 PMCID: PMC6529589 DOI: 10.1016/j.ijscr.2019.04.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2019] [Revised: 03/27/2019] [Accepted: 04/05/2019] [Indexed: 11/17/2022] Open
Abstract
Subglottic stenosis is defined as airway narrowing below the true vocal folds. Subglottic stenosis commonly occurs after endotracheal intubation in newborns. The incidence of subglottic stenosis has decreased to 1–2% of premature patients. The single-stage procedure avoids prolonged hospitalization. The two-step procedure allows for treatment of a more extensively stenosed area.
Objective The purpose of this report is to examine a grade III subglottic stenosis case with double-stage laryngotracheal reconstruction using a costal cartilage graft and to explore the relevant literature regarding these topics. Context In this report, the authors examine a severe grade III subglottic stenosis pediatric case and its subsequent laryngotracheal reconstruction with costal cartilage graft. This case demonstrates a surgical intervention which has become infrequently utilized since neonatologists began using noninvasive positive pressure airway support rather than intubation; thus, the incidence of acquired subglottic stenosis is decreasing. Features of the case and its surgical correction are discussed in detail. Case Report Summary The patient is a 3-year-old African-American female born prematurely at 30 weeks by emergent cesarean section complicated by placenta previa, twin gestation and absent end diastolic flow. The patient has a past medical history significant for apnea of prematurity, necrotizing enterocolitis, bronchopulmonary dysplasia, hyaline membrane disease, pneumonia, abnormal electroencephalogram, cardiac arrest due to respiratory disorder, parainfluenza infection, chronic respiratory failure, laryngomalacia and grade III subglottic stenosis. The patient’s surgical history is significant for supraglottic laryngoplasty, tracheostomy placement, gastrostomy tube placement and laryngotracheal reconstruction with anterior and posterior costal cartilage graft and stent placement with subsequent stent removal. As of March 2019, the patient continues to have follow up laryngoscopy/bronchoscopy with dilation. Ultimately, the patient will maintain her own airway with tracheostomy tube removal. Data sources and overall comparisons A PubMed literature review of subglottic stenosis and laryngotracheal reconstruction with costal cartilage graft was performed. Twenty sources were reviewed leading to greater understanding of the evidence supporting the laryngotracheal reconstruction with graft treatment modality. Conclusion Optimal management and correction of subglottic stenosis is possible via laryngotracheal reconstruction with cartilage graft. The reconstruction procedure, first utilized in the 1970’s, allows correction of severe (grades III and IV) subglottic stenosis. After healing is complete, the patient regains function of her own airway.
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Affiliation(s)
| | - Samuel Ostrower
- Pediatric Otolaryngology Joe DiMaggio Children's Hospital, Hollywood, FL, United States
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