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Hanubal KS, Chheda NN, Dziegielewski PT. Neopharyngeal Stricture following Laryngectomy. Semin Plast Surg 2023; 37:31-38. [PMID: 36776807 PMCID: PMC9911225 DOI: 10.1055/s-0042-1759796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Stricture formation is a serious complication following pharyngeal reconstruction. These strictures can be life-threatening and can severely impact quality of life. In this article, the existing literature on surgical risk factors linked to neopharyngeal stricture formation is reviewed. Intraoperative preventative measures reconstructive surgeons should consider are also discussed. Finally, this article will describe the evaluation and management of pharyngoesophageal strictures, including the challenges and options when dealing with refractory strictures.
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Affiliation(s)
| | - Neil N. Chheda
- Department of Otolaryngology, University of Florida, Gainesville, Florida
| | - Peter T. Dziegielewski
- Department of Otolaryngology, University of Florida, Gainesville, Florida
- University of Florida Health Cancer Center, Gainesville, Florida
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Endoscopic Injection of Mitomycin C for the Treatment of Pharyngoesophageal Stenosis Refractory to Endoscopic Treatment with Dilatation in Patients Treated for Head and Neck Cancer. Gastroenterol Res Pract 2018; 2018:5428157. [PMID: 30538738 PMCID: PMC6260406 DOI: 10.1155/2018/5428157] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Revised: 08/27/2018] [Accepted: 09/13/2018] [Indexed: 11/25/2022] Open
Abstract
Background Management of pharyngoesophageal stenosis (PES) in patients after head and neck cancer (HNC) treatment remains a challenge. It is not uncommon that PES is refractory to dilation sessions. This study aimed at evaluating the efficacy of Mitomycin C (MMC) endoscopic injection for the treatment of refractory pharyngoesophageal stenosis. Patients and methods This is a prospective study in patients with dysphagia following head and neck cancer treatment, without evidence suggestive of tumor recurrence, and refractory to endoscopic treatment. These patients were submitted to endoscopic dilation of the stenotic segment with thermoplastic bougies, followed by injection of MMC. We repeated the endoscopic sessions every three weeks. Results From January 2015 to May 2015, we treated 13 patients with PES. Three patients were initially enrolled in the study for refractory stricture. We observed adverse events in all of them, with intense neck pain and ulcer development, justifying the interruption of the trial. Conclusion The repeated injection in the short interval of MMC in refractory PES is not recommended, because it resulted in serious adverse events.
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Zenga J, Goldsmith T, Bunting G, Deschler DG. State of the art: Rehabilitation of speech and swallowing after total laryngectomy. Oral Oncol 2018; 86:38-47. [DOI: 10.1016/j.oraloncology.2018.08.023] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Revised: 08/22/2018] [Accepted: 08/31/2018] [Indexed: 10/28/2022]
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Optimizing Outcomes in Pharyngoesophageal Reconstruction and Neck Resurfacing: 10-Year Experience of 294 Cases. Plast Reconstr Surg 2017; 139:105e-119e. [PMID: 28027247 DOI: 10.1097/prs.0000000000002915] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Pharyngoesophageal reconstruction is a complex endeavor that poses many challenges. This 10-year series examines factors impacting the need for neck skin resurfacing and evaluates the impact of reconstructive modalities on outcomes. METHODS A review identified 294 patients who underwent pharyngoesophageal reconstruction from 2002 to 2012. Patients were divided based on neck skin resurfacing requirements. Patients undergoing neck resurfacing were further subdivided into reconstructive technique, including a second skin paddle or muscle component from the same free flap pedicle, a local flap, or a second free flap. All groups were compared by comorbidities, complications, and functional outcomes. RESULTS Of 294 patients, 179 (60.9 percent) required neck skin resurfacing. In the resurfaced group, there were 90 circumferential defects (50.3 percent) and 89 partial defects (49.7 percent). In the resurfaced group, 110 (61.4 percent) underwent reconstruction with a second skin paddle from the same free flap pedicle, 21 (11.7 percent) underwent reconstruction with a muscle component from the same pedicle, and 25 (13.9 percent) received a pectoralis major flap. There were five external paddle flap losses in the resurfaced group (2.8 percent) and no internal flap losses. Overall complications were similar among groups. The resurfaced group had a lower pharyngocutaneous fistula rate (4.5 percent) compared with the primary closure group (11.3 percent) (p = 0.026). Prior neck surgery and radiation therapy were strong predictors of neck skin resurfacing (p < 0.001). CONCLUSIONS Neck resurfacing is often required in salvage pharyngoesophageal reconstruction. Providing additional vascularized tissue over the neoconduit is predictive of lower pharyngocutaneous fistula rates. An algorithmic approach to neck resurfacing is presented.
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Bartel MJ, Seeger K, Jeffers K, Clayton D, Wallace MB, Raimondo M, Woodward TA. Topical Mitomycin C application in the treatment of refractory benign esophageal strictures in adults and comprehensive literature review. Dig Liver Dis 2016; 48:1058-65. [PMID: 27443493 DOI: 10.1016/j.dld.2016.06.024] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2016] [Revised: 06/08/2016] [Accepted: 06/20/2016] [Indexed: 12/11/2022]
Abstract
BACKGROUND Recurrent complex esophageal strictures remain difficult to manage. AIMS To determine the efficacy of topical Mitomycin C application for recurrent benign esophageal strictures. METHODS All patients who underwent balloon dilation followed by topical Mitomycin C application for recurrent benign esophageal strictures were included. Primary outcome was number of dilations and change of dysphagia score. RESULTS Nine patients with anastomotic (3), radiation-induced (3), caustic (2), and combined anastomotic and radiation-induced (1) strictures were included. Strictures had a mean length of 13.75mm, diameter of 8.0mm, and were dilated 10.7 times over a median of 8 months (1.5 dilations per month). Following Mitomycin C application, the need for further dilation decreased to 0.39 dilations per month over a median of 10 months; however, dysphagia scores improved not significantly from 3.2 to 2.6 (mean). CONCLUSION In this pilot study, topical Mitomycin C in conjunction with dilation decreased the frequency of esophageal dilations for recurrent benign esophageal strictures.
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Affiliation(s)
- Michael J Bartel
- Gastroentrology and Hepatology, Mayo Clinic, Jacksonville, FL, USA
| | - Kristina Seeger
- General Internal Medicine, Mayo Clinic, Jacksonville, FL, USA
| | - Kayin Jeffers
- General Internal Medicine, Mayo Clinic, Jacksonville, FL, USA
| | | | | | - Massimo Raimondo
- Gastroentrology and Hepatology, Mayo Clinic, Jacksonville, FL, USA
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Goguen LA, Posner MR, Norris CM, Tishler RB, Wirth LJ, Annino DJ, Gagne A, Sullivan CA, Sammartino DE, Haddad RI. Dysphagia after Sequential Chemoradiation Therapy for Advanced Head and Neck Cancer. Otolaryngol Head Neck Surg 2016; 134:916-22. [PMID: 16730530 DOI: 10.1016/j.otohns.2006.02.001] [Citation(s) in RCA: 72] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2005] [Accepted: 02/01/2006] [Indexed: 10/24/2022]
Abstract
OBJECTIVES: Assess impact of sequential chemoradiation therapy (SCRT) for advanced head and neck cancer (HNCA) on swallowing, nutrition, and quality of life. STUDY DESIGN: Prospective cohort study of 59 patients undergoing SCRT for advanced head and neck cancer. Follow-up median was 47.5 months. SETTING: Regional Cancer Center. RESULTS: Median time to gastrostomy tube removal was 21 weeks. Eighteen of 23 patients who underwent modified barium swallow demonstrated aspiration; none developed pneumonia. Six of 7 with pharyngoesophageal stricture underwent successful dilatation. Functional Assessment of Cancer Therapy—Head and Neck Scale questionnaires at median 6 months after treatment revealed “somewhat” satisfaction with swallowing. At the time of analysis, 97% have the gastronomy tube removed and take soft/regular diet. CONCLUSION: Early after treatment dysphagia adversely affected weight, modified barium swallow results, and quality of life. Diligent swallow therapy, and dilation as needed, allowed nearly all patients to have their gastronomy tubes removed and return to a soft/regular diet. SIGNIFICANCE: Dysphagia is significant after SCRT but generally slowly recovers 6 to 12 months after SCRT.
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Affiliation(s)
- Laura A Goguen
- Department of Surgery/Division of Otolaryngology, at the Brigham and Women's Hospital and the Dana Farber Cancer Institute, Boston, MA 02115, USA.
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Shvidler J, Bothwell NE, Cable B. Refining indications for the use of mitomycin C using a randomized controlled trial with an animal model. Otolaryngol Head Neck Surg 2016; 136:653-7. [PMID: 17418268 DOI: 10.1016/j.otohns.2006.10.037] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2006] [Accepted: 10/27/2006] [Indexed: 10/23/2022]
Abstract
Objectives To evaluate the effect of mitomycin on the repair of acquired subglottic stenosis and to define the optimal concentration of mitomycin that would minimize restenosis after repair. Study Design And Setting A randomized prospective model was used in which 20 ferrets ( Mustela putorius furo) underwent simulated intubation injury that was then treated with CO2 laser lysis. Results Comparison of cross-sectional airway areas, after stenosis repair, showed no significant differences between control and mitomycin treatment groups. Comparison of histologic scores for both inflammation and mucosalization yielded no difference between control and treatment animals. Conclusions Mitomycin C appeared to have no benefit when placed after repair of an acquired stenosis. Significance This study closely models the injury experienced by children with acquired subglottic stenosis. These data provide clear evidence that mitomycin is limited in its effect on established wounds and help further define its role as an adjuvant for surgery in the aerodigestive tract.
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Stewart CE, Kim JY. Application of mitomycin-C for head and neck keloids. Otolaryngol Head Neck Surg 2016; 135:946-50. [PMID: 17141089 DOI: 10.1016/j.otohns.2005.07.026] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2005] [Indexed: 10/23/2022]
Abstract
Keloids of the head and neck are a relatively common entity in darker-skinned races, occurring in 5%-15% of skin wounds. Keloids are fibrotic lesions that are a result of an abnormal wound-healing process that lacks control of the mechanisms that regulate tissue repair and regeneration. The proliferation of normal tissue-healing processes results in scarring that enlarges well beyond the original wound margins. Many treatment modalities for keloids have been tried with variable amounts of success. Surgical excision, compressive therapy, silicon dressings, corticosteroid injections, radiation, cryotherapy, interferon therapy, and laser therapy have all been used alone or in combination. Despite this wide range of available treatments, recurrence rates typically remain in the 50%-70% range. In this study, we present our results in a series of 10 patients who were treated with surgical excision of head and neck keloids and the application of topical mitomycin-C. Mitomycin-C is a chemotherapeutic agent that inhibits DNA synthesis and fibroblast proliferation. It has been used in ophthalmologic procedures and airway surgery to decrease scar formation. In these 10 patients, we combined surgical excision of keloids with the application of topical mitomycin-C. The patients were then followed postoperatively for recurrence (range, 7-14 months). We have found topical application of mitomycin-C to be an effective therapy for prevention of keloid recurrence in the head and neck, with a success rate of 90% as reported in this series.
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Affiliation(s)
- Charles E Stewart
- Division of Otolaryngology Head and Neck Surgery, Loma Linda University, Loma Linda, CA 92354, USA.
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9
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Goguen LA, Norris CM, Jaklitsch MT, Sullivan CA, Posner MR, Haddad RI, Tishler RB, Burke E, Annino DJ. Combined antegrade and retrograde esophageal dilation for head and neck cancer-related complete esophageal stenosis. Laryngoscope 2010; 120:261-6. [PMID: 19998421 DOI: 10.1002/lary.20727] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVES/HYPOTHESIS Assess the safety and efficacy of combined antegrade and retrograde esophageal dilation (CARD) for complete esophageal stenosis following head and neck cancer (HNC) treatment. Review HNC dysphagia management. STUDY DESIGN Retrospective review of all patients undergoing CARD following HNC treatment between May 2001 and September 2008. METHODS Forty-five patients were identified for review. Parameters assessed included: ability to obtain intraoperative esophageal patency, complications, number of dilations required, diet, and gastric tube (GT) status. Factors associated with dilation failure were analyzed. RESULTS Intraoperative esophageal patency was obtained in 91% of patients. Median number of all dilations per patient was three. Median number of CARDs per patient was one. Resumption of oral intake occurred in 36/45 (80%). Diet results included: regular or soft diet 32/45 (71%), GT removal 27/45 (60%), and GT dependence with nothing by mouth 9/45 (20%). Laryngeal and pharyngeal stenosis, radionecrosis, tracheotomy dependence, and elongated stenosis were associated with dilation failure. Complications occurred in 18/63 (29%) CARD procedures: eight pneumomediastinum, seven GT site problems, two esophageal perforations, and one pharyngeal infection. All complications resolved spontaneously or with minimal interventions. CONCLUSIONS CARD was safe and effective. Intraoperative patency was achieved in 91% of patients. Eighty percent resumed oral intake. The majority of patients had their GTs removed and resumed a soft or regular diet. Dilation failure was associated with laryngeal, pharyngeal, and excessively long esophageal stenosis, often resulting from radionecrosis. Complications were minor. CARD should be considered before relegating patients with complete esophageal stenosis to chronic GT dependence or subjecting them to laryngopharyngo esophagectomy.
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Affiliation(s)
- Laura A Goguen
- Department of Surgery/Division of Otolaryngology, Brigham and Women's Hospital and Dana Farber Cancer Institute, Boston, Massachusetts 02115, USA.
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Hirshoren N, Eliashar R. Wound-healing modulation in upper airway stenosis-Myths and facts. Head Neck 2009; 31:111-26. [DOI: 10.1002/hed.20925] [Citation(s) in RCA: 67] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Silverman JB, Deschler DG. A novel approach for dilation of neopharyngeal stricture following total laryngectomy using the tracheoesophageal puncture site. Laryngoscope 2008; 118:2011-3. [PMID: 18758385 DOI: 10.1097/mlg.0b013e31817fd3dd] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Affiliation(s)
- Joshua B Silverman
- Department of Otology and Laryngology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts 02114, USA
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Daher P, Riachy E, Georges B, Georges D, Adib M. Topical application of mitomycin C in the treatment of esophageal and tracheobronchial stricture: a report of 2 cases. J Pediatr Surg 2007; 42:E9-11. [PMID: 17848232 DOI: 10.1016/j.jpedsurg.2007.06.007] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
We present 2 cases of successful treatment of recurrent anastomotic strictures using a topical application of mitomycin C. In the first case, a 4-year-old boy had a cervical cyst excised, which appeared to be an ectopic gastric mucosa. He consequently presented severe stenosis at the origin of the cervical esophagus that needed repeated balloon dilatations. The second case is about a 12-year-old girl who presented a traumatic complete rupture of the right mainstem bronchus managed by primary repair, with subsequent anastomotic stricture. Both patients were successfully managed with topical application of mitomycin C (1 mg/mL), and needed no more dilatations.
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Affiliation(s)
- Paul Daher
- Department of Pediatric Surgery, Hotel Dieu de France Hospital, Beirut, Lebanon.
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13
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Chang AC, Orringer MB. Management of the cervical esophagogastric anastomotic stricture. Semin Thorac Cardiovasc Surg 2007; 19:66-71. [PMID: 17403460 DOI: 10.1053/j.semtcvs.2006.11.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/01/2006] [Indexed: 12/28/2022]
Abstract
Esophagogastric anastomotic stricture following esophagectomy with a gastric esophageal substitute can be a vexing problem for the patient and treating physician. We describe the clinical practice at a single center with extensive experience in esophageal surgery for management of this complication.
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Affiliation(s)
- Andrew C Chang
- Section of Thoracic Surgery, University of Michigan Medical Center, Ann Arbor, MI 48109, USA.
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14
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Rosseneu S, Afzal N, Yerushalmi B, Ibarguen-Secchia E, Lewindon P, Cameron D, Mahler T, Schwagten K, Köhler H, Lindley KJ, Thomson M. Topical application of mitomycin-C in oesophageal strictures. J Pediatr Gastroenterol Nutr 2007; 44:336-41. [PMID: 17325554 DOI: 10.1097/mpg.0b013e31802c6e45] [Citation(s) in RCA: 80] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
BACKGROUND Benign oesophageal strictures may occur as a complication of caustic ingestion or severe gastro-oesophageal reflux or as a sequela of oesophageal surgery and other fibrosing conditions. The traditional initial treatment of oesophageal strictures is intraluminal dilation; however, even if frequent, this occasionally may not provide adequate oesophageal lumen capacity or give significant symptom-free intervals, and restricturing after dilation is difficult and challenging. Topical postdilation application of an antifibrotic agent, mitomycin-C, in the treatment of an oesophageal stricture has been described. PATIENTS AND METHODS Eight centres participated, with a total of 16 patients (4 girls), median age 48 (range 0-276) months. The causes of stricture were as follows: caustic (10), post-trachea-oesophageal fistula repair (2), peptic (2), Crohn disease (1), and dystrophic epidermolysis bullosa (1). The median (range) length and diameter of the strictures were as follows: 22 mm (8-50 mm) and 1.5 mm (1-6 mm). Of the 16 patients, 15 had undergone repeated dilations varying from 3 to more than 1000 (daily self-bouginage) before mitomycin-C, and the median interval between dilations was 4 weeks. Mitomycin-C 0.1 mg/mL was applied after dilation for a median time of 3.5 minutes and a median of 3 (1-12) times. RESULTS Major success, both endoscopic and clinical improvement or cure, occurred in 10 of 16 patients. In 3 of 16 patients the interval period between dilations increased dramatically. Failure of therapy was considered in 3 of 16. All of the patients remained symptom free for a follow-up time of as long as 5 years. CONCLUSIONS Postdilation application of topical mitomycin-C resulted in major success in 62.5% of patients and partial success in 19%, and it may be a useful strategy in oesophageal strictures of differing causes that are refractory to repeated perendoscopic dilation.
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15
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Smith LP, Roy S. Treatment strategy for iatrogenic nasal vestibular stenosis in young children. Int J Pediatr Otorhinolaryngol 2006; 70:1369-73. [PMID: 16564097 DOI: 10.1016/j.ijporl.2006.01.015] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2006] [Accepted: 01/30/2006] [Indexed: 11/30/2022]
Abstract
Iatrogenic nasal vestibular stenosis is an uncommon complication of supportive care in neonates. There is minimal literature describing this entity; previous treatment strategies focus on correction with local flaps or skin grafts. We describe symptomatic iatrogenic vestibular stenosis treated successfully with endoscopic lysis of synechiae and nasal stenting. Three children with nasal stenosis were identified from 2003 to 2004 at a large academic tertiary care medical center. All patients were born premature (25-34 weeks). Two developed vestibular stenosis after extended use of nasal CPAP; one developed unilateral nasal stenosis 4 years after use of a nasal feeding tube. Age at time of surgical repair was from 4 months to 5 years. Two patients (4 and 5 months) presented with nasal airway obstruction, and difficulty breathing during feeding. One patient (5 years) presented with right-sided nasal obstruction and nasal whistling. Endoscopic lysis of nasal synechiae and release of vestibular scarring was performed in all three cases without complication. Nasal stenting with a modified endotracheal tube was used for 4-6 weeks. Topical Mitomycin C was utilized in two patients. All patients had complete resolution of airway symptoms after stent removal and all three remain asymptomatic 1 year after repair with no recurrence of vestibular stenosis. Nasal vestibular stenosis is a rare complication following supportive care in premature infants, causing airway and feeding difficulties in the obligate nasal breather. This can be successfully corrected with endoscopic repair, nasal stenting and application of Mitomycin C.
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Affiliation(s)
- Lee P Smith
- University of Miami--Miller School of Medicine, Department of Otolaryngology Head and Neck Surgery, FL 33136, USA
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Van Haverbeke C, Lawson G, Remacle M. Re-use of pectoralis major myocutaneous flap for the treatment of recurrent hypopharyngeal stenosis following total laryngectomy and postoperative radiotherapy: a case report. Eur Arch Otorhinolaryngol 2006; 263:661-3. [PMID: 16691417 DOI: 10.1007/s00405-006-0044-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2005] [Accepted: 01/09/2006] [Indexed: 12/01/2022]
Abstract
Management of recurrent hypopharyngeal stenosis following total laryngectomy and postoperative radiotherapy is a challenging problem. Because of previous surgery, free flaps may not always be performed. We report a case of recurrent hypopharyngeal stenosis after a first attempt of reconstruction with a pectoralis major myocutaneous pedicled flap (PMMPF) failed. The problem was solved by reusing the previous PMMPF as a rotary door flap according to Eliachar and suturing it to the prevertrebral fascia according to Spriano. The follow-up is now of 9 months without recurrence. This new technique is described and discussed in comparison with other possible options.
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Affiliation(s)
- Christophe Van Haverbeke
- Department of Otorhinolaryngology and Head and Neck Surgery, University UCL Hospital of Mont-Godinne, Avenue Therasse 1, 5530, Yvoir, Belgium
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17
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Olutoye OO, Shulman RJ, Cotton RT. Mitomycin C in the management of pediatric caustic esophageal strictures: a case report. J Pediatr Surg 2006; 41:e1-3. [PMID: 16677867 DOI: 10.1016/j.jpedsurg.2005.12.051] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Although the incidence of caustic ingestion is declining, the management of caustic esophageal strictures remains a challenge. Mitomycin C (MMC) inhibits fibroblast proliferation and is effective in reducing scar in animal experiments. We report the case of a child with a distal esophageal stricture from lye ingestion managed with MMC. Despite repeated dilatations, at 1 year post injury, the stricture was 20% of esophageal diameter. Mitomycin C (4 microg/mL) was applied topically and circumferentially by endoscopy and repeated 4 months later. At 20 months follow-up, the child eats normally, and esophagram showed decreased stenosis (stricture was 50% of esophageal diameter). No complications were observed. Although controlled trials are required to confirm its efficacy, MMC should be considered as an adjunct in the management of caustic esophageal strictures in children.
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Affiliation(s)
- Oluyinka O Olutoye
- Pediatric Surgery Division, Michael E. DeBakey Department of Surgery, Texas Children's Hospital, Baylor College of Medicine, Houston, TX 77030-2399, USA.
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Gillespie MB, Day TA, Sharma AK, Brodsky MB, Martin-Harris B. Role of mitomycin in upper digestive tract stricture. Head Neck 2006; 29:12-7. [PMID: 17022087 DOI: 10.1002/hed.20476] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Mitomycin C is an anti-fibroblast chemotherapeutic agent that has demonstrated promise in the treatment of head and neck cancer-related cervical stenosis. The present study investigates whether the application of mitomycin C at the time of dilation is both safe and effective in the treatment of head and neck cancer-related upper digestive tract stricture. METHODS Twelve patients with progressive dysphagia and video-fluoroscopic evidence of upper digestive tract stricture after head and neck cancer treatment were dilated by Maloney or Savory dilators followed by the application of mitomycin C (0.2 mg/0.4 mL saline) to the stenotic segment for 5 minutes. Outcome measures included complication rate, improvement in baseline dietary consistency, and improvement in swallowing-related quality of life as measured by the M. D. Anderson Dysphagia Inventory. RESULTS All patients experienced improvement in their baseline dietary consistency (p = .002) and M. D. Anderson Dysphagia Inventory composite score (p = .001) after a mean follow-up time of 19 months. No complications from mitomycin use were observed. CONCLUSION Mitomycin application appears to be a safe and potentially effective treatment for head and neck cancer-related upper digestive tract stricture. Given the small sample size and limited follow-up time, a randomized, controlled trial is needed to determine whether mitomycin application offers additional benefit over standard dilation therapy.
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Affiliation(s)
- M Boyd Gillespie
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA.
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Phillips PS, Amonoo-Kuofi K, Hore IDB, Atherton DJ, Albert DM. Successful treatment of laryngeal stenosis in laryngo-onycho-cutaneous syndrome with topical mitomycin C. Pediatr Dermatol 2006; 23:75-7. [PMID: 16445419 DOI: 10.1111/j.1525-1470.2006.00176.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Laryngo-onycho-cutaneous syndrome is a very rare entity found in Punjabi families. It affects the skin, nails, and larynx. Laryngeal involvement may cause lethal airway obstruction, and has in the past proved very difficult to treat. Mitomycin C is an antibiotic that acts as an alkylating agent, inhibiting DNA synthesis. It reduces fibroblast proliferation, and has previously been used to treat choanal atresia and laryngeal stenosis. We report an 18-year-old man with complete transglottic laryngeal stenosis secondary to laryngo-onycho-cutaneous syndrome. An airway was established by dissection with a bougie and sickle knife, and was initially maintained by the upper limb of a Montgomery T-tube. Laryngeal granulation tissue present on removal of the T-tube was treated with topical mitomycin C (2 mg/mL) applied for 4 minutes on two occasions with an interval of 1 month. A year later, the airway remained patent, with no granulation tissue.
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Affiliation(s)
- P Seamus Phillips
- Department of Pediatric ENT, Great Ormond Street Hospital for Children, London, United Kingdom.
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Sullivan CA, Jaklitsch MT, Haddad R, Goguen LA, Gagne A, Wirth LJ, Posner MR, Tishler RB, Norris CM. Endoscopic management of hypopharyngeal stenosis after organ sparing therapy for head and neck cancer. Laryngoscope 2005; 114:1924-31. [PMID: 15510015 DOI: 10.1097/01.mlg.0000147921.74110.ee] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
OBJECTIVES The objective of this study was to describe and evaluate the efficacy of an endoscopic technique for the management of postchemoradiation hypopharyngeal stenosis in head and neck cancer patients. STUDY DESIGN Retrospective review. METHODS Patients with postchemoradiation hypopharyngeal stenoses were identified from the Dana Farber Cancer Institute head and neck database. Patients who had undergone extirpative surgery and reconstruction were excluded. All patients underwent either anterograde dilatation (AD) by the lead author (C.A.S.) or transgastric retrograde esophagoscopy with anterograde dilatation (TREAD) (C.A.S., M.T.J.). Chemoradiation records, clinic notes, operative reports, and swallowing test data were reviewed. Removal of the gastric feeding tube was considered the endpoint of rehabilitation. RESULTS Seventeen patients had postcricoid stenoses identified by modified barium swallow. Endoscopy confirmed 15 postcricoid stenoses and 2 proximal esophageal stenoses. Nine (53%) patients had partial stenoses, and eight (47%) had complete stenoses. Eight partial stenosis patients underwent 10 AD procedures and 3 TREAD procedures. Eight complete stenosis patients underwent 9 TREAD procedures and 26 subsequent AD procedures. Fifteen of 16 (93%) patients resumed swallowing after dilatation. Thirteen (81%) patients maintained their weight on an oral diet and had their gastric feeding tubes removed. Complications included hypopharyngeal perforation (13%), abdominal wall infection (6%), stomach wall dehiscence (6%), and chondroradionecrosis of the cricoid cartilage (6%). CONCLUSIONS Postcricoid hypopharyngeal stenosis may be partial or complete after organ sparing chemoradiation for head and neck cancer. Using the TREAD technique, successful rehabilitation of swallowing can be achieved with a low incidence of complications.
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Affiliation(s)
- Christopher A Sullivan
- Division of Otolaryngology, Head and Neck Surgery, Brigham and Women's Hospital, Dana Farber Cancer Institute, Boston, Massachusetts 02115, USA.
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