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Feng M, Ahmed KH, Punjabi N, Inman JC. A Contemporary Review of Trachea, Nose, and Ear Cartilage Bioengineering and Additive Manufacturing. Biomimetics (Basel) 2024; 9:327. [PMID: 38921207 PMCID: PMC11202182 DOI: 10.3390/biomimetics9060327] [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: 04/17/2024] [Revised: 05/18/2024] [Accepted: 05/28/2024] [Indexed: 06/27/2024] Open
Abstract
The complex structure, chemical composition, and biomechanical properties of craniofacial cartilaginous structures make them challenging to reconstruct. Autologous grafts have limited tissue availability and can cause significant donor-site morbidity, homologous grafts often require immunosuppression, and alloplastic grafts may have high rates of infection or displacement. Furthermore, all these grafting techniques require a high level of surgical skill to ensure that the reconstruction matches the original structure. Current research indicates that additive manufacturing shows promise in overcoming these limitations. Autologous stem cells have been developed into cartilage when exposed to the appropriate growth factors and culture conditions, such as mechanical stress and oxygen deprivation. Additive manufacturing allows for increased precision when engineering scaffolds for stem cell cultures. Fine control over the porosity and structure of a material ensures adequate cell adhesion and fit between the graft and the defect. Several recent tissue engineering studies have focused on the trachea, nose, and ear, as these structures are often damaged by congenital conditions, trauma, and malignancy. This article reviews the limitations of current reconstructive techniques and the new developments in additive manufacturing for tracheal, nasal, and auricular cartilages.
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Affiliation(s)
- Max Feng
- Department of Otolaryngology–Head and Neck Surgery, Loma Linda University Medical Center, Loma Linda, CA 92354, USA
| | - Khwaja Hamzah Ahmed
- Department of Otolaryngology–Head and Neck Surgery, Loma Linda University Medical Center, Loma Linda, CA 92354, USA
| | - Nihal Punjabi
- Department of Otolaryngology–Head and Neck Surgery, Loma Linda University Medical Center, Loma Linda, CA 92354, USA
- School of Medicine, Case Western Reserve University, Cleveland, OH 44116, USA
| | - Jared C. Inman
- Department of Otolaryngology–Head and Neck Surgery, Loma Linda University Medical Center, Loma Linda, CA 92354, USA
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Kim TH, Heo SY, Oh GW, Park WS, Jung WK. Biocompatibility and sub-chronic toxicity studies of phlorotannin/polycaprolactone coated trachea tube for advancing medical device applications. Sci Rep 2024; 14:3945. [PMID: 38365854 PMCID: PMC10873353 DOI: 10.1038/s41598-024-54684-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Accepted: 02/15/2024] [Indexed: 02/18/2024] Open
Abstract
The phlorotannin-polycaprolactone-coated endotracheal tube (PP tube) has been developed with the aim of preventing tracheal stenosis that can result from endotracheal intubation, a factor that can lead to a serious airway obstruction. Its preventive efficacy has been assessed through both in vitro and in vivo investigations. However, there is a lack of studies concerning its biocompatibility and sub-chronic toxicity in animal models, a crucial factor to ensure the safety of its usage as a functional endotracheal tube. Thus, this study aimed to evaluate the biocompatibility and sub-chronic (13 weeks) toxicity of the PP tube through L929 cell line and diverse in vivo models. The cytotoxicity testing was performed using the extracts of PP tube on L929 cells for 72 h. Furthermore, other tests conducted on animal models, including ICR mice (acute systemic toxicity), New Zealand white rabbit (intradermal reactivity and pyrogen tests), guinea pig (maximization sensitization), and Sprague Dawley rats (sub-chronic toxicity). In both biocompatibility and sub-chronic toxicity analyses, no significant adverse effects are observed in the groups exposed to the PP tube, when compared to control group. Altogether, the findings suggested that the PP tube exhibits relative non-toxic and safety, supporting its suitability for clinical usage. However, extended periods of intubation may produce mild irritant responses, highlighting the clinical caution of limiting intubation duration to less than 13 weeks.
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Affiliation(s)
- Tae-Hee Kim
- Research Center for Marine-Integrated Bionics Technology, Pukyong National University, Busan, 48513, Republic of Korea
- Marine Integrated Biomedical Technology Center, The National Key Research Institutes in Universities, Pukyong National University, Busan, 48513, Republic of Korea
| | - Seong-Yeong Heo
- Jeju Bio Research Center, Korea Institute of Ocean Science and Technology (KIOST), Jeju, 63349, Republic of Korea
| | - Gun-Woo Oh
- National Marine Biodiversity Institute of Korea, Seochun, Chungcheongnam-do, 33662, Republic of Korea
| | - Won Sun Park
- Department of Physiology, Kangwon National University School of Medicine, Chuncheon, 24341, Republic of Korea
| | - Won-Kyo Jung
- Research Center for Marine-Integrated Bionics Technology, Pukyong National University, Busan, 48513, Republic of Korea.
- Marine Integrated Biomedical Technology Center, The National Key Research Institutes in Universities, Pukyong National University, Busan, 48513, Republic of Korea.
- Major of Biomedical Engineering, Division of Smart Healthcare, College of Information Technology and Convergence and New-Senior Healthcare Innovation Center (BK21 Plus), Busan, 48513, Republic of Korea.
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Messina G, Di Filippo V, Capasso F, Puca MA, Leonardi B, Grande M, Rainone A, Leone F, Vicario G, De Gregorio S, Cerullo G, Ponticiello A, Pirozzi M, Farese S, Zotta A, Natale G, Messina G, Vicidomini G, Fiorelli A, Ciardiello F, Fasano M. Modified blade: an interventional option in rigid bronchoscopy for non-resectable benign tracheal stenosis. J Cardiothorac Surg 2024; 19:73. [PMID: 38331792 PMCID: PMC10851474 DOI: 10.1186/s13019-024-02576-3] [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: 06/13/2023] [Accepted: 01/30/2024] [Indexed: 02/10/2024] Open
Abstract
INTRODUCTION Benign tracheobronchial stenosis is a abnormal tracheal lumen narrowing that may incur progressive dyspnea and life-threatening hypoxemia. There is no consensus on which patients should be treated with endoscopic or surgical method. This study investigates the outcomes of bronchoscopic dilatation in the treatment of benign tracheal stenosis using a device equipped with a blade to cut the stenotic lesions with dense fibrosis. MATERIALS AND METHODS The procedure was carried out in an operating room under general anesthesia. All patients were intubated with a Rigid Bronchoscope (RB) placed just above the stenosis. Through Rigid Bronchoscopy combined modalities were used as needed: radial incisions of the mucosal stenosis with blade at the levels of 4, 8 and 12 o'clock, with back and forth movements, then the stenotic area was dilated more easily with a rigid bronchoscope. Dilatation was performed by passing the RB of increasing diameter through stenotic areas and then Balloon dilatation of increasing diameter. There were no complications during the procedure. RESULT We conducted an observational, retrospective, single-centre study in the Thoracic Surgery Unit of the University of 'Luigi Vanvitelli' of Naples from November 2011 to September 2021. We included all consecutive patients with benign tracheal stenosis inoperable. During the study period, 113 patients were referred to our department with benign tracheal stenosis inoperable. 61 patients were treated with the blade. During the follow-up, a recurrence of the stenosis was observed in 8 patients in the first month and in 4 patients in the third month. Instead in the patients treated with the use of laser (52 patients), during the follow-up a recurrence was observed in 16 patients in the first month and in 6 patients in the third month; no patient relapsed after 6 months and after 1 year. Long term successful bronchoscopic management with blade was attained by 99% in simple and 93% in mixed stenosis and in complex type stenosis. CONCLUSION Our study underlines the importance of the use of the blade in bronchoscopic treatment as a valid conservative approach in the management of patients with inoperable benign tracheal stenosis as an alternative to the use of the laser, reducing the abnormal inflammatory reaction in order to limit recurrences.
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Affiliation(s)
- Gaetana Messina
- Thoracic Surgery Unit, Università Degli Studi Della Campania "Luigi Vanvitelli", Via Pansini 5, 80131, Naples, Campania, Italy.
| | - Vincenzo Di Filippo
- Thoracic Surgery Unit, Università Degli Studi Della Campania "Luigi Vanvitelli", Via Pansini 5, 80131, Naples, Campania, Italy
| | - Francesca Capasso
- Thoracic Surgery Unit, Università Degli Studi Della Campania "Luigi Vanvitelli", Via Pansini 5, 80131, Naples, Campania, Italy
| | - Maria Antonietta Puca
- Thoracic Surgery Unit, Università Degli Studi Della Campania "Luigi Vanvitelli", Via Pansini 5, 80131, Naples, Campania, Italy
- Highly Specialized Medical-Surgical Department, Università Degli Studi Della Campania "Luigi Vanvitelli", Naples, Campania, Italy
- Oncology, Department of Precision Medicine, Università Della Campania "L. Vanvitelli", Naples, Campania, Italy
- Nutrition Science, University of Foggia, Foggia, Italy
- Pneumology Unit, Hospital of Caserta, Caserta, Italy
| | - Beatrice Leonardi
- Thoracic Surgery Unit, Università Degli Studi Della Campania "Luigi Vanvitelli", Via Pansini 5, 80131, Naples, Campania, Italy
| | - Mario Grande
- Thoracic Surgery Unit, Università Degli Studi Della Campania "Luigi Vanvitelli", Via Pansini 5, 80131, Naples, Campania, Italy
| | - Anna Rainone
- Thoracic Surgery Unit, Università Degli Studi Della Campania "Luigi Vanvitelli", Via Pansini 5, 80131, Naples, Campania, Italy
| | - Francesco Leone
- Thoracic Surgery Unit, Università Degli Studi Della Campania "Luigi Vanvitelli", Via Pansini 5, 80131, Naples, Campania, Italy
| | - Giuseppe Vicario
- Thoracic Surgery Unit, Università Degli Studi Della Campania "Luigi Vanvitelli", Via Pansini 5, 80131, Naples, Campania, Italy
| | - Simona De Gregorio
- Highly Specialized Medical-Surgical Department, Università Degli Studi Della Campania "Luigi Vanvitelli", Naples, Campania, Italy
| | - Giuseppe Cerullo
- Highly Specialized Medical-Surgical Department, Università Degli Studi Della Campania "Luigi Vanvitelli", Naples, Campania, Italy
| | | | - Mario Pirozzi
- Oncology, Department of Precision Medicine, Università Della Campania "L. Vanvitelli", Naples, Campania, Italy
| | - Stefano Farese
- Oncology, Department of Precision Medicine, Università Della Campania "L. Vanvitelli", Naples, Campania, Italy
| | - Alessia Zotta
- Oncology, Department of Precision Medicine, Università Della Campania "L. Vanvitelli", Naples, Campania, Italy
| | - Giovanni Natale
- Thoracic Surgery Unit, Università Degli Studi Della Campania "Luigi Vanvitelli", Via Pansini 5, 80131, Naples, Campania, Italy
| | | | - Giovanni Vicidomini
- Thoracic Surgery Unit, Università Degli Studi Della Campania "Luigi Vanvitelli", Via Pansini 5, 80131, Naples, Campania, Italy
| | - Alfonso Fiorelli
- Thoracic Surgery Unit, Università Degli Studi Della Campania "Luigi Vanvitelli", Via Pansini 5, 80131, Naples, Campania, Italy
| | - Fortunato Ciardiello
- Oncology, Department of Precision Medicine, Università Della Campania "L. Vanvitelli", Naples, Campania, Italy
| | - Morena Fasano
- Oncology, Department of Precision Medicine, Università Della Campania "L. Vanvitelli", Naples, Campania, Italy
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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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Singh E, Hullfish H, Fils A, Ma R, Rosow D. Predictors of Clinical Outcomes in Adult Laryngotracheal Stenosis. Laryngoscope 2024; 134:257-263. [PMID: 37497850 DOI: 10.1002/lary.30908] [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: 02/24/2023] [Revised: 05/27/2023] [Accepted: 06/23/2023] [Indexed: 07/28/2023]
Abstract
OBJECTIVES Sequelae of laryngotracheal stenosis (LTS) can be devastating, often necessitating tracheostomy. This study aims to describe the characteristics and outcomes of patients with LTS and identify risk factors for long-term tracheostomy dependence stratified by etiology. METHODS A retrospective chart review was performed on 215 patients diagnosed with LTS from 09/01/2011 to 12/31/2020. Patients were grouped based on the cause of LTS. Patient factors were compared to evaluate risk factors for long-term tracheostomy dependence. RESULTS Of the 215 patients, 129 (60%) were classified as iatrogenic, 41 (19%) idiopathic, 10 (4.7%) cancer treatment, 18 (8.3%) autoimmune, and 17 (8%) patients unknown. Idiopathic patients were significantly less likely to be tracheostomy-dependent compared with iatrogenic patients (p < 0.001) and cancer patients (p < 0.05). The mortality rate did not significantly differ among the categories (p = 0.1078). Significant improvement was seen after treatment, as the median percent of stenosis at presentation was 52.5%, and the median percent of stenosis at the most recent visit was 10% (p < 0.001). The autoimmune group received the most steroid injections (mean = 6.56; SD = 11.96). The idiopathic group had the longest surgery-free interval (mean = 30.8 months; SD = 27.7). CONCLUSION Iatrogenic and cancer patients were more likely to be tracheostomy-dependent. There was a significant improvement in percent and length of stenosis after treatment, with the idiopathic group having the longest surgery-free interval. Mortality risk did not differ among the different etiologies of LTS. LEVEL OF EVIDENCE 3 Laryngoscope, 134:257-263, 2024.
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Affiliation(s)
- Eshita Singh
- Department of Otolaryngology, University of Miami Miller School of Medicine, Miami, Florida, U.S.A
| | - Haley Hullfish
- Department of Otolaryngology, University of Miami Miller School of Medicine, Miami, Florida, U.S.A
| | - Aaron Fils
- Department of Otolaryngology, University of Miami Miller School of Medicine, Miami, Florida, U.S.A
| | - Ruixuan Ma
- Division of Biostatistics, Department of Public Health Sciences, Biostatistics Collaboration and Consulting Core, University of Miami Miller School of Medicine, Miami, Florida, U.S.A
| | - David Rosow
- Department of Otolaryngology, University of Miami Miller School of Medicine, Miami, Florida, U.S.A
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Feng YG, Tao SL, Mei LY, Dai FQ, Tan QY, Wang RW, Zhou JH, Deng B. Surgical treatment of severe benign tracheal stenosis. J Cardiothorac Surg 2023; 18:293. [PMID: 37833733 PMCID: PMC10576339 DOI: 10.1186/s13019-023-02369-0] [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: 03/25/2023] [Accepted: 09/26/2023] [Indexed: 10/15/2023] Open
Abstract
OBJECTIVE To present clinical experiences regarding surgical treatment of patients with severe cicatricial tracheal stenosis. PATIENTS AND METHODS From January 2008 to March 2020, 14 patients underwent tracheal resection and reconstruction under general anesthesia. Nine cases had cervical tracheal stenosis and five cases had thoracic tracheal stenosis. The mean diameter and length of strictured trachea was 0 - 8 mm with a mean of 4.5 ± 2.4 mm and 1 - 3 cm with a mean of 1.67 ± 0.63 cm, respectively. General anesthesia and mechanical ventilation were performed in ten cases and four patients underwent femoral arteriovenous bypass surgery due to severe stenosis. End-to-end anastomosis of trachea was performed in 13 cases and the anastomosis between trachea and cricothyroid membrane was performed in one case. Absorbable and unabsorbable sutures were used for the anterior and posterior anastomoses, respectively. Postoperative neck anteflexion was maintained by a suture between the chin and superior chest wall. The relevant data of the 14 patients were retrospectively reviewed, and the operation time, blood loss, postoperative hospital stay, postoperative complications and follow-up were retrieved. RESULTS There was no intraoperative death. The length of resected trachea ranged from 1.5 to 4.5 cm with a mean of 1.67 ± 0.63 cm. Operation time ranged from 50 - 450 min with a mean of 142.8 ± 96.6 min and intraoperative hemorrhage ranged from 10 - 300 ml with a mean of 87.8 ± 83.6 ml. Follow-up period ranged from 5 to 43 months with a mean of 17.9 ± 10.6 months. None of the patients had recurrent laryngeal nerve paralysis during postoperative follow-up. Ten cases were discharged uneventfully. Anastomosis stenosis occurred in three cases who received interventional therapies. Bronchopleurocutaneous fistula occurred in one patient after 6 days postoperatively and further treatment was declined. CONCLUSION The strategies of anesthesia, mechanical ventilation, identification of stenosis lesion, the "hybrid" sutures and postoperative anteflexion are critical to be optimized for successful postoperative recovery.
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Affiliation(s)
- Yong-Geng Feng
- Thoracic Surgery Department, Institute of Surgery Research, Daping Hospital, Army Medical University, Changjiang Branch St, 10#, Yuzhong District, Chongqing city, 400042, China
| | - Shao-Lin Tao
- Thoracic Surgery Department, Institute of Surgery Research, Daping Hospital, Army Medical University, Changjiang Branch St, 10#, Yuzhong District, Chongqing city, 400042, China
| | - Long-Yong Mei
- Thoracic Surgery Department, Institute of Surgery Research, Daping Hospital, Army Medical University, Changjiang Branch St, 10#, Yuzhong District, Chongqing city, 400042, China
| | - Fu-Qiang Dai
- Thoracic Surgery Department, Institute of Surgery Research, Daping Hospital, Army Medical University, Changjiang Branch St, 10#, Yuzhong District, Chongqing city, 400042, China
| | - Qun-You Tan
- Thoracic Surgery Department, Institute of Surgery Research, Daping Hospital, Army Medical University, Changjiang Branch St, 10#, Yuzhong District, Chongqing city, 400042, China
| | - Ru-Wen Wang
- Thoracic Surgery Department, Institute of Surgery Research, Daping Hospital, Army Medical University, Changjiang Branch St, 10#, Yuzhong District, Chongqing city, 400042, China
| | - Jing-Hai Zhou
- Thoracic Surgery Department, Institute of Surgery Research, Daping Hospital, Army Medical University, Changjiang Branch St, 10#, Yuzhong District, Chongqing city, 400042, China.
| | - Bo Deng
- Thoracic Surgery Department, Institute of Surgery Research, Daping Hospital, Army Medical University, Changjiang Branch St, 10#, Yuzhong District, Chongqing city, 400042, China.
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Patel R, Dhanda AK, Georges K, Cohen DA, Patel P, Eloy JA. Length of Stay in Patients Undergoing Tracheoplasty: A NSQIP Study. Laryngoscope 2022. [PMID: 36214517 DOI: 10.1002/lary.30424] [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: 04/18/2022] [Revised: 08/21/2022] [Accepted: 09/15/2022] [Indexed: 11/08/2022]
Abstract
BACKGROUND Prolonged length of stay (LOS) has been associated with increased morbidity and resource utilization in various surgical procedures. We aim to determine factors associated with increased hospital stay in patient undergoing tracheoplasty. METHODS The 2012-2018 National Surgical Quality Improvement Program (NSQIP) database was queried for patients undergoing tracheoplasty. Patient LOS was the primary clinical outcome. A LOS >75th percentile was considered as prolonged and was utilized for bivariate analysis of demographic, comorbidity, and operative characteristics. LOS was utilized as a continuous variable for multivariate linear regression analysis. RESULTS A total of 252 patients were queried. The majority of patients were female (67.5%), white (82.4%), and over the age of 65 (77.0%). Patients had a median LOS of 7 days with the 75th percentile cutoff being defined at 10 days. On bivariate analysis of associated comorbidities, patients with prolonged LOS were more commonly obese (72.4% vs. 53.1%, p = 0.009), diabetic (37.9% vs. 16.5%, p < 0.001), dyspneic (58.6% vs. 40.7%, p = 0.016), and had chronic steroid use (25.9% vs. 12.9%, p = 0.018). Multivariable logistic regression analysis demonstrated significant associations between prolonged LOS and both chronic obstructive pulmonary disorder (COPD) (OR: 3.43, p = 0.020) and chronic steroid use (OR: 3.81, p = 0.018). CONCLUSIONS This study elucidates factors associated with prolonged LOS in patients undergoing tracheoplasty. Patients with COPD and chronic steroid use were significantly associated with prolonged LOS. LEVEL OF EVIDENCE 4 Laryngoscope, 2022.
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Affiliation(s)
- Rushi Patel
- Department of Otolaryngology - Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Aatin K Dhanda
- Department of Otolaryngology - Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Kirolos Georges
- Department of Otolaryngology - Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - David A Cohen
- Department of Otolaryngology - Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Prayag Patel
- Department of Otolaryngology - Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Jean Anderson Eloy
- Department of Otolaryngology - Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA.,Center for Skull Base and Pituitary Surgery, Neurological Institute of New Jersey, Rutgers New Jersey Medical School, Newark, New Jersey, USA.,Department of Neurological Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA.,Department of Ophthalmology and Visual Science, Rutgers New Jersey Medical School, Newark, New Jersey, USA.,Department of Otolaryngology and Facial Plastic Surgery, Cooperman Barnabas Medical Center - RWJ Barnabas Health, Livingston, New Jersey, USA
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Onorati I, Bonnet N, Radu DM, Freynet O, Guiraudet P, Kambouchner M, Uzunhan Y, Zogheib E, Martinod E. Case Report: Laryngotracheal Post-Intubation/Tracheostomy Stenosis in COVID-19 Patients. Front Surg 2022; 9:874077. [PMID: 35548193 PMCID: PMC9082634 DOI: 10.3389/fsurg.2022.874077] [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: 02/11/2022] [Accepted: 03/15/2022] [Indexed: 11/23/2022] Open
Abstract
Introduction The novel Coronavirus disease 2019 (COVID-19), which is caused by severe acute respiratory syndrome coronavirus 2 (SARSCoV-2), has spread rapidly to become a major global public health emergency since March 2020. Laryngotracheal stenosis (LTS) has been observed more frequently since the onset of the COVID-19 pandemic. Methods All patients referred to our 24/7 Airway Diseases Center for laryngotracheal post-intubation/tracheostomy stenosis from May 2020 to May 2021were evaluated retrospectively. Patient data on comorbidities, diagnosis, type of procedures, lengths of ICU stay and invasive mechanical ventilation, medical treatment, and the severity of illness were recorded. Results This case series included nine patients (five women and four men), with a mean age of 52.9 years, most with a BMI >30, all with a severe illness revealed by the Simplified Acute Physiology Score (SAPS) II >31. From May 2020 to May 2021, 21 procedures were performed on seven patients, consisting of bronchoscopic rigid interventions, T-tube Montgomery tracheostomy, and one cricotracheal resection with end-to-end anastomosis. Histologic examination of tracheal biopsies showed an inflammatory state of the airway mucosa. Two patients only had medical therapy. Discussion and Conclusions Pneumonia caused by SARSCoV-2 can lead to severe acute respiratory distress syndrome (ARDS) requiring invasive mechanical ventilation. The time of intubation, the drugs used, the prone position, comorbidities (diabetes, obesity), and the inflammatory state of the upper airways linked to the viral infection, predispose to an increased tendency to stenosis and its recurrence. A conservative approach with medical and endoscopic treatment should be preferred in case of persistence of local airways inflammation. Further studies with a larger sample of patients will help to a better understanding of the disease, reduce the prevalence, and improve its treatment.
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Affiliation(s)
- Ilaria Onorati
- Department of Thoracic and Vascular Surgery, Assistance Publique-Hôpitaux de Paris, UFR de Santé Médecine Biologie Humaine, Université Sorbonne Paris Nord, Bobigny, France
- *Correspondence: Ilaria Onorati
| | - Nicolas Bonnet
- Department of Intensive Care Medicine, Assistance Publique Hôpitaux de Paris, UFR de Santé Médecine Biologie Humaine, Université Sorbonne Paris Nord, Bobigny, France
| | - Dana Mihaela Radu
- Department of Thoracic and Vascular Surgery, Assistance Publique-Hôpitaux de Paris, UFR de Santé Médecine Biologie Humaine, Université Sorbonne Paris Nord, Bobigny, France
| | - Olivia Freynet
- Department of Pulmonology, Assistance Publique Hôpitaux de Paris, UFR de Santé Médecine Biologie Humaine, Université Sorbonne Paris Nord, Bobigny, France
| | - Patrice Guiraudet
- Department of Thoracic and Vascular Surgery, Assistance Publique-Hôpitaux de Paris, UFR de Santé Médecine Biologie Humaine, Université Sorbonne Paris Nord, Bobigny, France
| | | | - Yurdagul Uzunhan
- Department of Pulmonology, Assistance Publique Hôpitaux de Paris, UFR de Santé Médecine Biologie Humaine, Université Sorbonne Paris Nord, Bobigny, France
| | - Elie Zogheib
- Department of Anesthesiology, Assistance Publique Hôpitaux de Paris, UFR de Santé Médecine Biologie Humaine, Université Sorbonne Paris Nord, Bobigny, France
| | - Emmanuel Martinod
- Department of Thoracic and Vascular Surgery, Assistance Publique-Hôpitaux de Paris, UFR de Santé Médecine Biologie Humaine, Université Sorbonne Paris Nord, Bobigny, France
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Aydogmus U, Kis A, Ugurlu E, Ozturk G. Superior Strategy in Benign Tracheal Stenosis Treatment: Surgery or Endoscopy? Thorac Cardiovasc Surg 2020; 69:756-763. [PMID: 32886930 DOI: 10.1055/s-0040-1715435] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Due to the variations in (laryngeal) tracheal stenosis (TS) patient groups, there is still no consensus on which patient should be treated with endoscopy or surgery. The aim of the present study was to generate an algorithm in the light of the related literature and the data obtained from a clinic where both endoscopic and surgical treatments are conducted. METHOD A retrospective analysis was performed on the data of a total of 56 patients during 2013 to 2019. A total of 38 patients were subject to surgery with 31 as a first treatment option and 7 due to the unsatisfactory results of endoscopic treatments. Endoscopic approaches were tried on a total of 29 patients with 25 as initial treatment and 4 due to postsurgical recurrence. RESULTS Symptomatic full control ratio was determined as 69% with endoscopic treatments, 89.5% in subglottic stenosis (SGS) surgery (n = 19), and 89.5% in trachea surgery (n = 19). However, success rates with no recurrence were determined, respectively, as 40.0, 36.4, and 36.4% for patients subject to dilatation, stent, or T tube treatment. Dilatation was observed to be successful in patients with stenotic segment lengths of less than 1.5 cm (p = 0.02). Failure rates increased in SGS (p = 0.03) and TS (p = 0.12) in the surgical group with increasing stenotic segment length. The presence of comorbidities was not effective on treatment success. CONCLUSION Endoscopic methods are preferred in cases of web-like stenosis. Surgical methods should first be considered for other patients and endoscopic methods should be used on patients who are not suited for surgery or in cases of postsurgical recurrence.
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Affiliation(s)
- Umit Aydogmus
- Department of Thoracic Surgery, Pamukkale University, Denizli, Turkey
| | - Argun Kis
- Department of Thoracic Surgery, Pamukkale University, Denizli, Turkey
| | - Erhan Ugurlu
- Department of Chest Disease, Pamukkale University, Denizli, Turkey
| | - Gokhan Ozturk
- Department of Thoracic Surgery, Pamukkale University, Denizli, Turkey
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10
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Lee HS, Jeong M, Ko S, Heo S, Kang HW, Kim SW, Hwang CW, Lee KD, Oak C, Jung MJ, Oh J, Park WS, Choi I, Jung W. Fabrication and biological activity of polycaprolactone/phlorotannin endotracheal tube to prevent tracheal stenosis: An in vitro and in vivo study. J Biomed Mater Res B Appl Biomater 2019; 108:1046-1056. [DOI: 10.1002/jbm.b.34456] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2019] [Revised: 06/30/2019] [Accepted: 07/17/2019] [Indexed: 11/09/2022]
Affiliation(s)
- Hyoung Shin Lee
- Department of Otolaryngology‐Head and Neck SurgeryKosin University College of Medicine Busan Republic of Korea
- Marine‐Integrated Bionics Research CenterPukyong National University Busan Republic of Korea
| | - Min‐Seon Jeong
- Marine‐Integrated Bionics Research CenterPukyong National University Busan Republic of Korea
- Department of Biomedical Engineering and Center for Marine‐Integrated Biomedical TechnologyPukyong National University Busan Republic of Korea
| | - Seok‐Chun Ko
- National Marine Bio‐Resources and Information CenterNational Marine Biodiversity Institute of Korea Seochun Chungcheongnam‐do Republic of Korea
| | - Seong‐Yeong Heo
- Marine‐Integrated Bionics Research CenterPukyong National University Busan Republic of Korea
- Department of Biomedical Engineering and Center for Marine‐Integrated Biomedical TechnologyPukyong National University Busan Republic of Korea
| | - Hyun Wook Kang
- Marine‐Integrated Bionics Research CenterPukyong National University Busan Republic of Korea
- Department of Biomedical Engineering and Center for Marine‐Integrated Biomedical TechnologyPukyong National University Busan Republic of Korea
| | - Sung Won Kim
- Department of Otolaryngology‐Head and Neck SurgeryKosin University College of Medicine Busan Republic of Korea
- Marine‐Integrated Bionics Research CenterPukyong National University Busan Republic of Korea
| | - Chi Woo Hwang
- Department of Molecular BiologyKosin University College of Medicine Busan Republic of Korea
| | - Kang Dae Lee
- Department of Otolaryngology‐Head and Neck SurgeryKosin University College of Medicine Busan Republic of Korea
- Marine‐Integrated Bionics Research CenterPukyong National University Busan Republic of Korea
| | - Chulho Oak
- Department of Internal MedicineKosin University College of Medicine Busan Republic of Korea
| | - Min Jung Jung
- Department of PathologyKosin University College of Medicine Busan Republic of Korea
| | - Junghwan Oh
- Department of Otolaryngology‐Head and Neck SurgeryKosin University College of Medicine Busan Republic of Korea
- Marine‐Integrated Bionics Research CenterPukyong National University Busan Republic of Korea
| | - Won Sun Park
- Department of PhysiologyKangwon National University, School of Medicine Chuncheon Gangwon Republic of Korea
| | - Il‐Whan Choi
- Department of MicrobiologyInje University College of Medicine Busan Republic of Korea
| | - Won‐Kyo Jung
- Marine‐Integrated Bionics Research CenterPukyong National University Busan Republic of Korea
- Department of Biomedical Engineering and Center for Marine‐Integrated Biomedical TechnologyPukyong National University Busan Republic of Korea
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11
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Luffy SA, Wu J, Kumta PN, Gilbert TW. Evaluation of magnesium alloys for use as an intraluminal tracheal for pediatric applications in a rat tracheal bypass model. J Biomed Mater Res B Appl Biomater 2018; 107:1844-1853. [DOI: 10.1002/jbm.b.34277] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Revised: 10/12/2018] [Accepted: 10/17/2018] [Indexed: 01/26/2023]
Affiliation(s)
- Sarah A. Luffy
- Department of Bioengineering University of Pittsburgh Pittsburgh Pennsylvania 15261
- McGowan Institute of Regenerative Medicine University of Pittsburgh Pittsburgh Pennsylvania 15261
| | - Jingyao Wu
- Department of Bioengineering University of Pittsburgh Pittsburgh Pennsylvania 15261
- McGowan Institute of Regenerative Medicine University of Pittsburgh Pittsburgh Pennsylvania 15261
| | - Prashant N. Kumta
- Department of Bioengineering University of Pittsburgh Pittsburgh Pennsylvania 15261
- McGowan Institute of Regenerative Medicine University of Pittsburgh Pittsburgh Pennsylvania 15261
- Department of Mechanical Engineering and Materials Science University of Pittsburgh Pittsburgh Pennsylvania 15261
- Department of Chemical and Petroleum Engineering University of Pittsburgh Pittsburgh Pennsylvania 15261
- Department of Oral Biology, School of Dental Medicine University of Pitsburgh Pennsylvania 15261
| | - Thomas W. Gilbert
- Department of Bioengineering University of Pittsburgh Pittsburgh Pennsylvania 15261
- McGowan Institute of Regenerative Medicine University of Pittsburgh Pittsburgh Pennsylvania 15261
- Department of Cardiothoracic Surgery Children's Hospital of Pittsburgh of UPMC Pittsburgh Pennsylvania
- ACell, Inc. Columbia MD 21046
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12
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Bi Y, Yu Z, Ren J, Han X, Wu G. Metallic stent insertion and removal for post-tracheotomy and post-intubation tracheal stenosis. Radiol Med 2018; 124:191-198. [PMID: 30357596 DOI: 10.1007/s11547-018-0953-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Accepted: 10/18/2018] [Indexed: 12/19/2022]
Abstract
PURPOSE To study the safety and effectiveness of fluoroscopic insertion and removal of self-expandable metallic airway stent for post-tracheotomy tracheal stenosis (PTTS) and post-intubation tracheal stenosis (PITS). METHODS We conducted a retrospective analysis of 32 patients who underwent fluoroscopic stenting from September 2011 to March 2017. The patients ranged in age from 12 to 69 years. Thirty-eight airway stents were implanted, 35 covered stents and three bare stents. Nineteen airway stents were used for 16 cases of PITS or PTTS. All patients underwent chest CT scans with/without bronchoscopy prior to stent removal. The indication of stent removal and post-interventional complications were analyzed. RESULTS All 38 airway stents were successfully inserted. Insufficient expansion and tissue hyperplasia were most common complications after stenting. Thirty five of 38 airway stents were successfully removed fluoroscopically, with a technical success rate of 92.1%. Routine removal was performed after 2.9 ± 0.3 months, and stent restenosis was found after a mean duration of 2.7 ± 0.3 months. There were six complications of stent removal with no death. Four stents showed strut fracture after removal, of which three stent pieces retained. Two patients showed dyspnea immediately after removal and required mechanical ventilation in PTTS. One patient with PTTS lost of follow-up during a mean period of 33.7 ± 3.9 months. The one-, three- and five-year patency rates were 87.1%, 76.2% and 70.8%, respectively. There was no significant difference between PITS and PTTS. CONCLUSIONS Fluoroscopic insertion and removal of airway stent is safe and effective for PITS and PTTS. A three-month retention time is reasonable for airway stents.
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Affiliation(s)
- Yonghua Bi
- Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University, No.1, East Jian She Road, Zhengzhou, 450052, China
| | - Zepeng Yu
- Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University, No.1, East Jian She Road, Zhengzhou, 450052, China
| | - Jianzhuang Ren
- Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University, No.1, East Jian She Road, Zhengzhou, 450052, China
| | - Xinwei Han
- Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University, No.1, East Jian She Road, Zhengzhou, 450052, China.
| | - Gang Wu
- Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University, No.1, East Jian She Road, Zhengzhou, 450052, China.
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Micucci S, Keschner DB, Liang J. Eustachian Tube Balloon Dilation: Emerging Practice Patterns for a Novel Procedure. Ann Otol Rhinol Laryngol 2018; 127:848-855. [PMID: 30227726 DOI: 10.1177/0003489418798858] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES To review the role of eustachian tube balloon dilation (ETBD) in the setting of chronic Eustachian tube dysfunction (ETD) and ascertain how ETBD is currently being used in practice today. METHODS An online survey included 20 questions designed by 3 investigators to examine how otolaryngologists utilize ETBD in the management of ETD. The survey was distributed to the members of the American Rhinologic Society (ARS), American Otological Society (AOS), and American Neurotology Society (ANS) in their respective annual electronic mailings in April and May of 2017. RESULTS A total of 1105 and 633 surveys were sent to ARS and AOS/ANS members, respectively. Of those, 157 surveys were returned (126 from ARS and 31 from AOS/ANS). Of those returning the survey, 72 (50%) had not performed ETBD and were excluded from subsequent analysis. Forty-four (66%) respondents consider ETBD after failure of medical management; conversely, 18 (27%) and 26 (39%) consider ETBD after failure of 1 or more trial of myringotomy tube placement. Routine testing for ETBD includes audiogram with tympanometry 64 (96%) and preoperative computer tomography (CT) 38 (57%). Fifty-three (80%) practitioners only perform ETBD in adults 18 years and older. Thirty-four (53%) respondents describe ETBD as "great" or "good," while 27 (42%) were unsure, and only 3 (5%) did not like ETBD. CONCLUSIONS Eustachian tube balloon dilation is a novel technique for the treatment of chronic ETD, and its role continues to evolve and develop. Current practice patterns demonstrate wide variability in the assessment of ETD, heterogeneity in the timing of ETBD, and controversy in preoperative CT screening.
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Affiliation(s)
- Steven Micucci
- 1 Kaiser Permanente Oakland Medical Center, Oakland, Caliornia, USA
| | | | - Jonathan Liang
- 1 Kaiser Permanente Oakland Medical Center, Oakland, Caliornia, USA
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14
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Lin EL, Bock JM, Zdanski CJ, Kimbell JS, Garcia GJM. Relationship between degree of obstruction and airflow limitation in subglottic stenosis. Laryngoscope 2017; 128:1551-1557. [PMID: 29171660 DOI: 10.1002/lary.27006] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2017] [Revised: 10/06/2017] [Accepted: 10/13/2017] [Indexed: 11/06/2022]
Abstract
OBJECTIVES Subglottic stenosis (SGS) is one of the most common airway disorders in pediatric patients. Currently, treatment decisions rely primarily on the Cotton-Myer scale, which classifies SGS severity based on percentage reduction in airspace cross-sectional area (CSA). However, the precise relationship between upper airway resistance and subglottic CSA is unknown. We hypothesize that airway resistance can be described by the Bernoulli Obstruction Theory, which predicts that airway resistance is inversely proportional to airspace CSA ( R∝A-1) in cases of severe constriction. METHODS Computed tomography (CT) scans of six healthy subjects and five SGS patients were used to create three-dimensional models of the respiratory tract from nostrils to carina. Cylindrical segments of varying lengths and varying diameters were digitally inserted in the subglottis of the healthy subjects to create simulated SGS models. Computational fluid dynamics simulations were run, and airway resistance was computed in the simulated SGS models and actual SGS models. RESULTS Constriction diameter had a greater impact in airway resistance than constriction length. In agreement with the Bernoulli Obstruction Theory, airway resistance in the simulated SGS models was well represented by the power law R=aAb, where a is a constant and the exponent b ranged from -0.85 to -1.07. The percentage reduction in airflow (QOBSTRUCTIONQHEALTHY) at a constant pressure drop was found to be directly proportional to the percentage reduction in CSA (AOBSTRUCTIONAHEALTHY) in the limit of severe constrictions, namely QOBSTRUCTIONQHEALTHY=kAOBSTRUCTIONAHEALTHY, where k=2.25 ± 0.15. Airway resistances in the simulated SGS models were similar to resistances in models based on CT scans of actual SGS patients, suggesting that our simulated SGS models were representative of airway resistance in actual SGS patients. CONCLUSION Our computer simulations suggest that the degree of airflow limitation in SGS patients may be estimated based on anatomic measurements alone. Future studies are recommended to test these predictions in larger cohorts. LEVEL OF EVIDENCE 4. Laryngoscope, 128:1551-1557, 2018.
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Affiliation(s)
- Emily L Lin
- Department of Biomedical Engineering, Marquette University & The Medical College of Wisconsin, Milwaukee, Wisconsin, U.S.A.,Department of Otolaryngology and Communication Sciences, Medical College of Wisconsin, Milwaukee, Wisconsin, U.S.A
| | - Jonathan M Bock
- Department of Otolaryngology and Communication Sciences, Medical College of Wisconsin, Milwaukee, Wisconsin, U.S.A
| | - Carlton J Zdanski
- Department of Otolaryngology-Head and Neck Surgery, University of North Carolina School of Medicine, Chapel Hill, North Carolina, U.S.A
| | - Julia S Kimbell
- Department of Otolaryngology-Head and Neck Surgery, University of North Carolina School of Medicine, Chapel Hill, North Carolina, U.S.A
| | - Guilherme J M Garcia
- Department of Biomedical Engineering, Marquette University & The Medical College of Wisconsin, Milwaukee, Wisconsin, U.S.A.,Department of Otolaryngology and Communication Sciences, Medical College of Wisconsin, Milwaukee, Wisconsin, U.S.A
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16
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Lee HS, Kim SW, Oak C, Kang HW, Oh J, Jung MJ, Kim SB, Won JH, Lee KD. Rabbit model of tracheal stenosis using cylindrical diffuser. Lasers Surg Med 2016; 49:372-379. [DOI: 10.1002/lsm.22615] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/03/2016] [Indexed: 02/03/2023]
Affiliation(s)
- Hyoung Shin Lee
- Department of Otolaryngology-Head and Neck Surgery; Kosin University College of Medicine; Busan Korea
- Innovative Biomedical Technology Research Center; College of Medicine; Kosin University; Busan Korea
| | - Sung Won Kim
- Department of Otolaryngology-Head and Neck Surgery; Kosin University College of Medicine; Busan Korea
- Innovative Biomedical Technology Research Center; College of Medicine; Kosin University; Busan Korea
| | - Chulho Oak
- Innovative Biomedical Technology Research Center; College of Medicine; Kosin University; Busan Korea
- Department of Internal Medicine; Kosin University College of Medicine; Busan Korea
| | - Hyun Wook Kang
- Innovative Biomedical Technology Research Center; College of Medicine; Kosin University; Busan Korea
- Department of Biomedical Engineering and Center for Marine-Integrated Biomedical Technology; Pukyong National University; Busan South Korea
| | - Junghwan Oh
- Innovative Biomedical Technology Research Center; College of Medicine; Kosin University; Busan Korea
- Department of Biomedical Engineering and Center for Marine-Integrated Biomedical Technology; Pukyong National University; Busan South Korea
| | - Min Jung Jung
- Department of Pathology; Kosin University College of Medicine; Busan Korea
| | - Sung Bin Kim
- Kosin University College of Medicine; Busan Korea
| | - Jun Hee Won
- Department of Pharmacology; Kosin University Graduate School; Busan Korea
| | - Kang Dae Lee
- Department of Otolaryngology-Head and Neck Surgery; Kosin University College of Medicine; Busan Korea
- Innovative Biomedical Technology Research Center; College of Medicine; Kosin University; Busan Korea
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Ozkul Y, Songu M, Ozturkcan S, Imre A, Erdogan N, Ates D, Ozkul Z. Is T-tube treatment effective in Meyer-Cotton grade 3 tracheal stenosis: long-term outcomes. Acta Otolaryngol 2016; 136:933-6. [PMID: 27092981 DOI: 10.3109/00016489.2016.1170877] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVES To present retrospective experience in Meyer-Cotton grade 3 tracheal stenosis of 17 patients treated by T-tube, considering the characteristics of the treated stenosis, surgical procedures performed, and post-operative outcomes and complications. METHODS All demographic and clinical data were collected retrospectively. Chest and neck computed tomography scans were performed to assess the stenosis, including length, location, and glottic involvement. The stenotic area was evaluated endoscopically according to an adapted Meyer and Cotton grading scale. RESULTS The aetiology of the tracheal stenosis was intubation-related in all cases. The duration of intubation ranged between 1 hour to 40 days. According to the Myers-Cotton classification, all patients were at stage 3. Mean length of the stenosis was 26.58 ± 12.02 (range =15-70) mm. Mean follow-up for the study group was 60.16 ± 34.10 (range =18-137) months. Two patients died during follow-up, one due to stroke, one due to chronic lymphocytic leukemia; no deaths were attributable to TS. The remaining 15 patients could be evaluated up to the present time. Post-operative decannulation was achieved in three of 15 patients (20%), and decannulation was not achieved in 12 of 15 patients (80%). CONCLUSION T-tube is not an effective treatment of tracheal stenosis.
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Affiliation(s)
- Yilmaz Ozkul
- a Department of Otorhinolaryngology , Izmir Katip Celebi University, Ataturk Training and Research Hospital , Izmir , Turkey
| | - Murat Songu
- a Department of Otorhinolaryngology , Izmir Katip Celebi University, Ataturk Training and Research Hospital , Izmir , Turkey
| | - Sedat Ozturkcan
- a Department of Otorhinolaryngology , Izmir Katip Celebi University, Ataturk Training and Research Hospital , Izmir , Turkey
| | - Abdulkadir Imre
- a Department of Otorhinolaryngology , Izmir Katip Celebi University, Ataturk Training and Research Hospital , Izmir , Turkey
| | - Nezahat Erdogan
- b Department of Radiology , Izmir Katip Celebi University, Ataturk Training and Research Hospital , Izmir , Turkey
| | - Duzgun Ates
- a Department of Otorhinolaryngology , Izmir Katip Celebi University, Ataturk Training and Research Hospital , Izmir , Turkey
| | - Zelal Ozkul
- c Department of Anaesthesia and Reanimation , Izmir Katip Celebi University, Ataturk Training and Research Hospital , Izmir , Turkey
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Jung YR, Taek Jeong J, Kyu Lee M, Kim SH, Joong Yong S, Jeong Lee S, Lee WY. Recurred Post-intubation Tracheal Stenosis Treated with Bronchoscopic Cryotherapy. Intern Med 2016; 55:3331-3335. [PMID: 27853078 PMCID: PMC5173503 DOI: 10.2169/internalmedicine.55.6421] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Post-intubation tracheal stenosis accounts for the greatest proportion of whole-cause tracheal stenosis. Treatment of post-intubation tracheal stenosis requires a multidisciplinary approach. Surgery or an endoscopic procedure can be used, depending on the type of stenosis. However, the efficacy of cryotherapy in post-intubation tracheal stenosis has not been validated. Here, we report a case of recurring post-intubation tracheal stenosis successfully treated with bronchoscopic cryotherapy that had previously been treated with surgery. In this case, cryotherapy was effective in treating web-like fibrous stenosis, without requiring more surgery. Cryotherapy can be considered as an alternative or primary treatment for post-intubation tracheal stenosis.
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Affiliation(s)
- Ye-Ryung Jung
- Department of Internal Medicine, Yonsei University, Wonju College of Medicine, Korea
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20
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Ozkul Y, Songu M, Imre A, Ates D, Arslanoglu S, Pinar E, Onal K. CO₂ laser treatment of tracheal stenosis. Acta Otolaryngol 2015; 135:1160-2. [PMID: 26137899 DOI: 10.3109/00016489.2015.1063687] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
CONCLUSION Delivery of a carbon dioxide laser is an effective method and can be used in selected cases of tracheal stenosis. OBJECTIVES To present retrospective experience in tracheal stenosis of 16 patients treated by bronchoscopic delivery of carbon dioxide laser, considering the characteristics of the treated stenosis, surgical procedures performed, and post-operative outcomes and complications. METHODS All demographic and clinical data were collected retrospectively. Chest and neck computed tomography scans were performed to assess the stenosis, including length, location, and glottic involvement. The stenotic area was evaluated endoscopically according to an adapted Meyer and Cotton grading scale. RESULTS The aetiology of the tracheal stenosis was intubation-related in 14 cases, and idiopathic in two cases. The duration of intubation ranged between 1 hour to 26 days. According to the Myers-Cotton classification, mean stage of stenosis for the study group was 3.3 ± 0.5. Mean length of the stenosis was 23.75 ± 6.95 (range = 15-40) mm. Mean follow-up for the study group was 23.81 ± 7.11 (range = 12-38) months. Postoperative decannulation was achieved in 13 patients (81.3%), and decannulation was not achieved in three patients (18.7%).
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Affiliation(s)
- Yilmaz Ozkul
- a Department of Otorhinolaryngology, Izmir Katip Celebi University, Ataturk Training and Research Hospital , Izmir, Turkey
| | - Murat Songu
- a Department of Otorhinolaryngology, Izmir Katip Celebi University, Ataturk Training and Research Hospital , Izmir, Turkey
| | - Abdulkadir Imre
- a Department of Otorhinolaryngology, Izmir Katip Celebi University, Ataturk Training and Research Hospital , Izmir, Turkey
| | - Duzgun Ates
- a Department of Otorhinolaryngology, Izmir Katip Celebi University, Ataturk Training and Research Hospital , Izmir, Turkey
| | - Secil Arslanoglu
- a Department of Otorhinolaryngology, Izmir Katip Celebi University, Ataturk Training and Research Hospital , Izmir, Turkey
| | - Ercan Pinar
- a Department of Otorhinolaryngology, Izmir Katip Celebi University, Ataturk Training and Research Hospital , Izmir, Turkey
| | - Kazim Onal
- a Department of Otorhinolaryngology, Izmir Katip Celebi University, Ataturk Training and Research Hospital , Izmir, Turkey
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Ahmad FI, O'Dell K, Peck JJ, Wax MK, Milczuk HA. Pediatric airway reconstruction with a prefabricated auricular cartilage and radial forearm free flap. Laryngoscope 2015; 125:1979-82. [PMID: 25645935 DOI: 10.1002/lary.25128] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2014] [Revised: 11/25/2014] [Accepted: 12/11/2014] [Indexed: 11/11/2022]
Abstract
Prefabricated composite free flaps for complex airway reconstruction have been described for an adult series at our institution. We extended this approach to a pediatric patient with lifelong subglottic stenosis who had failed previous open airway reconstructions. A staged procedure was utilized in which a composite graft was created using conchal cartilages and a radial forearm free flap. This reconstruction improved the patency of her airway and decreased her dependency on intermittent airway dilations. Airway reconstruction with prefabricated conchal cartilage composite free flaps may be used as a salvage procedure for complex pediatric airway reconstruction when other methods have failed.
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Affiliation(s)
- Faisal I Ahmad
- Department of Otolaryngology-Head & Neck Surgery, Oregon Health & Science University, Portland, Oregon, U.S.A
| | - Karla O'Dell
- Department of Otolaryngology-Head & Neck Surgery, University of Southern California, Los Angeles, Los Angeles, California, U.S.A
| | - Jessica J Peck
- Department of Otolaryngology-Head & Neck Surgery, Dwight D. Eisenhower Army Medical Center, Fort Gordon, Georgia, U.S.A
| | - Mark K Wax
- Department of Otolaryngology-Head & Neck Surgery, Oregon Health & Science University, Portland, Oregon, U.S.A
| | - Henry A Milczuk
- Department of Otolaryngology-Head & Neck Surgery, Oregon Health & Science University, Portland, Oregon, U.S.A
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Ahn HY, Su Cho J, Kim YD, I H. Surgical outcomes of post intubational or post tracheostomy tracheal stenosis: report of 18 cases in single institution. Ann Thorac Cardiovasc Surg 2014; 21:14-7. [PMID: 24747550 DOI: 10.5761/atcs.oa.13-00335] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
PURPOSE Tracheal resection and end-to end anastomosis (TRE) is known as standard treatment of tracheal stenosis (TS) and there are various methods to keep ventilation during operation. We reviewed ventilation methods and postoperative outcomes in patients with postintubational (PI) or posttracheostomy (PT) TS. PATIENTS AND METHODS From May 2006 to May 2013, 18 patients with PI or PTTS underwent TRE in our hospital. All patients' records were retrospectively reviewed. RESULTS The mean duration of intubation and tracheostomy were 14.2 days (range: 2 to 27 days) and 114.9 days (range: 43 to 215 days). The location of stenosis was tube cuffs (n = 10), stoma (n = 6) and double stenosis involving cuff and stoma (n = 2). The mean diameter of stenotic lesion was 5.4 mm (range: 2 to 9 mm. ECMO (n = 4) was performed in critical stenosis. Of two cases with double stenosis, one underwent preoperative endotracheal balloon dilatation and the other underwent TRE with cricoplasty. The overall complication rate was 11.8%. The mean follow-up duration was 14.0 months (range: 0.9 to 56.3 months). CONCLUSION Comparing with the literatures, TS treated by TRE in our hospital has shown satisfactory outcomes. To maintain appropriate ventilation for critical stenosis, ECMO could be one of safe methods.
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Affiliation(s)
- Hyo Yeong Ahn
- Department of Thoracic and Cardiovascular Surgery, Pusan National University School of Medicine, Medical Research Institute, Busan, Korea
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Powers MA, Mudd P, Gralla J, McNair B, Kelley PE. Sedation-related outcomes in postoperative management of pediatric laryngotracheal reconstruction. Int J Pediatr Otorhinolaryngol 2013; 77:1567-74. [PMID: 23932833 DOI: 10.1016/j.ijporl.2013.07.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2013] [Revised: 07/10/2013] [Accepted: 07/16/2013] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Examine outcomes of varied postoperative sedation management in pediatric patients recovering from single stage laryngotracheal reconstruction. DESIGN Retrospective review of 34 patients treated with single stage laryngotracheal reconstruction from 2001 through 2011. SETTING Tertiary children's hospital. METHODS Patients were divided into 2 groups: those managed postoperatively with sedation, with or without paralysis (group 1), and those managed awake with narcotic pain medication as needed for primary management (group 2). Outcomes were measured as a function of sedation management. Outcomes investigated focused on those related to the success of the airway reconstruction, and those related to sedation management. RESULTS Out of 68 cases of laryngotracheal reconstruction reviewed from 2001 to 2011, 34 were single stage reconstructions. Nineteen patients were sedated postoperatively (group 1) and fifteen patients were left awake (group 2). There were no significant differences between groups in airway-related outcomes, including risk of accidental decannulation, revision rates, and need for secondary airway procedures such as balloon dilation. Sedation-related outcomes, specifically focusing on differences in medical management, showed significant increases in rates of withdrawal (p<0.0001), nursing concerns of withdrawal (p<0.0001) and sedation level (p<0.0001), pulmonary complications (OR 7.7, p=0.008), and prolonged hospital stay due to withdrawal (p=0.0005) in patients managed with sedation with or without paralysis. Multivariable regression analysis revealed that duration of sedation was the primary risk factor for increased postoperative morbidity, while younger age, lower weight, and use of a posterior graft were also significant variables assessed. CONCLUSION Avoiding sedation as the standard for postoperative management of single stage laryngotracheal reconstruction airway patients leads to an overall decreased risk of morbidity without increasing risk of airway-specific morbidity. This is specifically as related to withdrawal, pulmonary complications, concerns about sedation level and prolonged hospital course, all of which increase significantly with increased level and duration of sedation.
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Affiliation(s)
- Matthew A Powers
- University of Colorado School of Medicine, Department of Otolaryngology & Children's Hospital Colorado, 13120 E. 19th Avenue, Mail Stop C292, Aurora, CO 80045, United States
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Abstract
Tracheobronchial stenosis, narrowing of the airways by neoplastic or nonneoplastic processes, may be focal, as occurs with postintubation tracheal stenosis or a focal narrowing from a tumor, or more diffuse, such as those caused by inflammatory diseases. Symptoms develop when the narrowing impedes flow and increases resistance within the airways. Computed tomography defines the extent and severity of disease; endoscopy facilitates understanding of the cause so that an algorithm for treatment can be devised. Bronchoscopic interventions include balloons, ablative treatment, and stenting to provide symptomatic relief. Surgical resection may be curative and a multidisciplinary approach to tracheobronchial stenosis is required.
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Affiliation(s)
- Jonathan Puchalski
- Thoracic Interventional Program, Division of Pulmonary, Critical Care and Sleep Medicine, Yale University School of Medicine, Laboratory of Clinical Investigation (LCI), New Haven, CT 06510, USA.
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