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Kao DD, Fuu-Kou Y, Wang CS, Lehenbauer D, Zak S, Benscoter D, Morales DL, de Alarcon A, Rutter MJ. Characteristics and Outcomes of Surgical Treatment for Bronchial Anomalies. Laryngoscope 2023; 133:3334-3340. [PMID: 37159210 DOI: 10.1002/lary.30737] [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: 10/24/2022] [Revised: 04/10/2023] [Accepted: 04/28/2023] [Indexed: 05/10/2023]
Abstract
OBJECTIVES Bronchial anomalies are rare but challenging conditions to treat in children, encompassing a variety of structural abnormalities that could compromise airway patency. This includes complete rings, absent cartilage, traumatic avulsions, bronchoesophageal fistulas, and cartilaginous sleeves. The objective of this study is to describe the characteristics and outcomes of a series of pediatric cases of bronchial anomalies that were treated by slide tracheobronchoplasty. METHODS This is a single-institution retrospective case series of pediatric patients with bronchial anomalies who underwent surgical treatment between February 2004 and April 2020. Data extracted from electronic medical records included patient demographics, comorbidities, and surgical outcomes. RESULTS There were a total of 29 patients included in the study, of which 14 had complete bronchial rings, 8 had absent bronchial rings, 4 had traumatic bronchial avulsions, 2 had bronchoesophageal fistulas, and one had a cartilaginous sleeve. Median follow-up time was 13 months (with a range of 0.5-213 months). The overall mortality rate was 17.2% (5 patients), all of whom had complete bronchial rings. Patients with complete bronchial rings also had a higher rate of not only cardiac (85.7%) and pulmonary comorbidities (85.7%) but also secondary airway lesions (78.6%). CONCLUSION This is the largest series to date describing surgical treatment for bronchial anomalies. Complete bronchial rings were the most common anomaly treated, followed by absent rings and trauma. Surgical treatment can be successful but mortality rates are higher in patients with complete bronchial rings, possibly due to higher rates of pulmonary and cardiac comorbidities. LEVEL OF EVIDENCE 4 Laryngoscope, 133:3334-3340, 2023.
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Affiliation(s)
- Derek D Kao
- Division of Pediatric Otolaryngology-Head and Neck Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
- Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Yann Fuu-Kou
- Department of Otolaryngology-Head and Neck Surgery, Division of Pediatric Otolaryngology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Cynthia S Wang
- Division of Pediatric Otolaryngology-Head and Neck Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
- Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - David Lehenbauer
- Division of Cardiothoracic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Sara Zak
- Division of Pulmonary Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Dan Benscoter
- Division of Pulmonary Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - David Ls Morales
- Division of Cardiothoracic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Alessandro de Alarcon
- Division of Pediatric Otolaryngology-Head and Neck Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
- Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Michael J Rutter
- Division of Pediatric Otolaryngology-Head and Neck Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
- Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
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Angeles C, Kille T, Hermsen JL, DeCamp MM, Anagnostopoulos PV. Congenital absence of tracheal rings: A video case report. JTCVS Tech 2023; 21:184-187. [PMID: 37854825 PMCID: PMC10580095 DOI: 10.1016/j.xjtc.2023.06.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Revised: 06/23/2023] [Accepted: 06/26/2023] [Indexed: 10/20/2023] Open
Affiliation(s)
- Clara Angeles
- Department of Surgery, University of Wisconsin, Madison, Wis
- Division of Cardiothoracic Surgery, University of Wisconsin, Madison, Wis
- Division of Cardiothoracic Surgery, Section of Pediatric Cardiothoracic Surgery, University of Wisconsin, Madison, Wis
| | - Tony Kille
- Department of Surgery, University of Wisconsin, Madison, Wis
- Division of Otolaryngology, Head, and Neck Surgery, Section of Pediatric Otolaryngology, University of Wisconsin, Madison, Wis
| | - Joshua L. Hermsen
- Department of Surgery, University of Wisconsin, Madison, Wis
- Division of Cardiothoracic Surgery, University of Wisconsin, Madison, Wis
- Division of Cardiothoracic Surgery, Section of Pediatric Cardiothoracic Surgery, University of Wisconsin, Madison, Wis
| | - Malcolm M. DeCamp
- Department of Surgery, University of Wisconsin, Madison, Wis
- Division of Cardiothoracic Surgery, University of Wisconsin, Madison, Wis
| | - Petros V. Anagnostopoulos
- Department of Surgery, University of Wisconsin, Madison, Wis
- Division of Cardiothoracic Surgery, University of Wisconsin, Madison, Wis
- Division of Cardiothoracic Surgery, Section of Pediatric Cardiothoracic Surgery, University of Wisconsin, Madison, Wis
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Tambucci R, Wautelet O, Haenecour A, François G, Goubau C, Scheers I, Halut M, Menten R, Schmitz S, de Toeuf C, Pirotte T, D'hondt B, Reding R, Poncelet A. Esophageal Trachea, a Unique Foregut Malformation Requiring Multistage Surgical Reconstruction: Case Report. Front Pediatr 2020; 8:605143. [PMID: 33330293 PMCID: PMC7714922 DOI: 10.3389/fped.2020.605143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Accepted: 10/26/2020] [Indexed: 11/13/2022] Open
Abstract
Abnormal connections between the esophagus and low respiratory tract can result from embryological defects in foregut development. Beyond well-known malformations, including tracheo-esophageal fistula and laryngo-tracheo-esophageal cleft, rarer anomalies have also been reported, including communicating bronchopulmonary foregut malformations and tracheal atresia. Herein, we describe a case of what we have called "esophageal trachea," which, to our knowledge, has yet to be reported. A full-term neonate was born in our institution presenting with a foregut malformation involving both the middle esophagus and the distal trachea, which were found to be longitudinally merged into a common segment, 3 cm in length, located just above the carina and consisted of esophageal tissue without cartilaginous rings. At birth, the esophagus and trachea were surgically separated via right thoracotomy, the common segment kept on the tracheal side only, creating a residual long-gap esophageal atresia. The resulting severe tracheomalacia was treated via simultaneous posterior splinting of such diseased segment using an autologous pericardium patch, as well as by anterior aortopexy. Terminal esophagostomy and gastrostomy were created at that stage due to the long distance between esophageal segments. Between ages 18 and 24 months, the patient underwent native esophageal reconstruction using a multistage traction-and-growth surgical strategy that combined Kimura extra-thoracic esophageal elongations at the upper esophagus and Foker external traction at the distal esophagus. Ten months after esophageal reconstruction, prolonged, refractory, and severe tracheomalacia was further treated via anterior external stenting using a semitubular ringed Gore-Tex® prosthesis, through simultaneous median sternotomy and tracheoscopy. Currently, 2 years after the last surgery, respiratory stabilization, and full oral feeding were stably achieved. Multidisciplinary management was crucial for assuring lifesaving procedures, correctly assessing anatomy, and planning for multiple sequential surgical approaches that aimed to restore long-term respiratory and digestive functions.
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Affiliation(s)
- Roberto Tambucci
- Pediatric Surgery and Transplantation Unit, Department of Surgery, Saint-Luc University Clinics, Brussels, Belgium
| | - Océane Wautelet
- Pediatric Surgery and Transplantation Unit, Department of Surgery, Saint-Luc University Clinics, Brussels, Belgium
| | - Astrid Haenecour
- Pediatric Intensive Care Unit, Emergency Department, Saint-Luc University Clinics, Brussels, Belgium
| | - Geneviève François
- General Pediatric Unit, Department of Pediatrics, Saint-Luc University Clinics, Brussels, Belgium
| | - Christophe Goubau
- Pediatric Pneumology Unit, Department of Pediatrics, Saint-Luc University Clinics, Brussels, Belgium
| | - Isabelle Scheers
- Pediatric Gastroenterology and Hepatology Unit, Department of Pediatrics, Saint-Luc University Clinics, Brussels, Belgium
| | - Marin Halut
- Pediatric Radiology Unit, Department of Radiology, Saint-Luc University Clinics, Brussels, Belgium
| | - Renaud Menten
- Pediatric Radiology Unit, Department of Radiology, Saint-Luc University Clinics, Brussels, Belgium
| | - Sandra Schmitz
- Otolaryngology Unit, Department of Surgery, Saint-Luc University Clinics, Brussels, Belgium
| | - Caroline de Toeuf
- Otolaryngology Unit, Department of Surgery, Saint-Luc University Clinics, Brussels, Belgium
| | - Thierry Pirotte
- Pediatric Anesthesiology Unit, Emergency Department, Saint-Luc University Clinics, Brussels, Belgium
| | - Beelke D'hondt
- Pediatric Surgery and Transplantation Unit, Department of Surgery, Saint-Luc University Clinics, Brussels, Belgium
| | - Raymond Reding
- Pediatric Surgery and Transplantation Unit, Department of Surgery, Saint-Luc University Clinics, Brussels, Belgium
| | - Alain Poncelet
- Pediatric Cardiac and Thoracic Surgery Unit, Department of Surgery, Saint-Luc University Clinics, Brussels, Belgium
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