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Alvarado-Sarzosa F, Peláez M, Russi H, Bayona JG, Cendales A, Rosselli D. Reconstrucción de estenosis traqueal benigna: experiencia de un hospital de alta complejidad en Colombia. REVISTA COLOMBIANA DE CIRUGÍA 2021. [DOI: 10.30944/20117582.967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Introducción. La causa más común de estenosis laringotraqueal benigna es iatrogénica, secundaria a intubación orotraqueal. El manejo quirúrgico sigue siendo la alternativa que ha mostrado mejores resultados a largo plazo. El objetivo de este estudio fue analizar la experiencia en el manejo quirúrgico de la estenosis laringotraqueal durante 15 años en un hospital de alta complejidad en Colombia.
Métodos. En este estudio se revisaron las historias clínicas de todos los pacientes tratados con reconstrucción de estenosis traqueal benigna, entre los años 2005 y 2020. Para el análisis estadístico se usaron métodos de estadística descriptiva, con análisis de frecuencias y medidas de tendencia central o de dispersión.
Resultados. Se identificaron 38 pacientes con estenosis laringotraqueal, con un grado variable de estenosis. La nasofibrolaringoscopia fue bien tolerada y segura para determinar el grado y la longitud de la estenosis. El uso de tomografía sirvió para determinar la extensión y las características anatómicas. Los resultados del presente estudio son similares a los de la literatura en cuanto a complicaciones, mortalidad y falla de la anastomosis. Las complicaciones más frecuentemente reportadas son reestenosis, infección del sitio operatorio, lesión nerviosa y fístula, que en general se presentan en un tercio de los pacientes.
Conclusiones. La experiencia de manejo quirúrgico de estenosis laringotraqueal en este hospital permite concluir que la reconstrucción traqueal es una opción segura en nuestro medio. Las tasas de éxito y de falla del tratamiento son equiparables a las reportadas en la literatura.
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Huang J, Zhang Z, Zhang T. Suture fixation of tracheal stents for the treatment of upper trachea stenosis: a retrospective study. J Cardiothorac Surg 2018; 13:111. [PMID: 30413207 PMCID: PMC6234787 DOI: 10.1186/s13019-018-0790-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2018] [Accepted: 09/25/2018] [Indexed: 11/28/2022] Open
Abstract
Background Stent migration is a common complication in treating trachea stenosis. There is no report concerning suture fixation of tracheal stent. The aim of this study was to investigate whether suture fixation of tracheal stent could avoid stent migration in patients with upper trachea stenosis. The complications were further investigated. Methods The patients with upper trachea stenosis who underwent tracheal stent placement for benign/malignant conditions in our hospital between May 2016 and April 2018 were retrospectively reviewed. Clinical data were collected for each patient, including age, gender, co-morbid diseases, site of tracheal obstruction, degree of tracheal obstruction, success of stent placement, impact on patient’s symptoms, complications, etc. Results Eleven patients (8 males and 3 females; range of age: 17–85, and average age of 63) were enrolled into this study. Six silicone stents and five membrane-covered metal stents were used. The surgery was successfully performed in all the cases. The postoperative recovery was uneventful. All symptoms of the patients were relieved. No complications occurred. The average follow-up for patients was 5 months (range of 1–13 months). During the follow-up, no stent migration was observed according to CT and bronchoscope. Conclusion The results suggested that suture fixation of stents could avoid stent migration in treating upper trachea stenosis with metal stent or silicone stent. This method seemed to be effective without operation complications.
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Affiliation(s)
- Jingtao Huang
- Department of Thoracic Surgery, Tianjin Nankai Hospital, No. 6 Changjiang Road, Nankai District, Tianjin, 300100, China.
| | - Zhongwei Zhang
- Department of Thoracic Surgery, Tianjin Nankai Hospital, No. 6 Changjiang Road, Nankai District, Tianjin, 300100, China
| | - Tao Zhang
- Department of Thoracic Surgery, Tianjin Nankai Hospital, No. 6 Changjiang Road, Nankai District, Tianjin, 300100, China
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Raman T, Chatterjee K, Alzghoul BN, Innabi AA, Tulunay O, Bartter T, Meena NK. A bronchoscopic approach to benign subglottic stenosis. SAGE Open Med Case Rep 2017; 5:2050313X17713151. [PMID: 28620493 PMCID: PMC5464515 DOI: 10.1177/2050313x17713151] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Accepted: 05/10/2017] [Indexed: 11/16/2022] Open
Abstract
Objectives: Subglottic stenosis is an abnormal narrowing of the tracheal lumen at the level of subglottis (the area in between the vocal cords and the cricoid cartilage). It can cause significant symptoms due to severe attenuation of airflow. We describe our experience in alleviating symptoms by addressing the stenosis using fibreoptic bronchoscopic methods. Methods: We report all concurrent cases performed between September 2015 and July 2016. We use a combination of balloon dilation, electro-surgery knife to dilate and incise stenotic segments followed by steroid injection to modulate healing. Results: We treated 10 patients in the study period, 8 of which were women. A total of 39 procedures were performed on these patients during this period. Gastro-esophageal reflux was the most common comorbidity associated with stenosis. The majority of the patients required more than 2 therapeutic procedures, but none required more than 4 procedures. There were no complications. Conclusion: Tracheal stenosis and in particular subglottic stenosis is a recurrent process and its management requires extensive collaboration amongst treating specialties. Our technique of steroid injection after dilation of the stenosis was effective in symptom control and decreased the number of repeat procedures.
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Affiliation(s)
- Tuhina Raman
- Division of Pulmonary and Critical Care Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Kshitij Chatterjee
- Residency Program, Department of Internal Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Bashar N Alzghoul
- Residency Program, Department of Internal Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Ayoub A Innabi
- Residency Program, Department of Internal Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Ozlem Tulunay
- Department of Otolaryngology, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Thaddeus Bartter
- Division of Pulmonary and Critical Care Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Nikhil K Meena
- Division of Pulmonary and Critical Care Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, USA
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Abstract
The trachea and bronchus surgery is generally performed due to stenosis, traumatic injury, foreign body and tumors. Preoperative evaluation and anesthesia management are very important issues because of higher mortality and morbidity rates. Patients may be asymptomatic, but airway difficulties, hypoxia, stridor, cough, hemoptysis are common conditions in these patient population. The collaboration between the surgeon and the anesthesiologist is very substantial and necessary. Anesthetic techniques include various applications such as one lung ventilation, fiberoptic intubation, jet ventilation, and apneic oxygenation, general anesthesia with or without neuromuscular blockade. In this review, anesthesia management of the trachea and bronchus surgery is evaluated in the light of new knowledge.
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Affiliation(s)
- Zehra Hatipoglu
- Department of Anesthesiology and Reanimation, Çukurova University Faculty of Medicine, Adana, Turkey
| | - Mediha Turktan
- Department of Anesthesiology and Reanimation, Çukurova University Faculty of Medicine, Adana, Turkey
| | - Alper Avci
- Department of Thoracic Surgery, Çukurova University Faculty of Medicine, Adana, Turkey
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Aydogmus U, Topkara A, Akbulut M, Ozkan A, Turk F, Sahin B, Yuncu G. Effectiveness of Palatal Mucosa Graft in Surgical Treatment of Sub-Glottic Stenosis. Clin Exp Otorhinolaryngol 2016; 9:358-365. [PMID: 27416739 PMCID: PMC5115148 DOI: 10.21053/ceo.2015.01508] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2015] [Revised: 12/08/2015] [Accepted: 01/12/2016] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVES Mucosal free grafts may be successfully applied in many surgical interventions. This study aims at investigating the feasibility of palatal mucosa graft in sub-glottic field in an animal model. METHODS This randomized prospective controlled study was conducted with an animal model. Sub-glottic inflammation was created in 15 adult rabbits in each group and sub-glottic stenosis surgery was applied thereafter. The rabbits in group 1 (control group) underwent segmental resection, partial cricoidectomy, and trachea-thyroid cartilage anastomosis; the rabbits in group 2 underwent segmental resection, cricoplasty, and crico-tracheal anastomosis using free buccal mucosa graft; and the rabbits in group 3 underwent segmental resection, cricoplasty, and crico-tracheal anastomosis using free palatal mucosa graft. Re-stenosis was evaluated after 42 days. RESULTS The percentages of stenosis were 27%±20%, 40%±20%, and 34%±23% for group 1, 2, and 3, respectively and the difference was not statistically significant (P=0.29). Intensive and tight fibrosis was observed in 2 rabbits (13%) in group 1, in 5 rabbits (33%) in group 2, and in 3 rabbits (20%) in group 3. There was not a statistically significant difference between groups (P=0.41). Excessive inflammation was observed in 3 rabbits (20%) in group 1, in 7 rabbits (47%) in group 2, and 3 rabbits (20%) in group 3. There was no a statistically significant difference between groups although inflammation rate was higher in the rabbits which underwent buccal mucosa graft (P=0.18). CONCLUSION The surgical treatments applied with free mucosa graft reduced anastomosis tension through enabling anastomosis to the distal of cricoid instead of thyroid cartilage. Free palatal mucosa grafts may be used in sub-glottic field, one of the most challenging fields of trachea surgery, due to ease of application and rapid vascularization.
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Affiliation(s)
- Umit Aydogmus
- Department of Thoracic Surgery, Reconstructive and Aesthetic Surgery, Medical Faculty of Pamukkale University, Denizli, Turkey
| | - Adem Topkara
- Department of Plastic, Reconstructive and Aesthetic Surgery, Medical Faculty of Pamukkale University, Denizli, Turkey
| | - Metin Akbulut
- Department of Pathology, Medical Faculty of Pamukkale University, Denizli, Turkey
| | - Adem Ozkan
- Department of Plastic, Reconstructive and Aesthetic Surgery, Medical Faculty of Pamukkale University, Denizli, Turkey
| | - Figen Turk
- Department of Thoracic Surgery, Reconstructive and Aesthetic Surgery, Medical Faculty of Pamukkale University, Denizli, Turkey
| | - Barbaros Sahin
- Department of Experimental Research Laboratory, Medical Faculty of Pamukkale University, Denizli, Turkey
| | - Gokhan Yuncu
- Department of Thoracic Surgery, Liv Hospital, Istanbul, Turkey
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Engineered cartilaginous tubes for tracheal tissue replacement via self-assembly and fusion of human mesenchymal stem cell constructs. Biomaterials 2015; 52:452-62. [PMID: 25818451 DOI: 10.1016/j.biomaterials.2015.01.073] [Citation(s) in RCA: 80] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2014] [Revised: 01/22/2015] [Accepted: 01/25/2015] [Indexed: 01/14/2023]
Abstract
There is a critical need to engineer a neotrachea because currently there are no long-term treatments for tracheal stenoses affecting large portions of the airway. In this work, a modular tracheal tissue replacement strategy was developed. High-cell density, scaffold-free human mesenchymal stem cell-derived cartilaginous rings and tubes were successfully generated through employment of custom designed culture wells and a ring-to-tube assembly system. Furthermore, incorporation of transforming growth factor-β1-delivering gelatin microspheres into the engineered tissues enhanced chondrogenesis with regard to tissue size and matrix production and distribution in the ring- and tube-shaped constructs, as well as luminal rigidity of the tubes. Importantly, all engineered tissues had similar or improved biomechanical properties compared to rat tracheas, which suggests they could be transplanted into a small animal model for airway defects. The modular, bottom up approach used to grow stem cell-based cartilaginous tubes in this report is a promising platform to engineer complex organs (e.g., trachea), with control over tissue size and geometry, and has the potential to be used to generate autologous tissue implants for human clinical applications.
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Hussain S, Manuel CT, Protsenko DE, Wong BJF. Electromechanical reshaping of ex vivo porcine trachea. Laryngoscope 2015; 125:1628-32. [PMID: 25692713 DOI: 10.1002/lary.25189] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2014] [Revised: 12/26/2014] [Accepted: 01/12/2015] [Indexed: 11/08/2022]
Abstract
OBJECTIVES The trachea is a composite cartilaginous structure particularly prone to various forms of convexities. Electromechanical reshaping (EMR) is an emerging technique used to reshape cartilaginous tissues by applying electric current in tandem with imposed mechanical deformation to achieve shape change. In this study, EMR was used to reshape tracheal cartilage rings to demonstrate the feasibility of this technology as a potentially minimally invasive procedure to alter tracheal structure. STUDY DESIGN Controlled laboratory study using ex vivo porcine tracheae. METHODS The natural concavity of each porcine tracheal ring was reversed around a cork mandrel. Two pairs of electrodes were inserted along the long axis of the tracheal ring and placed 1.5 millimeters from the midline. Current was applied over a range of voltages (3 volts [V], 4V, and 5V) for either 2 or 3 minutes. The degree of EMR-induced reshaping was quantified from photographs using digital techniques. Confocal imaging with fluorescent live and dead assays was conducted to determine viability of the tissue after EMR. RESULTS Specimens that underwent EMR for 2 or 3 minutes at 4V or 5V were observed to have undergone significant (P < .05) reshaping relative to the control. Viability results demonstrated that EMR reshaping occurs at the expense of tissue injury, although the extent of injury is modest relative to conventional techniques. CONCLUSION EMR reshapes tracheal cartilage rings as a function of voltage and application time. It has potential as a minimally invasive and cost-efficient endoscopic technology to treat pathologic tracheal convexities. Given our findings, consideration of EMR for use in larger ex vivo tracheal segments and animal studies is now plausible.
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Affiliation(s)
- Syed Hussain
- Beckman Laser Institute, University of California Irvine, Irvine, U.S.A
| | - Cyrus T Manuel
- Beckman Laser Institute, University of California Irvine, Irvine, U.S.A
| | | | - Brian J F Wong
- Beckman Laser Institute, University of California Irvine, Irvine, U.S.A.,Department of Biomedical Engineering, 3120 Natural Sciences II, University of California Irvine, Irvine, U.S.A.,Department of Otolaryngology, Head and Neck Surgery, University of California Irvine, Orange, California, U.S.A
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Prasanna Kumar S, Ravikumar A, Senthil K, Somu L, Nazrin MI. Role of Montgomery T-tube stent for laryngotracheal stenosis. Auris Nasus Larynx 2013; 41:195-200. [PMID: 24172854 DOI: 10.1016/j.anl.2013.10.008] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2013] [Revised: 09/27/2013] [Accepted: 10/04/2013] [Indexed: 12/20/2022]
Abstract
OBJECTIVE To identify the indications, complications and outcome of patients of LTS managed with Montgomery T-tube stenting and review the current literature about the role of stenting in LTS. METHODS Retrospective chart reviews of 39 patients of laryngotracheal stenosis managed by T-tube stenting for temporary or definitive treatment during the period 2004-2011 were considered. The data on indications for stenting, type of stent, problems/complications of stenting, duration of stenting, additional intervention and outcome of management were collected, tabulated and analyzed. RESULTS Of the 51 cases of laryngotracheal stenosis 39 patients were treated by Montgomery T-tube stenting. There was no mortality associated with the procedure or stenting. 82% of the patients were successfully decannulated. The problems and complications encountered were crusting within the tube in 44% and granulation at the subglottis in 33%. Two patients had complication due to T-tube itself: One patient developed tracheomalacia and the other had stenosis at both ends of the T-tube. CONCLUSION Stenting still has a role in management of inoperable or in some deadlock situations where resection anastomosis is not feasible. It is easier to introduce the stent and to maintain it. Complications are minor and can be managed easily. It is safe for long term use. We emphasize that the treating surgeon needs to use prudence while treating stenosis using stents.
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Affiliation(s)
- Saravanam Prasanna Kumar
- Department of E.N.T. Head & Neck Surgery, Sri Ramachandra Medical College & Research Institute, Porur, Chennai 600116, India.
| | - Arunachalam Ravikumar
- Department of E.N.T. Head & Neck Surgery, Sri Ramachandra Medical College & Research Institute, Porur, Chennai 600116, India.
| | - Kannan Senthil
- Department of E.N.T. Head & Neck Surgery, Sri Ramachandra Medical College & Research Institute, Porur, Chennai 600116, India.
| | - Lakshman Somu
- Department of E.N.T. Head & Neck Surgery, Sri Ramachandra Medical College & Research Institute, Porur, Chennai 600116, India.
| | - Mohd Ismail Nazrin
- Resident in Otorhinolaryngology, Sri Ramachandra Medical College & Research Institute, Porur, Chennai 600116, India.
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Morcillo A, Wins R, Gómez-Caro A, Paradela M, Molins L, Tarrazona V. Single-staged laryngotracheal reconstruction for idiopathic tracheal stenosis. Ann Thorac Surg 2012; 95:433-9; discussion 439. [PMID: 23218969 DOI: 10.1016/j.athoracsur.2012.09.093] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2012] [Revised: 08/28/2012] [Accepted: 09/04/2012] [Indexed: 11/19/2022]
Abstract
BACKGROUND This study retrospectively evaluated the results of surgically treated idiopathic tracheal stenosis. METHODS Of the 220 patients surgically treated for idiopathic subglottic and tracheal stenosis in the participating hospitals, we reviewed the surgical records of all patients with idiopathic tracheal stenosis. This subgroup required resection of all of the involved mucosa but frequently had undergone more conservative treatments that damaged the tracheal mucosa and cartilage and complicated the definitive surgical treatment. RESULTS During the study period, 60 women (93.8%) and 4 men (6.2%), who were a mean age of 50 years (range, 19 to 77 years), were surgically treated for idiopathic tracheal stenosis, with no operative deaths. Of these 64 patients, 38 (59.3%) had undergone previous treatments in other centers: dilation, 26 (40.6%); laser only, 19 (31%); laser plus tracheal prosthesis, 5 (7.8%); tracheostomy, 7 (11.6%); T tube, 2 (3%); and laryngotracheal operations, 5 (7.8%). All patients were treated with a single-staged tracheal or laryngotracheal operation, of which 59 (98%) successful. Four of the most complex stenoses, with vocal cords and cricoid plate involvement, underwent reoperation for restenosis or larynx inconsistency. One patient was considered biologically unfit for reoperation and required a permanent T tube for restenosis. Half of the operations were temporary tracheostomies with T tube for larynx modelling. The most frequent postoperative complications were dysphonic voice in 10 patients (although in 7 instances this began months or years before the operation), granulation tissue in 10, aspiration in 3, and wound infections in 2. CONCLUSIONS Idiopathic stenosis occurred predominantly (90% of cases) in women. Single-staged laryngotracheal correction was successful in 97%. Technique selection, with or without temporary laryngeal stenting, must be individualized with respect to the vocal cords' mobility, function, and distance from the stenosis.
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Affiliation(s)
- Alfonso Morcillo
- General Thoracic Surgery Department, Hospital Clínico, Universidad de Valencia, Valencia, Spain.
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