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Congenital Laryngeal Disease
Published in Raymond W Clarke, Diseases of the Ear, Nose & Throat in Children, 2023
Most cases can be managed conservatively in the expectation that the calibre of the airway will expand as the child gets older. More severe cases may need laryngotracheal reconstruction or cricoid resection (see Chapter 24). ‘Complete tracheal rings’ is a particularly difficult condition where the entire tracheal circumference is encircled by rigid cartilaginous rings rather than the normal horseshoe shape which does not extend to the posterior tracheal wall. This is especially challenging surgically (slide tracheoplasty) and requires very highly specialised care.
Acquired Laryngotracheal Stenosis
Published in R James A England, Eamon Shamil, Rajeev Mathew, Manohar Bance, Pavol Surda, Jemy Jose, Omar Hilmi, Adam J Donne, Scott-Brown's Essential Otorhinolaryngology, 2022
Tracheostomy as treatment is appropriate in the child with an unsafe, unstable airway in whom laryngotracheal reconstruction (LTR) is not advisable. Tracheostomy through tracheal rings 2–4 is recommended. Tracheostomy is often necessary, but it places a physical and emotional burden on child and family.
Enzymatic Modulation of Tachykinins and VIP in the Lung
Published in Sami I. Said, Proinflammatory and Antiinflammatory Peptides, 2020
Craig M. Lilly, Stephanie A. Shore
The hypothesis that tachykinins are involved in the acute phase response to antigen exposure is suggested by the ability of phosphoramidon to augment antigen-induced constriction in mechanically ventilated, sensitized guinea pigs (94). Similar findings have been demonstrated in tracheal rings taken from sensitized animals (95). These studies show that NEP activity is not diminished acutely by the process of sensitization and that NEP is active during the acute contractile response. To determine whether the airway hyperresponsiveness and allergic inflammation that occur in the hours following antigen exposure are associated with altered NEP activity, we determined the NEP inhibitor sensitivity and SP hydrolysis product profile of hyper-responsive, inflamed, tracheally perfused guinea pig lungs (96). We found that lungs with antigen-induced airway inflammation were less sensitive to NEP inhibitors and generated smaller quantities of NEP hydrolysis fragments than control lungs. When levels of the guinea pig homolog of NEP mRNA was compared in groups of lungs, lungs from SP-responsive animals with lower perfusate levels of SP NEP hydrolysis fragments had lower levels of NEP mRNA. These findings suggest that severe allergen-induced airway inflammation is associated with decreased NEP activity and increased sensitivity to SP.
Pediatric bronchoscopy: recent advances and clinical challenges
Published in Expert Review of Respiratory Medicine, 2021
P Goussard, P Pohunek, E Eber, F Midulla, G Di Mattia, M Merven, JT Janson
The most common indication for endoscopy is the presence of signs of airway obstruction. Persistent or severe inspiratory stridor should be evaluated, if associated with poor weight growth, episodes of apnea, cough while feeding, history suggestive for congenital malformations. In this case, the most common finding is laryngomalacia, even if the main purpose of bronchoscopy is to exclude other or concomitant malformations, like vocal cord paralysis, laryngeal web, subglottic stenosis, hemangioma, laryngeal cyst, or vocal cord dysfunction [25,27]. Bronchoscopy is mandatory even in case of stridor, to rule out if tracheomalacia, congenital (e.g. complete tracheal rings) or acquired (e.g. post-intubation) tracheal stenosis, or extrinsic compression of the trachea (e.g. vascular anomalies) are present [27]. Other indications are persistent or recurrent atelectasis, persistent or recurrent localized pneumonia, localized wheezing, or pulmonary hyperinflation, or bronchiectasis, and history suggestive for foreign body inhalation. In these cases, bronchial obstruction (e.g. mucus plug, foreign body, or endobronchial tumor), stenosis (e.g. web), compression (e.g. from bronchogenic cysts, vessels, or lymph nodes), anatomical malformation, or bronchomalacia are the most frequent findings [25–27]. In case of mucus plug or foreign body bronchial obstruction, bronchoscopy is both diagnostic and therapeutic. While mucus plugs could be simply aspirated with flexible bronchoscopes, foreign bodies removal with flexible bronchoscopes should be tried only if there is the immediate possibility to switch to rigid bronchoscopy [28].
Voice rehabilitation after total laryngectomy with the infrahyoid musculocutaneous flap
Published in Acta Oto-Laryngologica, 2021
Changjiang Li, Yi Fang, Haitao Wu, Min Shu, Lei Cheng, Peijie He
Incisions of total laryngectomy and cervical lymph node dissection were designed in advance (Figure 1(a)). After completion of the ipsilateral modified radical or selective neck dissection, an infrahyoid musculocutaneous flap was harvested from the contralateral side to ensure the safety of the flap [5]. The harvesting did not technically interfere with the extent of the neck dissection. Four patients who had lymph node metastasis underwent ipsilateral modified radical lymph node dissection, while the remaining 14 patients underwent selective neck dissection. The infrahyoid musculocutaneous flap harvested was composed of the sternohyoid muscle, the superior belly of the omohyoid muscle, and the sternothyroid muscle. The flap was oval-shaped in the vertical position, and the skin paddle was fitted and included in the incision made for unilateral or bilateral neck dissection. The medial edge of the flap was set at the midline; the upper edge, at the level of the incisura cartilago thyreoidea; the lower edge, at inferior margin of cricoid cartilage; and the lateral edge, at a distance of 3 cm from the midline. A trachea was opened and a ‘U-shaped’ tracheal flap was created between the third and fourth tracheal rings, under the thyroid isthmus. The length of the pronunciation tube created was about 4–5 cm.
Techniques for lung transplantation in the rat
Published in Experimental Lung Research, 2019
Three safeguards clinically confirm successful endotracheal intubation. Firstly, it is usually possible to feel the discrete resistance from individual tracheal rings as the tip of the ETT slides along the anterior wall of the trachea.2121 Secondly, endotracheal intubation results in symmetrical expansion of the chest. If the esophagus is intubated then the greatest expansion is observed in the left upper quadrant of the abdomen as the stomach is inflated. Finally, the greater compliance of the lungs compared to the stomach results in characteristically prolonged bubbling of the expiratory gas in the ventilator PEEP chamber if the lungs are intubated. In contrast, explosive bubbling of the expiratory gas in the PEEP chamber is observed if the stomach is intubated. If available, capnography can also serve as evidence for endotracheal intubation. Once endotracheal intubation has been confirmed, the ETT is secured to the malar skin with an interrupted suture.