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Congenital Laryngeal Disease
Published in Raymond W Clarke, Diseases of the Ear, Nose & Throat in Children, 2023
Webbing or atresia can occur at various sites in the larynx, but most commonly at the level of the vocal cords (Figure 23.3). Mild cases may not require intervention, but severe cases where there is near-complete airway obstruction will need definitive surgical repair, often involving laryngotracheal reconstruction. A preliminary tracheostomy can be life-saving. A laryngeal web may seem fairly innocuous when discovered at endoscopy, and it can be tempting to divide it in the expectation that this will give immediate and sustained relief of airway obstruction, but almost always the visible ‘web’ is the upper limit of a longer atretic segment, and more extensive surgery is required. Balloon dilatation is an increasingly popular strategy to expand the airway.
Contemporary Management of Laryngotracheal Trauma
Published in John C Watkinson, Raymond W Clarke, Terry M Jones, Vinidh Paleri, Nicholas White, Tim Woolford, Head & Neck Surgery Plastic Surgery, 2018
Carsten E. Palme, Malcolm A. Buchanan, Shruti Jyothi, Faruque Riffat, Ralph W. Gilbert, Patrick Gullane
The use of stents in laryngotracheal reconstruction is recommended where there is disruption of the anterior commissure anatomy, extensive mucosal trauma and comminuted fractures with significant damage to the laryngotracheal complex (Figure 71.8). Ideally these stents should be softer and more inert than hard intra-luminal stents, and inserted for the shortest time possible, to avoid growth of granulation tissue.78, 79 Schaefer recommends that they be secured in the larynx by double sutures, and closed at the superior end, to avoid aspiration of fluids via the stent lumen.9 In addition to a rolled silastic sheet and moulded Portex tracheostomy tube stent, a variety of newer laryngeal stents are available, which are softer and more inert. These include the Montgomery laryngeal stent, Montgomery T-tube, Aboulker stent, Eliachar laryngotracheal stent and the LT-Mold stent. However, regardless of the type of stent used, the decision to stent is made based on the need to stabilize the airway versus the potential for further laryngeal injury and infection from stenting.80
Acquired Laryngotracheal Stenosis
Published in John C Watkinson, Raymond W Clarke, Christopher P Aldren, Doris-Eva Bamiou, Raymond W Clarke, Richard M Irving, Haytham Kubba, Shakeel R Saeed, Paediatrics, The Ear, Skull Base, 2018
Michael J. Rutter, Alessandro de Alarcón, Catherine K. Hart
In concept, laryngotracheal reconstruction may be managed either endoscopically or by expansion grafting, resection (tracheal or cricotracheal), or the slide tracheoplasty. Although the latter operation was conceived for the management of tracheal stenosis, it may extend into the larynx if appropriate.
Application of digital modeling and three-dimensional printing of titanium mesh for reconstruction of thyroid cartilage in partial laryngectomy
Published in Acta Oto-Laryngologica, 2022
Hao Tian, Shuichao Gao, Jianjun Yu, Xiao Zhou, Xing Chen, Liang Zuo, Xu Cai, Bo Song, Kun Yu
Exposure of the titanium mesh is one of the risk factors after titanium implantation. The risk of exposure of titanium mesh tends to increase due to the movement of the thyroid cartilage during pronunciation and swallowing. A number of scholars assessed the feasibility and efficacy of laryngeal framework reconstruction using titanium mesh in patients with glottic cancer after frontolateral vertical partial laryngectomy, and found that titanium mesh could be a good alternative for reconstruction of the laryngeal framework [17]. We, in the present research, found several challenges in the process of laryngeal framework reconstruction using titanium mesh. It is a time-consuming process to reshape the titanium mesh, and the edge of the titanium mesh is very sharp. Besides, accurate construction of the structure of larynx is an important drawback. These barriers may disrupt laryngotracheal reconstruction and affect the swallowing exercises and pronunciation. In this study, the personalized titanium mesh fabricated with 3D printing was very thin with a large number of small holes and the edge was obtuse, which appeared advantageous for reconstruction of the larynx and soft tissues. The risk of displacement and deformation of titanium mesh was reduced, which accordingly led to the reduction of the risk of exposure of titanium mesh.
Life-threatening idiopathic subglottic stenosis misdiagnosed as asthma
Published in Acta Oto-Laryngologica Case Reports, 2022
Niloofar Sherazi Dreyer, Kristine Grubbe Gregersen, Kristian Hveysel Bork
Other treatment options include laser therapy (CO2 or Nd:YAG). The different surgical approaches can be used in combinations and supplemented with mitomycin C and/or corticosteroids. In severe or recurrent cases open surgery with laryngotracheal reconstruction surgery is required. In urgent cases tracheostomy may be the modality of choice.
Risk factors for decannulation failure after single-stage reconstruction of adult post-intubation tracheal stenosis: 10-year experience at a tertiary center
Published in Acta Oto-Laryngologica, 2020
In this study, patient-related risk factors were compared for both study groups. Cavaliere et al. [10] mentioned obesity as a coexisting underlying condition in 14% of the cases first time in the literature. In the same period, Wu et al. [11] analyzed 560 patients for risk factors causing TS after tracheotomy and revealed that increased BMI has a suggested association, with an increased risk of tracheal injury with intubation and worse response to procedural intervention. Until 2007, no studies in the literature have previously correlated obesity with TS. It is well established throughout the scientific literature that obesity triggers a chronic inflammatory state that promotes the production of pro-inflammatory markers [12]. Patients with chronic inflammatory states such as obesity may be more susceptible to laryngotracheal injury. Halum et al. [13] evaluated the risk factors associated with tracheotomy tube complications and stated that obesity is a major risk factor for the development of postoperative airway stenosis. Recently, Li et al. [14] stated that obese patients had longer durations of preceding orotracheal intubation and were more likely to receive late tracheostomy. Despite the aforementioned studies, there are also studies that show the opposite results. Wright et al. [8] and Tawfik et al. [9] found that obesity was not associated with a trend toward higher anastomotic failure. In this study, compared to controls, patients with decannulation failure had a significantly higher BMI. As has been consistently shown across other large series, patients with diabetes are particularly vulnerable to airway injury and have a higher likelihood of long-term tracheostomy dependence when an injury occurs [15–17]. Ettema et al. [15] showed the presence of diabetes to be associated with more severe stenosis: diabetes was diagnosed in 5.3% of patients with Cotton–Myer grade I or II stenosis compared to 36.4% of patients with grade III or IV stenosis. Another review, by Sinacori et al. [16], showed the impact on clinical course, showing that subglottic stenosis in diabetic patients did not recur more than in non-diabetics, but the time to recurrence in diabetic patients was significantly shorter. More recently, a study by Tawfik et al. [9] showed that patients with diabetes were at an increased risk for decannulation failure after laryngotracheal reconstruction. In this study, compared to controls, patients with decannulation failure were more likely to have diabetes.