[Application of acellular dermal matrix in prevention of laryngeal stenosis in glottic carcinoma].

Objective:To investigate the effect of acellular dermal matrix in preventing laryngeal stenosis in glottic carcinoma patients. Methods:Fifty-five patients with glottic carcinoma（T2, T3） from February 2018 to December 2022 were divided into experimental group（28 cases） and control group（27 cases） according to their wishes. Acellular dermal matrix was placed in the operation cavity in the experimental group after laryngofission, while control group 12 cases were sutured by pulling the upper and lower edges, 15 cases were repaired with sternohyoid muscle fascia flap. Results:In the experimental group, 1 case had laryngeal stenosis caused by laryngeal mucosa swelling after operation, and extubated successfully after symptomatic treatment. In the control group, 7 cases had laryngeal stenosis after operation, of which 3 cases were caused by granulation tissue hyperplasia in laryngeal cavity, and extubated after symptomatic treatment. 2 cases extubated after operation suffered from progressive dyspnea during radiotherapy, and underwent tracheotomy again, extubation successful after treatment. 2 cases caused by laryngeal mucosa swelling, after symptomatic treatment, one case was successfully extubated, and one case had long-term intubation. The laryngeal stenosis rate of the experimental group was 3.6%（1/28） , which was lower than control group 25.9%（7/27）, and the therapeutic effect of the experimental group was significantly better than control group （χ²=5.526, P=0.019）. Conclusion:Implanting acellular dermal matrix in the operation cavity of glottic carcinoma can reduce the occurrence of laryngeal stenosis and have satisfactory preventive effect on laryngeal stenosis.

Drug-Eluting Endotracheal Tubes for Preventing Bacterial Inflammation in Subglottic Stenosis.

OBJECTIVES/HYPOTHESIS: Subglottic stenosis (SGS) results from dysregulated extracellular matrix deposition by laryngotracheal fibroblasts causing scar tissue formation following intubation. Recent work has highlighted a relationship between this inflammatory state and imbalances in the upper airway microbiome. Herein, we engineer novel drug-eluting endotracheal (ET) tubes to deliver a model antimicrobial peptide Lasioglossin-III (Lasio) for the local modulation of the microbiome during intubation. STUDY DESIGN: Controlled in vitro study. METHODS: ET tubes were coated with a water-in-oil (w/o) emulsion of Lasio in poly(d,l-lactide-co-glycolide) (PLGA) by dipping thrice. Peptide release was quantified over 2 weeks via fluorometric peptide assays. The antibacterial activity was tested against airway microbes (Staphylococcus epidermidis, Streptococcus pneumoniae, and pooled human microbiome samples) by placing Lasio/PLGA-coated tubes and appropriate controls in 48 well plates with diluted bacteria. Bacterial inhibition and tube adhesion were tested by measuring optical density and colony formation after tube culture, respectively. Biocompatibility was tested against laryngotracheal fibroblasts and lung epithelial cells. RESULTS: We achieved a homogeneous coating of ET tubes with Lasio in a PLGA matrix that yields a prolonged, linear release over 1 week (typical timeframe before the ET tube is changed). We observed significant antibacterial activity against S. epidermidis, S. pneumoniae, and human microbiome samples, and prevention of bacterial adherence to the tube. Additionally, the released Lasio did not cause any cytotoxicity toward laryngotracheal fibroblasts or lung epithelial cells in vitro. CONCLUSION: Overall, we demonstrate the design of an effective-eluting ET tube to modulate upper-airway bacterial infections during intubation which could be deployed to help prevent SGS. LEVEL OF EVIDENCE: NA Laryngoscope, 132:1356-1363, 2022.

Length of the Cricoid and Trachea in Children: Predicting Intubation Depth to Prevent Subglottic Stenosis.

OBJECTIVE: Define the length of the subglottis and trachea in children to predict a safe intubation depth. METHODS: Patients <18 years undergoing rigid bronchoscopy from 2013 to 2020 were included. The carina and inferior borders of the cricoid and true vocal folds were marked on a bronchoscope and distances were measured. Patient age, weight, height, and chest height were recorded. Four styles of cuffed pediatric endotracheal tubes (ETT) were measured and potential positions of each cuff and tip were calculated within each trachea using five depth of intubation scenarios. Multivariate linear regression was performed to identify predictors of subglottic and tracheal length. RESULTS: Measurements were obtained from 210 children (141 male, 69 female), mean (SD) age 3.21 (3.66) years. Patient height was the best predictor of subglottic length (R2 : 0.418): Lengthsg (mm) = 0.058 * height (cm) + 2.8, and tracheal length (R2 : 0.733): Lengtht (mm) = 0.485 * height (cm) + 21.3. None of the depth of intubation scenarios maintained a cuff-free subglottis for all ETT styles investigated. A formula for depth of intubation: Lengthdi (mm) = 0.06 * height (cm) + 8.8 found that no ETT cuffs would be in the subglottis and all tips would be above the carina. CONCLUSION: Current strategies for determining appropriate depth of intubation pose a high risk of subglottic ETT cuff placement. Placing the inferior border of the vocal cords 0.06 * height (cm) + 8.8 from the superior border of the inflated ETT cuff may prevent subglottic cuff placement and endobronchial intubation. LEVEL OF EVIDENCE: 4 Laryngoscope, 132:S1-S10, 2022.

A Randomized Controlled Trial of Dexamethasone as a Prophylactic Treatment for Subglottic Stenosis in a Rabbit Model.

OBJECTIVE: Iatrogenic injury is a common cause of subglottic stenosis (SGS). We investigated the role of pre-injury dexamethasone as a preventive treatment for iatrogenic subglottic stenosis. METHODS: 16 New Zealand White rabbits were used in an IACUC approved study. Subjects were divided into two groups: intramuscular dexamethasone (DEX) at a dose of 2 mg/kg 15 minutes prior to an endoscopic injury to create SGS, and the same injury creation with a preoperative intramuscular saline (SAL) injection. Three independent, blinded raters evaluated endoscopic images to obtain cross sectional area (CSA) airway measurements. Rabbit airways were measured just prior to injury and at one week post-injury. All subjects were provided as-needed postoperative steroids and buprenorphine for symptoms of respiratory distress. Data analysis was performed using Student t-test. Intraclass correlation coefficients were used to assess inter-rater agreement. RESULTS: All subjects survived to the one-week post-injury airway evaluation. There was no difference in airway size between groups prior to injury (P = .28). Subjects in the DEX group demonstrated an average stenosis of 20.3% (95% CI 10.2-30.5) at one week compared to 60.6% (95% CI 40.3-80.9) in the SAL group (P = .01). Subjects in the control group required significantly more doses of postoperative dexamethasone (P = .02). Inter-rater agreement for between raters was excellent (ICC = .88). CONCLUSION: This is the first study to examine the role of pre-injury glucocorticoids in preventing iatrogenic subglottic stenosis. In our model, a single dose of intramuscular dexamethasone given prior to a subglottic injury resulted in a statistically significant reduction in airway stenosis. This research suggests that administering systemic dexamethasone should be considered prior to any procedure that may injure the subglottis, including traumatic intubation, to prevent iatrogenic subglottic stenosis.

Transglottic corticosteroid injection for treatment of soft post-intubation subglottic stenosis: a retrospective analysis of 26 children.

PURPOSE: Surgical treatment is generally recommended for severe subglottic lesions following traumatic endotracheal intubation in children. An alternative approach is early transglottic corticosteroid administration to reduce scar formation and prevent the need for subsequent surgical intervention. This technique has been practiced successfully for several decades at the Children's Hospital of Cologne and the outcomes of 26 subsequent patients reviewed in this analysis. METHODS: All patients who underwent transglottic corticosteroid injection for treatment of post-intubation stridor and dyspnoea between 2012 and 2018 were identified and their records and endoscopy images analysed. Severity of the endoscopic findings was assessed using the Myer-Cotton classification (MCC) and an Expected Need for Surgical Intervention (ENSI) score (1 = inevitable; 2 = very likely necessary; 3 = probably avoidable and 4 = most likely not necessary) was recorded. Treatment was considered successful if the children had a complete resolution of clinical symptoms. RESULTS: A total of 26 patients with a median (range) age of 1.9 (0.02-7.2) years and weight of 9.8 (1.8-25) kg were identified and included into the analysis. Endoscopic images were available for 22 children. All children underwent transglottic corticosteroid injection prior to any potential surgical treatment. A total of 22 patients (85%) improved following transglottic corticosteroid injection including 4 of 5 patients with a MCC = 3 and ENSI = 1 avoiding surgical intervention. None of the patients experienced a deterioration of clinical symptoms or endoscopic findings. CONCLUSION: Transglottic corticosteroid injections as first-line treatment in children with severe post-endotracheal intubation trauma can successfully resolve symptoms and prevent invasive surgery.

Laryngotracheal foreign body: chicken neck bone.

We herein present a case involving a 78-year-old patient who had aspirated a laryngotracheal foreign body 3 days prior to hospital admission. The patient had severe congenital intellectual disability; however, no agitation, suffocation, or death occurred despite almost complete laryngeal obstruction. The laryngotracheal foreign body was removed by tracheotomy and suspended microlaryngoscopy.

Prevención, diagnóstico y manejo de lesiones laringotraqueales agudas y subagudas posintubación en pacientes pediátricos / Prevention, diagnosis and management of acute and subacute laryngotracheal post-intubation lesions in pediatric patients

Las lesiones laringotraqueales asociadas a intubación se deben principalmente a una técnica defectuosa y a daño por presión del tubo endotraqueal sobre la mucosa; además influyen características propias del paciente y de los cuidados de enfermería. Hasta el 40% de los pacientes pediátricos intubados pueden presentar alteraciones laríngeas inmediatas y hasta 30% tienen estridor o disnea posextubación. Si estos síntomas persisten por más de 3 días tendrían indicación de laringotraqueoscopía. Las lesiones más habituales son edema, úlceras y tejido de granulación. El edema puede producir obstrucción respiratoria aguda que puede manejarse con reintubación con tubos más pequeños y aplicación tópica de crema de corticoides con antibióticos. Las úlceras y granulaciones pueden evolucionar hacia secuelas cicatriciales que comprometen la fisiología laringotraqueal; las granulaciones exofíticas deben retirarse endoscópicamente. Aunque la incidencia de estenosis subglótica posintubación ha disminuido en las últimas décadas, situándose entre 2,7%y 4,2%, algunos estudios sugieren un subdiagnóstico debido a lesiones poco sintomáticas al alta. En el período cicatricial activo, estas estenosis pueden dilatarse para evitar llegar a una cirugía abierta. El manejo otorrinolaringológico de estos pacientes en etapas tempranas es fundamental para evitar secuelas cicatriciales irreversibles que requieren de cirugías complejas, con riesgo vital por obstrucción de la vía aérea.

Intubation-associated laryngotracheal injuries are mainly caused by a defective technique and endotracheal tube pressure-induced mucosal damage; patient factors and nursing care are also important. Up to 40% of intubated pediatric patients may show immediate laryngeal alterations and up to 30% have post-extubation stridor or dyspnea. If these symptoms last for over 3 days, laryngotracheoscopy is indicated. Edema, ulcers and granulation tissue are the most usual lesions. Edema can lead to acute airway obstruction, and is managed by reintubation with a smaller tube and topical application of a corticosteroid and antibiotic cream. Ulcers and granulations can lead to scarring that compromise laryngotracheal physiology; exophytic granulations must be removed endoscopically. Although the incidence of post-intubation subglottic stenosis has diminished over the last decades to about2,7% to 4,2%, some studies suggest that there is a subdiagnosis because of oligosymptomatic lesions at the time of discharge. On the active scarring period, dilatation of the stenosis can be used to avoid open surgery. Early otorhinolaryngologic management of these patients is fundamental for avoiding irreversible cicatricial sequels that require complex surgeries, with life risk due to airway obstruction.

[The algorithm for rehabilitation of the patients presenting with laryngeal cancer following open functionally sparing operations].

The objective of the present study was to increase the efficiency of the treatment of the patients presenting with laryngeal cancer by the enhancement of the functional reserve of the preserved portion of the larynx and the prevention of the narrowing of its lumen. Another objective was to develop an algorithm for the rehabilitation of the patients with laryngeal localization of the tumour following open functionally sparing operations that consists of the operative and postoperative stages. During the period from 2006 to 2014, a total of 71 patients underwent functionally sparing operations. 66 of them were operated for laryngeal cancer, 1 for thyroid cancer spreading over trachea and larynx, 3 for papillomatosis. Resection of the larynx in the vertical and horizontal planes was performed in 62 and 9 patients respectively. Vertical plane surgery included the following procedures: fronto-lateral resection of the larynx in 51 patients, extended fronto-lateral resection in 10, and combined resection in 1 patient. It is concluded that the systemic approach to the treatment of the patients with laryngeal cancer and the proposed algorithm for their rehabilitation made it possible to restore the laryngeal function in 68 of the 71 patients (95.8%).

Tacrolimus prevents laryngotracheal stenosis in an acute-injury rat model.

OBJECTIVES/HYPOTHESIS: Acquired laryngotracheal stenosis is a challenging problem for otolaryngologists. Several studies suggest tacrolimus may inhibit post-transplant airway stenosis that occurs with coronary drug-eluting stents. The objective of the present study was to determine whether tacrolimus modulates wound healing of the airway mucosa and prevents laryngotracheal stenosis in an acute injury animal model. STUDY DESIGN: Basic science. METHODS: The laryngotracheal mucosa of rats was scraped with a nylon brush through the tracheostoma. Tacrolimus (0.2 mg/kg or 1.0 mg/kg) was systemically administered intramuscularly for 5 days. Nine days after scraping, the pathological changes and the degree of stenosis were assessed by hematoxylin and eosin staining or by immunohistochemical staining for nuclear factor of activated T cell and interleukin 2. RESULTS: Lumen stenosis resulted from hyperplasia of the airway epithelium and a thickened submucosal layer with extensive fibrosis, angiogenesis, and collagen deposition. There was a significant preventive effect on airway stenosis at the tracheal and cricoid levels in the low-dose (0.2 mg/kg) tacrolimus-treated animals, compared to the untreated animals (P < .05). This effect was insignificant with treatment by high-dose tacrolimus (1.0 mg/kg). Immunohistochemistry showed that, after tacrolimus treatment, the expressions of nuclear factor of activated T cell and interleukin 2 were downregulated in submucosal fibroblasts, neovascular cells, and glandular cells. CONCLUSIONS: This study suggests that low-dose systemic tacrolimus has a preventive effect on laryngotracheal stenosis by inhibiting the activation of immune cells in the injured airway mucosa via the calcineurin/nuclear factor of activated T cell/interleukin 2 pathway. LEVEL OF EVIDENCE: NA.

Use of local mitomycin C in enhancing laryngeal healing after laser cordotomy: a prospective controlled study.

BACKGROUND: The purpose of this study was to investigate the role of intraoperative application of mitomycin C in prevention of glottic restenosis after posterior transverse CO2 laser cordotomy (PTLC) for patients with post-thyroidectomy bilateral vocal fold paralysis. METHODS: Twenty-five patients with an impaired airway because of bilateral vocal fold paralysis were treated with PTLC. Patients were divided into groups: the mitomycin C group (13 patients) had PTLC and topical mitomycin C; and the control group (12 patients) had PTLC only. RESULTS: No patients in the mitomycin C group developed glottic granulation or laryngeal scarring, whereas 5 of 12 patients in the control group developed granulation (p = .014) and 2 of 12 patients had laryngeal scarring (p = .28). Ten of 13 patients in the mitomycin C group ended up with mild dyspnea with no limitation to normal everyday activities whereas only a third of the control group achieved this outcome (p = .05). CONCLUSION: The use of topical mitomycin C has been shown to decrease postoperative laryngeal granulation, scarring, restenosis, and the need for revision surgery.

Endoscopic keel placement to treat and prevent anterior glottic webs.

We performed a retrospective chart review to examine and describe our clinical experience of use of the Lichtenberger technique to place silicone elastomer keels after lysis of existing webs or for prevention of webs following anterior commissure surgery in adults. Twenty-two patients were identified for inclusion, ranging in age from 24 to 80 years. For 18 patients with existing glottic webs,the surgical procedure involved laryngoscopy with complete lysis of the anterior glottic web by laser or sharp technique, followed by placement of a square of silicone elastomer that is sutured in place with the Lichtenberger needle holder and left in place for 3 to 5 weeks. The procedure was well tolerated, and successfully corrected the web in all but 2 cases. For 4 patients, the procedure was performed prophylactically at the time of anterior commissure surgery considered high-risk for web formation. The procedure does not require a tracheotomy, and patients can maintain a normal diet and have functional phonation while the keel is in place. This approach to treating anterior glottic webs offers several advantages over traditional open thyrotomy with keel placement and should be considered to treat or prevent anterior glottic webs.

[The potential of prophylaxis and optimization of the treatment of rhinosinusitis in the children presenting with stenosing laryngotracheitis].

The objective of the present work was to estimate the clinical, prophylactic, and microbiological effectiveness of fusafungine applied for the treatment of acute rhinosinusitis (ARS) in the children that develops as a consequence of acute stenosing laryngotracheitis. The study included 61 children presenting with ARS and concomitant acute stenosing laryngotracheitis (ASLT) that were treated with fusafungine (Bioparox). Both tolerance and safety of this preparation were evaluated. Fusaferine was prescribed after reduction of pharyngeal stenosis. The children were divided into two groups. Group 1 was comprised of the patients with the respiratory symptoms and rhinosinusitis (n = 36), group 2 consisted of the children with the respiratory symptoms in the absence of rhinosinusitis (n = 25). Subgroups of the children treated with fusafungine and without it were distinguished to estimate the clinical, prophylactic, and microbiological effectiveness of fusafungide. Within the first days after hospitalization, 59% of the children with diagnosis ASLT developed bilateral rhinosinusitis, in all probability of viral etiology. Fusafungine produced the clinically apparent effect in the patients with ASLT regardless of the presence of ARS. Specifically, this preparation decreased the degree of hypertrophy of pharyngeal tonsils three times faster than standard therapy; moreover, it reduced the requirement for systemic antibiotics by 1.9 times. The treatment with fusaferine prevented the development of acute bilateral rhinosinusitis in the children with ASLT and promoted compete decontamination of the nasopharynx from M. catarrhalis, Str. pneumonia, Str. pyogenes, H. influenza, Cor. s the nasopharynx pecies, E. faecalis, and C. albicans. The frequency of adverse reactions of organoleptic character was estimated at 16.6%.

Endotracheal tube: friend or foe? Bacteria, the endotracheal tube, and the impact of colonization and infection.

The microbiology of the endotracheal tube culture plays a role in diagnosing a variety of diseases in the newborn intensive care unit, including subglottic stenosis, bronchopulmonary dysplasia, and ventilator-associated pneumonia. Bacterial production of a biofilm that coats the endotracheal tube acts as a reservoir for infection, prevents eradication, and may play a role in the development of subglottic stenosis. The diagnosis of ventilator-associated pneumonia is limited by the CDC definition as well as currently available diagnostic methods. Biomarkers could aid in differentiating colonization from infection, but are not available to most clinicians. The etiology of ventilator-associated pneumonia is often polymicrobial. Failure to differentiate colonization from infection results in unnecessary prescription of antibiotics, which could contribute to antimicrobial resistance. Measures to prevent ventilator-associated pneumonia have been described, primarily in the adult population.

Cyclooxygenase-2 inhibition for the prevention of subglottic stenosis.

OBJECTIVE: To evaluate the role of targeted cyclooxygenase-2 inhibition in reducing scarring associated with a subglottic airway mucosal injury. DESIGN: Thirty-four New Zealand white rabbits underwent anterior cricothyroidotomy. Subglottic stenosis (SGS) was created by carbon dioxide laser injury. INTERVENTION: Treatment consisted of intraperitoneal injection of celecoxib or vehicle for 4 days. Endoscopies were performed to assess injury and healing. Subglottic mucosal secretions were collected with Gelfoam swabs (Pfizer Inc) before and after injury and at subsequent time points. Animals were humanely killed at 3 or 8 weeks after injury and airways were excised, followed by gross examination and histologic analysis to assess the severity of SGS. Secretions were analyzed for interleukin-1ß, prostaglandin E2 (PGE2), and matrix metalloproteinase-8 by enzyme-linked immunosorbent assays. RESULTS: Endoscopy showed mild to moderate stenosis in the celecoxib group, but mild to severe stenosis in the vehicle group. Histologic assessment confirmed and quantified reduction in stenosis and scarring as well as advanced reepithelialization. In the healing tissue, mucosal thickening (stenosis) was reduced significantly (P = .02) in celecoxib-treated animals compared with those treated with vehicle, at 3 and 8 weeks (decrease in thickness by 32% and 49%, respectively). Collagen density (fibrosis) was also reduced 25% at both 3 and 8 weeks but the difference was not statistically significant (P = .20). Reduced level of PGE2 in the subglottic mucosal secretions was correlated with mucosal thickness at 8 weeks (P = .02). CONCLUSION: Short-duration, anti-inflammatory therapy resulted in reduced stenosis and fibrosis with correlation of PGE2 levels in subglottic mucosal secretions.

Effect of pentoxifylline and 5-fluorouracil/triamcinolone on laryngotracheal stenosis developing as a complication of tracheostomy: study in rats.

We aimed to investigate the prophylactic effect of pentoxifylline (PTX) and 5-fluorouracil (5-FU) on laryngotracheal stenosis in tracheotomised rats by evaluating blood glutathione peroxidase (GPx) and superoxide dismutase activities and by histopathological evaluation of laryngotracheal segment. Randomized prospective single-blind study. Standard vertical tracheotomy was performed on 24 rats. Then, the animals were randomly divided into three groups. Intraperitoneal PTX administered to group A (study group) for 10 days. 5-FU was injected in paratracheal tissues in group B (study group) for 10 days. In group C (control group), intraperitoneal saline was administered for 10 days. After 10 days, tracheal cannules were removed. For biochemical analysis, two blood samples were obtained. Three weeks later, all animals were euthanized and trachea specimens were harvested. Stenosis index and mean wall thickness in PTX group were lower as compared to other groups but the difference was statistically insignificant. Minimum inflammation and fibrosis plus maximum epithelial regeneration were seen in PTX group. In addition, GPx activity was at highest level in PTX group and a statistically significant difference was found between control and PTX groups (P = 0.024) though the difference between remaining groups was statistically insignificant (P = 0.121). Superoxide dismutase activity was highest in PTX group but no statistically significant difference was found between the three groups (P = 0.305). The administration of PTX increases GPx activity and it may have some effect on tracheal scar formation which develops following tracheostomy.

A novel permanent tracheostomy technique for prevention of stomal stenosis (triangular tracheostomy).

OBJECTIVE: Stenosis of a permanent tracheostoma after total laryngectomy lowers postoperative quality of life (QOL), and its prevention is clinically important. METHODS: From April 2003 to March 2009, the authors performed 87 permanent tracheostomies. For the purpose of prevention of tracheostomal stenosis, we had applied new technique from October 2005. RESULTS: The incidence of the tracheostomal stenosis was retrospectively reviewed. Until September 2005, conventional permanent tracheostomy was applied for 33 cases and tracheostomal stenosis developed in 6 cases (18.2%). On the other hand, stenosis did not develop in any of the 54 cases in which the new technique was used. The triangular method was significantly superior to the conventional method in preventing stenosis. Stomal recurrence did not develop in either technique. CONCLUSION: The key point of the new technique is as follows: at the upper end of trachea, the posterior part of tracheal cartilage is preserved and the anterior edge of the tracheostoma is made much lower. The shape of the tracheostoma approximates a triangle, and the area is greater than with other methods. From our experience, this technique is safe and effective for the prevention of tracheostomal stenosis.

Granulation formation following tracheal stenosis stenting: influence of stent position.

OBJECTIVES/HYPOTHESIS: To determine whether stent-to-vocal fold distance influences morbidity following stent placement for tracheal stenosis. METHODS: Fifty-five stent procedures (46 Montgomery T-tube [Boston Medical Products, Westborough, MA] and 9 Dumon stents [Novatech, Grasse, France]) were performed in 40 patients enrolled in this study. RESULTS: The most common complication of stenting for tracheal stenosis was granulation (23 procedures, 41.82%). Of 43 procedures where the stent upper edge was located at or below the vocal folds, granulation occurred in 21 procedures (48.84%). Of 12 procedures where the stent edge was located above the vocal fold, granulation occurred in two procedures, or 16.67% (odds ratio = 4.773, P = .0458, chi(2) test). Among patients in whom the stent edge was located at or below the vocal folds, the granulation complication rate was higher in those with a stent-to-vocal fold distance of <10 mm. Multivariate analysis revealed that the stent-to-vocal fold distance independently predicted granulation formation; an inverse correlation was identified between stent-to-vocal fold distance and granulation severity (n = 43, r = -.501, P = .0006; Spearman ranking test). Receiver operating characteristic curve analysis further demonstrated that a stent-to-vocal fold distance cutoff value between 9.5 and 11 mm had the best accuracy in predicting granulation formation. CONCLUSIONS: A stent-to-vocal fold distance of 10 mm was found to be a critical distance for discriminating granulation formation. Optimal stent-to-vocal fold distance should routinely be evaluated before stent placement.

Perflubron residua: 12 years following therapy.

Partial liquid ventilation therapy utilizing perfluorocarbons has been used for patients with severe respiratory distress. Perfluorocarbons such as perflubron have been demonstrated to clear from the lungs shortly after therapy. We present a 13-year-old boy with residual perflubron in his lungs, 12 years following therapy with perflubron. The imaging features are important to recognize as these patients return for additional care and imaging.

Wound-healing modulation in upper airway stenosis-Myths and facts.

Wound healing plays a major role in the development of acquired subglottic stenosis. Pharmacologic treatment of subglottic stenosis must address both physiologic and pathologic healing processes. The relevant Pubmed and Ovid databases from 1960 to 2007 were systematically searched. Several modulating agents have been tested. Most of them were poorly investigated. Three modalities were thoroughly studied-steroids and antibiotics, mitomycin, and antireflux medications. However, there are conflicting data regarding their role in preventing and treating subglottic stenosis. Current data support to some extent the textbook suggestions of antibiotics, steroids, and antireflux treatment. As no other treatment options exist, we recommend using these modalities for pharmacologic modulation of subglottic stenosis. Mitomycin should still be considered as an unproven treatment; its use may be considered as an adjunct.