Open airway surgery for post-COVID laryngotracheal stenosis.

INTRODUCTION: This study reports our experience with open reconstructive surgery in patients with laryngotracheal stenosis (LTS) following prolonged intubation and/or tracheostomy in the context of COVID-19. METHODS: All patients underwent a preoperative endoscopic airway assessment. Posterior glottic lesions were graded according to the Bogdasarian classification, subglottic-tracheal lesions according to the Cotton-Myers classification and postoperative complications reported by the Clavien-Dindo classification. We report postoperative outcomes and functional results in this patient subset. RESULTS: We include 14 patients diagnosed to have post COVID LTS, one female and 13 males. This group was compared with a control group, diagnosed with LTS following prolonged intubation. In the COVID group, mean age of patients at the time of the airway surgery was 52.1 ± 16.8 years (range: 13.7-76.3). More than half the patients were multi-morbid with hypertension and obesity being the most common conditions. Eleven patients had multi-site stenoses. Open surgical interventions performed were tracheal resection and anastomosis, laryngotracheal reconstruction and extended cricotracheal resection, and postoperative complications were seen in 12 (85.6%) patients. 70% patients with pre-existing tracheostomy were decannulated. Oral swallowing was not tolerated in one-fifth of the patients and a significant number of them have poor voice quality. CONCLUSION: Post-COVID pandemic, airway surgeons are seeing an increased number of patients with complex LTS, and we report significant postoperative complications in this patient subset. Decannulation rates, voice and swallowing results are poor in patients with glottic involvement as compared to isolated tracheal stenosis.

[Postoperative monitoring after adenotonsillectomy of children with obstructive sleep apnea syndrome]. / Adéno-amygdalotomie chez les enfants avec syndrome d'apnées obstructives du sommeil. Recommandations pour la surveillance postopératoire.

Tonsillotomy or tonsillectomy, with or without adenoidectomy, is one of the most frequently performed procedure in the pediatric population. Obstructive sleep apnea is one of the main indications for these procedures. Respiratory problems following surgery are the most feared surgical complications. The criteria for identifying patients at risk of complications and the level of care required during monitoring remain controversial. This article reviews the literature on risk factors for respiratory complications. Recommendations for postoperative monitoring are proposed.

L'amygdalotomie ou l'amygdalectomie, avec ou sans adénoïdectomie, fait partie des interventions les plus fréquemment réalisées sur la population pédiatrique. Le syndrome d'apnées obstructives du sommeil est l'une des principales indications pour ce type d'intervention. Les problèmes respiratoires à la suite de l'opération sont les complications les plus redoutées. Les critères permettant d'identifier les patients à risque de complications et le niveau de soin nécessaire pour la surveillance sont controversés. Cet article propose une revue de la littérature des facteurs de risque de complications respiratoires. Des recommandations pour la surveillance postopératoire sont aussi proposées.