Birth of Airway Surgery and Evolution over the Past Fifty Years.

Significant developments in airway surgery occurred following the introduction of mechanical ventilators and intubation with cuffed endotracheal tubes during the poliomyelitis epidemic of the 1950s. The resulting plethora of postintubation injuries provided extensive experience with resection and reconstruction of stenotic tracheal lesions. In the early 1960s, it was thought that no more 2 cm of trachea could be removed. By the late 1960s, this was challenged owing to better knowledge of airway anatomy and blood supply, tension-releasing maneuvers, and improved anesthetic techniques. Currently, about half of the tracheal length can be safely removed and continuity restored by primary anastomosis.

Tracheal Injuries Complicating Prolonged Intubation and Tracheostomy.

Respiratory care advances such as the introduction of ventilatory assistance have been associated with postintubation airway stenosis resulting from tracheal injury at the site of the inflatable cuff on endotracheal or tracheostomy tubes. Low-pressure cuffs have significantly reduced this occurrence. Loss of airway stability at the site of a tracheostomy stoma may result in tracheal stenosis. Subglottic stenosis may result from a high tracheostomy site at, or just inferior to, the cricoid arch, or to malposition of an endotracheal tube cuff. Awareness of these complications and their causes is essential to prevent their occurrence.

The history of pediatric airway reconstruction.

OBJECTIVES/HYPOTHESIS: To review the history of pediatric laryngotracheal reconstruction and to highlight those who made major contributions in the field. STUDY DESIGN: Retrospective literature review. METHODS: A literature search using the PubMed database from 1950 to the present. Earlier references were obtained from the Adams Center, the National Library of Medicine, and Virginia Commonwealth University Library. RESULTS: A total of 20 articles were identified. The articles reported 274 airway reconstructions of which 79% were in children. Pre-1935 infection was the leading cause of laryngotracheal stenosis. Laryngostomy, pioneered by Chevalier Jackson, was the most common method of reconstruction. Between 1935 and 1970, trauma was the predominant cause of laryngotracheal stenosis. The most common procedure was the anterior/posterior cricoid split or Rethi procedure. It marked the introduction of bony grafts in laryngotracheal surgery as pioneered by Looper. Post-1970, prolonged intubation in neonates was the most common cause of subglottic stenosis. The field was revolutionized by the work of Evans and Cotton, with widespread use of costal cartilage grafts and laryngotracheoplasty leading to a decannulation rate of over 90%. Advances included decreased morbidity, tolerability, shorter recovery time, and fewer stages of reconstruction. CONCLUSIONS: The pioneering work of many leaders in the field of airway reconstruction over the last 100 years has resulted in a number of effective airway reconstructive procedures that have led to the majority of children being successfully decannulated. In the future, more extensive surgeries, such as tracheal transplantation, may address the small number of children who presently cannot be decannulated.

History of pediatric laryngotracheal reconstruction.

In the early twentieth century, John Winslow wrote that there was no more difficulty in laryngology than treating chronic stenosis of the larynx and trachea. Winslow described cases as "excessively rebellious to treatment" and treatment requiring "patience, persistence, self-sacrifice and skill on the part of the surgeon" and "discomfort or even suffering by the patient." Three decades later, Chevalier Jackson wrote that curing patients required perseverance over a period of time rarely as short as 3 months and as long as 7 years. Significant strides in surgical technique have been made; this article chronicles the development of laryngotracheal reconstruction in children.

Rings, slings, and other things: vascular compression of the infant trachea updated from the midcentury to the millennium--the legacy of Robert E. Gross, MD, and Edward B. D. Neuhauser, MD.

In the first half of the 20th century, pediatric chest imaging was limited mainly to the performance of conventional radiography, including barium esophagography and occasionally bronchography and angiography. Despite this limited imaging approach, by 1950 the diagnosis and treatment of vascular "rings" compressing infant airways had been accomplished with the pioneering efforts of Robert E. Gross, MD, in the field of surgery, and Edward B. D. Neuhauser, MD, in the field of radiology. The next two decades brought the recognition of pulmonary arterial "sling," or anomalous left pulmonary artery, in diagnosis and treatment. Recognition of still another vascular compressive syndrome in infants was identified as that due to the absence of the pulmonary valve. These "rings, slings, and other things" are now evaluated with magnetic resonance (MR) imaging, including MR angiography, and computed tomography (CT), including CT angiography, with the added use of three-dimensional reconstruction. These are the legacies of Drs Gross and Neuhauser.

[Leopold Schroetter von Kristelli and Polish laryngologists]. / Leopold Schroetter von Kristelli a polscy laryngolodzy.

The researches of Leopold Schroetter von Kristelli, Karl Stoerk, Johann Schnitzler, Ottokar Chiari, Markus Hajek and others, the best Viennese rhinolaryngologists clarified our knowledge on rhinolaryngology. Leopold Schroetter, the famous rhinolaryngologist and internist, was a head of rhinolaryngological clinic in Vienna. He is shown as a precursor of treatment tracheas stenosis, he was also the author of many scientific papers and several books, coeditor of scientific medical magazines, a good teacher of a great number of physicians also from Polish territories. The Polish doctors: Samuel Meyerson, Wladyslaw Rudnicki and Alfred M. Sokolowski were a reporters from Schroetter's clinic.

[Treatment of acute and chronic laryngeal and tracheal stenoses in the 19th and beginning of the 20th century by tracheotomy, coniotomy, intubation and dilatation. Pictures from the history of otorhinolaryngology illustrated by instruments from the collection of the Ingolstadt Medical History Museum]. / Die Behandlung akuter und chronischer Larynx- und Trachealstenosen im 19. und Anfang des 20. Jahrhunderts durch Tracheotomie, Koniotomie, Intubation und Dilatation. Bilder aus der Geschichte der Hals-Nasen-Ohren-Heilkunde, dargestellt an Instrumenten aus der Sammlung im Deutschen Medizinhistorischen in Ingolstadt.

Although tracheotomy had been described in the Middle Ages and especially in the 17th century in writings (Fabricius d'Aquapendente 1620) and illustrations (Scultetus 1645), there was hardly any possibility of actually performing this operation as a life-saving intervention until the middle of the 19th century. It was only after suitable cannulae had been introduced by Trousseau in 1851 (double cannula with removeable insert) that tracheotomy became a routine procedure, and it was immediately carried out in a great many cases of diphtheria, croup, typhus, and lues, which often caused critical dispnea. Within the following 25 years, all technical modifications of cannulae were devised that are in use up to this day: the flap valve for the artificial larynx (1861), inflatable cuff (1871), and extra long flexible cannula. Beginning in 1885, O'Dwyer's method of intubation became established as an alternative to tracheotomy. Both procedures, like the underlying disease itself, frequently resulted in a permanent stenosis of the larynx or the trachea rendering decannulation impossible. Since about 1870 the treatment of these stenoses, primarily by bougienage, became an important issue in laryngology, which had just been established as a discipline in its own right. The history of this evolution and the therapeutic approaches by Schrötter in Vienna and Thost in Hamburg are described in detail, including their specially devised equipment. Apart from that, other medical aspects of historical interest around the turn of the century are mentioned, such as artificial nutrition by subcutaneous injections and tracheotomy in horses.(ABSTRACT TRUNCATED AT 250 WORDS)