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1.
Artículo en Chino | MEDLINE | ID: mdl-32074745

RESUMEN

Objective: To assess the outcomes of partial cricotracheal resection (CTR) and extended cricotracheal resection (ECTR) for severe laryngotracheal stenosis. Methods: From November 2009 to September 2017, 18 patients underwent CTR and ECTR at the Department of Otorhinolaryngology Head and Neck Surgery, Tangdu Hospital, Air Force Medical University for severe laryngotracheal stenosis were reviewed retrospectively. There were 12-male and 6-female patients, with the age ranged from 4 to 56 years (median 25 years). The causes were postintubation in 11 cases, cervical trauma in 4, idiopathic in 3. The stenosis located in subglottic and tracheal (n=12), glottic and subglottic and tracheal (n=3), subglottic (n=2), and glottic and subglottic (n=1). Two patients had concurrent unilateral vocal cord palsy.One patient had undergone previous endoscopic balloon dilation and 8 patients had previous laryngotracheal reconstruction. The stenosis was graded according to modified Myer-Cotton classification as follows: Ⅲb (n=1), Ⅲc(n=1), Ⅳa (n=2), Ⅳb (n=12), Ⅳc (n=2). The surgical outcomes and complications were recorded. Results: Among 18 patients,11 of the 12 patients undergoing CTR were decannulated. Five of the 6 patients undergoing ECTR were decannulated. Resected airway length ranged from 1.5 to 4.0 cm (median 2.8 cm). Surgical complications included infection of incision wound in 2 cases, anastomotic granulation in 2, cervical subcutaneous emphysema in 1, aspiration in 1, and unilateral arytenoid prolapse in 1. No recurrent laryngeal nerve injury or tracheoesophageal fistula occurred. The median follow up was 11 months. Conclusions: CTR is efficient for severe subglottic and upper tracheal stenosis while ECTR is efficient for subglottic stenosis extended to the glottis. Both procedures also provide a salvage therapy for patients with previous failed treatments.


Asunto(s)
Cartílago Cricoides/cirugía , Laringoestenosis/cirugía , Estenosis Traqueal/cirugía , Adolescente , Adulto , Niño , Preescolar , Constricción Patológica/cirugía , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Tráquea/cirugía , Resultado del Tratamiento , Adulto Joven
2.
Khirurgiia (Mosk) ; (1): 80-84, 2020.
Artículo en Ruso | MEDLINE | ID: mdl-31994504

RESUMEN

We report one-stage radical surgical treatment of a 54-year-old patient with extensive cicatricial posttracheostomy tracheal stenosis complicated by tracheomalacia of anterior tracheal wall and previous numerous unsuccessful endoscopic attempts of tracheal recanalization. A new method of prevention of tracheal anastomosis failure was applied.


Asunto(s)
Anastomosis Quirúrgica/métodos , Tráquea/cirugía , Estenosis Traqueal/cirugía , Traqueomalacia/cirugía , Traqueostomía/efectos adversos , Humanos , Persona de Mediana Edad , Tráquea/lesiones , Estenosis Traqueal/etiología , Traqueomalacia/etiología
3.
Cir. pediátr ; 33(1): 43-46, ene. 2020. ilus, tab
Artículo en Español | IBECS | ID: ibc-186137

RESUMEN

Introducción: Los quistes ductales subglóticos adquiridos (QDSA) son una causa rara de obstrucción de la vía aérea, sin consenso en la literatura en cuanto al tratamiento más eficaz. Presentamos nuestra experiencia en el tratamiento de los QDSA. Material y métodos: Estudio retrospectivo de los pacientes trata-dos en nuestro centro por QDSA en los últimos 5 años. Se recogieron los antecedentes de intubación, la clínica presentada, el tratamiento realizado, la evolución postquirúrgica, el seguimiento en consulta y los controles endoscópicos. Resultados: Se identificaron 4 pacientes, con unas medianas de edad y peso de 6,5 meses (6-8) y 5,9 kg (3,6-7), respectivamente. Todos presentaron antecedentes de intubación por intervenciones quirúrgicas, siendo prematuros 2 de ellos. La mediana entre la última intubación y el diagnóstico fue de 119,5 días (71-171). La clínica consistió en estridor bifásico con mejoría postural presentando una ocupación de la luz traqueal de más del 50% en la endoscopia diagnóstica. Se realizó escisión endoscópica (EE) al diagnóstico en 3 de los pacientes y como técnica de rescate en el cuarto por recidiva tras tratamiento con drenaje y dilatación con balón. La mediana de tiempo de intubación postquirúrgico fue de 13,5 horas (0-48) y la estancia hospitalaria de 7 días (6-9). Tras un seguimiento mediano de 17,5 meses (6-42) no se ha presentado ninguna recidiva. Conclusión: Los QDSA son una causa poco frecuente de estridor post-extubación. La EE permite un tratamiento eficaz con baja tasa de recidiva


Introduction: Subglottic cyst is a rare cause of airway obstruction, and there is a lack of evidence about the best treatment in the literature. This report describes our experience with endoscopic removal. Materials and methods: A retrospective study of all patients un-dergoing endoscopic removal of subglottic cyst at our healthcare facility between 2014 and 2019 was performed. Clinic and demographic data regarding gestational age, intubation, comorbidities, surgical procedures, first symptoms, endoscopic findings, treatment, and follow-up were collected. Results: Four patients were identified. Two out of four (50%) were preterm, and all patients were intubated during their neonatal period. Median age and weight at diagnosis were 6.5 months (6-8) and 5.9 kg (3.6-7). Median time between last intubation and diagnosis was 119.5 days (71-171). Biphasic stridor and progressive respiratory distress were the most common clinical symptoms. Airway obstruction of at least 50% was found during upper airway endoscopy in all patients. Endoscopic removal was performed as a first-line treatment in 3 patients, and as a second-line treatment in 1 patient. Median intubation time after treatment and hospital stay were 13.5 hours (0-48) and 7 days (6-9). All four pa-tients are free of disease, with a median follow-up of 17.5 months (6-42). Conclusion: Subglottic cyst is a rare cause of post-extubation stri-dor. Endoscopic removal seems to be a feasible and effective treatment with a low recurrence rate


Asunto(s)
Humanos , Masculino , Femenino , Lactante , Quistes/diagnóstico por imagen , Quistes/cirugía , Glotis/cirugía , Endoscopía , Estudios Retrospectivos , Glotis/diagnóstico por imagen , Quistes/patología , Intubación , Tiempo de Internación , Tráquea/patología , Tráquea/cirugía , Tomografía de Coherencia Óptica
4.
BMC Infect Dis ; 20(1): 13, 2020 Jan 06.
Artículo en Inglés | MEDLINE | ID: mdl-31906888

RESUMEN

BACKGROUND: The development of respiratory infections secondary to Aspergillus spp. spores found ubiquitously in the ambient environment is uncommon in immunocompetent patients. Previous reports of invasive upper airway aspergillosis in immunocompetent patients have generally demonstrated the efficacy of treatment regimens utilizing antifungal agents in combination with periodic endoscopic debridement, with symptoms typically resolving within months of initiating therapy. CASE PRESENTATION: A 43-year-old previously healthy female presented with worsening respiratory symptoms after failing to respond to long-term antibiotic treatment of bacterial sinusitis. Biopsy of her nasopharynx and trachea revealed extensive fungal infiltration and Aspergillus fumigatus was isolated on tissue culture. Several months of oral voriconazole monotherapy failed to resolve her symptoms and she underwent mechanical debridement for symptom control. Following transient improvement, her symptoms subsequently returned and failed to fully resolve in spite of increased voriconazole dosing and multiple additional tissue debridements over the course of many years. CONCLUSIONS: Invasive upper airway aspergillosis is exceedingly uncommon in immunocompetent patients. In the rare instances that such infections do occur, combinatorial voriconazole and endoscopic debridement is typically an efficacious treatment approach. However, some patients may continue to experience refractory symptoms. In such cases, continued aggressive treatment may potentially slow disease progression even if complete disease resolution cannot be achieved.


Asunto(s)
Antifúngicos/uso terapéutico , Desbridamiento , Aspergilosis Pulmonar Invasiva/terapia , Adulto , Antifúngicos/farmacología , Aspergillus fumigatus/efectos de los fármacos , Aspergillus fumigatus/aislamiento & purificación , Terapia Combinada , Farmacorresistencia Fúngica , Endoscopía , Femenino , Humanos , Aspergilosis Pulmonar Invasiva/microbiología , Nasofaringe/microbiología , Nasofaringe/patología , Nasofaringe/cirugía , Tráquea/microbiología , Tráquea/patología , Tráquea/cirugía , Resultado del Tratamiento , Voriconazol/farmacología , Voriconazol/uso terapéutico
5.
Ann Otol Rhinol Laryngol ; 129(1): 46-54, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31466464

RESUMEN

OBJECTIVES: To assess and compare the face (FV) and content validity (CV) of three ex vivo animal models for simulation training in pediatric laryngotracheal reconstruction (LTR). METHODS: Feasibility of performing LTR was assessed on the head and neck of three different animals (lamb/suckling-pig/rabbit) and laryngeal dimensions and qualitative observations were recorded. A 19-item five-point Likert scale questionnaire was completed for each model to assess FV and CV. Data was prospectively collected and analyzed using descriptive and nonparametric statistics. RESULTS: All three models were suitable for LTR simulation with laryngeal dimensions corresponding to 0-2 years (rabbit), 5-10 (pig) and >10 years (lamb model). Five trainees and five expert pediatric otolaryngologists performed LTR on each model. The overall median FV score was 5 for the lamb model (IQR 4-5), 3 for the rabbit (IQR 2-3), and 4 for the pig (IQR 4-4). The overall median CV score was 5 for the lamb (IQR 5-5), 2 for the rabbit (IQR 2-3), and 4 for the pig model (IQR 4-4). Comparison of the models demonstrated the lamb to be favored as the most realistic and practical model for simulation training in pediatric LTR, with both the lamb and the porcine model attaining validation thresholds. CONCLUSION: Our study is the first comparative validation assessment of animal models for use in pediatric LTR simulation and it supports the use of ex vivo lamb and porcine models for use in LTR surgical skills training. The lamb model was the favored simulation model while the rabbit was considered inferior for simulation training in pediatric LTR. LEVEL OF EVIDENCE: 3b.


Asunto(s)
Laringe/cirugía , Procedimientos Quirúrgicos Otorrinolaringológicos/educación , Procedimientos Quirúrgicos Reconstructivos/educación , Entrenamiento Simulado , Tráquea/cirugía , Animales , Niño , Preescolar , Humanos , Lactante , Laringoestenosis/cirugía , Modelos Animales , Pediatría/educación , Conejos , Ovinos , Porcinos , Estenosis Traqueal/cirugía
6.
Medicine (Baltimore) ; 98(51): e18180, 2019 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-31860964

RESUMEN

RATIONALE: Primary schwannoma is extremely rare in the trachea, and its optimal treatment has not yet been established. Previous literature have indicated that traditional resection by thoracotomy is an effective surgical procedure but with huge trauma, and endoscopic excision is a minimally invasive surgical method but with possibility of recurrence. Window resection was usually utilized for selected patients with trachea invasion by thyroid carcinoma, but video-assisted thoracoscopic window resection for trachea schwannoma has not been reported previously. PATIENT CONCERNS: A 23-year-old woman was admitted to hospital due to dyspnea, coughing and wheezing that had persisted for 2 months with aggravation for 1 week. DIAGNOSES: Chest computed tomography (CT) scan revealed a well-circumscribed soft-tissue mass located on the right lateral posterior wall of the trachea. Bronchofibroscopy (BFS) showed a whitish, smooth and round mass with a wide base in the trachea. Immunohistochemical staining demonstrated cells labeled with Vim (+), S-100 (+), SOX-10 (+), SMA (-), CK (-). Histopathological examinations showed that the mass was a schwannoma. INTERVENTIONS: The tumor was nearly completely excised via BFS, but relapsed 2 times at 12 days and 3 weeks after endoscopic resection. Finally, the patient underwent video-assisted thoracoscopic window resection of trachea. OUTCOMES: The patient recovered rapidly and no recurrence was observed over 6 months of follow-up. LESSONS: The treatment of tracheal schwannoma depends on the characteristics of tumor and the condition of patient. Surgical resection is a preferred alternative for sessile or transmural tumors and recurrence after endoscopic excision. Tracheal window resection by video-assisted thoracoscopy is beneficial for some appropriate patients with a small and sessile tumor.


Asunto(s)
Neurilemoma/cirugía , Cirugía Torácica Asistida por Video/métodos , Neoplasias de la Tráquea/cirugía , Femenino , Humanos , Neurilemoma/diagnóstico , Neurilemoma/patología , Tomografía Computarizada por Rayos X , Tráquea/patología , Tráquea/cirugía , Neoplasias de la Tráquea/diagnóstico , Neoplasias de la Tráquea/patología , Adulto Joven
7.
Medicine (Baltimore) ; 98(46): e17871, 2019 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-31725630

RESUMEN

RATIONALE: Primary end-to-end anastomosis is common in adult trachea resection. Nevertheless, considering that the utilization of grafts is still essential for restoring defect in long-segment tracheal resection surgery, long-segment tracheal resection and reconstruction still remain challenging. Herein we present a novel case in which we resected a large tracheal mass and reconstructed the long-segment defect through using a thyroid-pericardium flap, which has not been reported yet. PATIENT CONCERNS: A 35-year old male patient was admitted due to 'Repeated dry cough for 2 years, shortness of breath after activities for 1 month'. Patient had no other obvious symptoms. DIAGNOSES: CT revealed that a large neoplasm was located in the cervical trachea and the pedicle was in the tracheal membrane, with total length of approximately 6 cm. Positron emission tomography computed tomography demonstrated an abnormally elevated levels of glucose metabolism in the upper part of the posterior tracheal wall. Therefore, this lesion was primarily considered as a malignancy. INTERVENTIONS: The patient was performed by a primary resection of long-segment tracheal mass followed by thyroid-pericardium composite tissue flap for reconstruction. OUTCOME: The operation was successful, without hydrops or pneumatosis in the mediastinum. One week postoperatively, CT showed that there was no pneumomediastinum and mediastinal abscess. Three weeks postoperatively, fiber bronchoscope showed the flap with normal color and the unobstructed tracheal cavity. The patient healed without complication. LESSONS: The thyroid-pericardium flap is a convenient, secure, and effective material for long-segment trachea mass resection and reconstruction.


Asunto(s)
Colgajos Quirúrgicos/cirugía , Tráquea/cirugía , Adulto , Anastomosis Quirúrgica , Humanos , Masculino , Neoplasias de la Tráquea/cirugía
9.
Khirurgiia (Mosk) ; (11): 5-12, 2019.
Artículo en Ruso | MEDLINE | ID: mdl-31714523

RESUMEN

OBJECTIVE: To analyze early and delayed results of various variants of circular tracheal resection (CTR) with anastomosis, to determine the safest approach, dates and conditions of correction, features of postoperative period in patients after previous tracheal surgery. MATERIAL AND METHODS: There were 831 patients with cicatricial tracheal stenosis. CTR was made in 330 (39.7%) patients. Most patients had previous prolonged ICU-stay. The patients were divided into 4 groups. Group 1 consisted of 61 (18.5%) patients after previous prolonged tracheal stenting. Group 2 included 45 (13.6%) patients who underwent circular tracheal resection with a functioning tracheostomy. Tracheostomy tube served as a stent in these patients. Group 3 enrolled 32 (9.7%) patients with previous staged reconstructive plastic surgeries on cranial segment of the respiratory tract. Tracheostomy or stent were absent in 192 (58.2%) patients who underwent circular tracheal resection at the first hospitalization. These patients were enrolled into the fourth (control) group. Favorable outcomes (without complications and mortality) were achieved in 85.5% (n=282) of patients. Postoperative complications occurred in 48 (14.5%) patients. Mortality rate was 0.6% (n=2). The greatest number of complications including anastomositis and restenosis was noted in patients after CTR and previous tracheoplasty with T-tube (n=8, 25%). The most common complication in patients after tracheal resection and previous stenting was anastomositis (14.7%). Long-term results depended on postoperative complications and methods of their correction. Recurrent stenosis occurred in 5 (1.5%) patients within the period of 3 months - 8 years. CTR after previous tracheoplasty with T-tube was carried out in 4 of these patients. CONCLUSION: Tracheal resection after preliminary stenting or tracheostomy is quite safe and technically feasible. Stenting allows postponing radical surgery for correction of concomitant diseases and closure of tracheostomy as a focus of infection within the surgical approach and further tracheal anastomosis. Tracheal resection with simultaneous closure of tracheostomy results a higher rate of postoperative complications compared with preliminary stenting.


Asunto(s)
Constricción Patológica/cirugía , Stents/efectos adversos , Estenosis Traqueal/cirugía , Traqueostomía/efectos adversos , Constricción Patológica/etiología , Humanos , Estudios Retrospectivos , Tráquea/patología , Tráquea/cirugía , Estenosis Traqueal/etiología
10.
Rev Med Suisse ; 15(665): 1765-1768, 2019 Oct 02.
Artículo en Francés | MEDLINE | ID: mdl-31580021

RESUMEN

Congenital tracheal stenosis is a rare malformation of the fibrino-cartilaginous tracheal skeleton, frequently associated with cardiac malformations. The symptoms and the age of presentation varie according to the severity of the stenosis. There is a risk of airway obstruction. The diagnosis is based on endoscopy and surgery is usually required.


Asunto(s)
Constricción Patológica/congénito , Constricción Patológica/cirugía , Tráquea/anomalías , Obstrucción de las Vías Aéreas , Constricción Patológica/diagnóstico , Humanos , Tráquea/cirugía , Estenosis Traqueal/congénito , Estenosis Traqueal/diagnóstico , Estenosis Traqueal/cirugía
13.
Int J Pediatr Otorhinolaryngol ; 127: 109672, 2019 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-31539787

RESUMEN

INTRODUCTION: Congenital tracheal stenosis (CTS) is a rare airway condition characterized by complete tracheal rings. Most patients undergo a slide tracheoplasty, which greatly reduces mortality but significant morbidity remains. The assessment of sleep disordered breathing (SDB) and use of non-invasive ventilation (NIV) in these children has not been described. AIM: To describe the presence of SDB and use of NIV in children diagnosed with CTS over a 10-year period (2005-2015). DESIGN: Retrospective case series at a tertiary children's hospital. RESULTS: There were 16 patients identified with CTS with a median [range] age at diagnosis of 2.5 months (0-9 months). One child died in the immediate post-operative period following a slide tracheoplasty, leaving 15 survivors. There were no later deaths during follow-up while using NIV for up to 3 years after surgery. Slide tracheoplasty was undertaken in (12/15) with long-segment tracheal stenosis. 3/15 patients had a short-segment tracheal stenosis and were managed conservatively. The use of NIV occurred in 10/15 (66.67%) patients, all of whom had long-segment CTS. Pre-operative polysomnography (PSG) showed a median (±SD) obstructive apnoea/hypopnoea index (OAHI) of 14.6/hr (±6.2) which reduced to 7.2/hour (±4.2) on NIV prior to slide tracheoplasty. The median oxygen desaturation index (ODI) before NIV use was 15.3 (±19.4) episodes/hour, which reduced to 6.3 (±11) on NIV. The median period of NIV use was 5 [1-24 months] months. CONCLUSION: Patients with CTS have obstructed sleep disordered breathing. Trials of NIV are well-tolerated and improve sleep disordered breathing.


Asunto(s)
Constricción Patológica/complicaciones , Constricción Patológica/cirugía , Ventilación no Invasiva , Síndromes de la Apnea del Sueño/terapia , Tráquea/anomalías , Preescolar , Femenino , Humanos , Lactante , Recién Nacido , Masculino , Polisomnografía , Periodo Posoperatorio , Procedimientos Quirúrgicos Reconstructivos , Estudios Retrospectivos , Índice de Severidad de la Enfermedad , Tráquea/cirugía , Resultado del Tratamiento
14.
Adv Respir Med ; 87(4): 254, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31476016

RESUMEN

Foreign-body aspiration is often a serious medical condition demanding timely recognition and prompt action. Flexible and rigid bronchoscopy have become the cornerstone of both the diagnosis and treatment of patients with suspected airway foreign bodies, which are most commonly seen in patients with foreign body aspiration. We describe a case of a 58-year-old man with a huge fishhook in the right main bronchus.


Asunto(s)
Bronquios/diagnóstico por imagen , Broncoscopía/métodos , Cuerpos Extraños/diagnóstico por imagen , Tráquea/diagnóstico por imagen , Bronquios/patología , Bronquios/cirugía , Cuerpos Extraños/cirugía , Humanos , Masculino , Persona de Mediana Edad , Tomografía Computarizada por Rayos X , Tráquea/patología , Tráquea/cirugía
15.
Int J Pediatr Otorhinolaryngol ; 125: 212-215, 2019 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-31442881

RESUMEN

INTRODUCTION: Open airway reconstruction is a highly specialized skill. Simulation affords the opportunity to practice surgical skills in a low stakes environment which is particularly important for a high acuity, low frequency operation. Although animal models have been described, these present ethical and financial barriers, and therefore are not ideal to expose residents to airway reconstruction techniques. To our knowledge there is not a commercially available simulator for laryngotracheal reconstruction. OBJECTIVES: This study describes a novel, low-fidelity simulation technique for laryngotracheal reconstruction using a cartilage graft. METHODS: We designed a low-fidelity simulator to represent the trachea, esophagus, and cartilage graft using tubing from a Luken's trap, vinyl backwash hose, and pig's ears from a non-specialty grocery store. The model was evaluated with a Likert scale (1 = strongly disagree to 5 = strongly agree). RESULTS: Twelve participants attended simulation sessions. Participants reported a mean score (+/-SD) 4.25 ± 0.75 that the tissue characteristics were adequate and 4.50 ± 0.79 that sutures could be placed. There was universal strong agreement that the tissue could be manipulated appropriately (5 ± 0). The cost per resident was less than 4 dollars. CONCLUSION: We present a readily available, easy to construct, and low cost simulation model for open airway reconstruction that can be used as a stand-alone simulator or in preparation for an animal dissection course. Our participants reported that the model had acceptable tissue characteristics to practice performing laryngotracheal reconstruction with a cartilage graft.


Asunto(s)
Laringe/cirugía , Modelos Anatómicos , Procedimientos Quirúrgicos Reconstructivos/educación , Entrenamiento Simulado , Técnicas de Sutura/educación , Tráquea/cirugía , Humanos
16.
World J Gastroenterol ; 25(30): 4213-4221, 2019 Aug 14.
Artículo en Inglés | MEDLINE | ID: mdl-31435174

RESUMEN

BACKGROUND: Clinically, tracheoesophageal fistula (TEF) is lack of effective surgical strategies. One reason is due to the lack of appropriate animal models of acquired TEF, which is usually complex and difficult. Recently, the magnetic compression technique has been applied for digestive tract anastomosis or vascular anastomosis in animals. In this study, an animal model of TEF in dogs was developed by using the magnetic compression technique, hoping to provide a new method for mimicking TEF. AIM: To establish a TEF model in dogs by using the magnetic compression technique. METHODS: Six male beagles were used as models with two Nd-Fe-B permanent magnets for TEF. The parent magnet and the daughter magnet were placed in the cervical esophagus and trachea, respectively. The anterior wall of the esophagus and the posterior wall of the trachea were compressed when the two magnets coupled. After 4-6 d, the necrotic tissue between the two magnets fell off and the parent and daughter magnets disengaged from the target location, leaving a fistula. Gastroscopy/bronchoscopy, upper gastrointestinal contrast study, and histological analysis were performed. RESULTS: The establishment of the TEF model in all six beagles was successful. The average time of magnet placement was 4.33 ± 1.11 min (range, 3-7 min). Mean time for the magnets to disengage from the target location was 4.67 ± 0.75 d (range, 4-6 d). TEFs were observed by gastroscopy/bronchoscopy and esophageal angiography. The gross anatomical structure of the esophagus and the trachea was in good condition. There was no esophageal mucosa or pseudostratified ciliated columnar epithelium at the site of the fistula according to histological analysis. CONCLUSION: It is simple, feasible, and minimally invasive to use the magnetic compression technique for the establishment of the TEF model in dogs.


Asunto(s)
Modelos Animales de Enfermedad , Esófago/patología , Tráquea/patología , Fístula Traqueoesofágica/patología , Animales , Perros , Esófago/cirugía , Humanos , Imanes , Masculino , Presión/efectos adversos , Tráquea/cirugía , Fístula Traqueoesofágica/etiología , Fístula Traqueoesofágica/cirugía , Resultado del Tratamiento
17.
BMJ Case Rep ; 12(8)2019 Aug 10.
Artículo en Inglés | MEDLINE | ID: mdl-31401579

RESUMEN

We present the complex and rare case of an inhaled stoma button causing proximal tracheal stenosis in a laryngectomy patient. The patient was unaware he had inhaled his button and presented with increasing shortness of breath and noisy breathing. In this case we discuss the challenging management of the stenotic tracheal segment above the impacted stoma button and the surgical approach to this difficult airway. The distal foreign body was safely removed using rigid bronchoscopy and balloon dilatation. This difficult airway required multidisciplinary input from the ENT, cardiothoracic and anaesthetic teams.


Asunto(s)
Cuerpos Extraños/cirugía , Laringectomía/efectos adversos , Laringoestenosis/etiología , Cuerpos Extraños/diagnóstico por imagen , Humanos , Masculino , Persona de Mediana Edad , Tomografía Computarizada por Rayos X , Tráquea/diagnóstico por imagen , Tráquea/cirugía
18.
BMC Pulm Med ; 19(1): 163, 2019 Aug 28.
Artículo en Inglés | MEDLINE | ID: mdl-31462237

RESUMEN

BACKGROUND: Ablepharon macrostomia syndrome (AMS) is a rare congenital malformation disorder caused by the autosomal-dominant mutations in gene TWIST2. Patients affected by the disease present abnormalities in ectoderm-derived structures mainly consisting in major facial dysmorphic features and rarely in visceral anomalies. The only laryngo-tracheal defect reported is malacia, with no reference to any anatomical stenosis. We describe a unique case of laryngo-tracheal stenosis in a woman, with genetically confirmed AMS currently followed at our Department. CASE PRESENTATION: A 37-year-old Caucasian woman was admitted to the intensive care unit for acute dyspnea that required orotracheal intubation followed by tracheostomy. The bronchoscopy revealed abnormal tracheal tissue at the level of the cricoid and the first three tracheal rings reducing airway caliber by 80% (grade III according to the Cotton-Meyer classification). Treatment of the stenosis by means of temporary tracheostomy and corticosteroids therapy resulted in airway patency restoration and patient's return to her normal activities. Bronchoscopy at four and five months showed disappearance of the abnormal tissue and a residual anatomical laryngo-tracheal stenosis of about 20% (grade I according to the Cotton-Meyer classification) of the normal airway caliber. CONCLUSIONS: To our knowledge, this is the first patient affected by AMS presenting with laryngo-tracheal stenosis.


Asunto(s)
Anomalías Múltiples/diagnóstico , Anomalías Múltiples/fisiopatología , Anomalías del Ojo/diagnóstico , Anomalías del Ojo/fisiopatología , Macrostomía/diagnóstico , Macrostomía/fisiopatología , Tráquea/cirugía , Estenosis Traqueal/terapia , Corticoesteroides/uso terapéutico , Adulto , Disnea/etiología , Femenino , Humanos , Intubación Intratraqueal , Mutación , Estenosis Traqueal/etiología , Traqueostomía
19.
Otolaryngol Clin North Am ; 52(5): 923-936, 2019 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-31320105

RESUMEN

The management of pediatric airway stenosis has evolved considerably over time. At the outset, dilation was the mainstay of management. In the 1900s, open surgery in the form of cricoid expansion procedures or resection procedures was the primary treatment with subsequent development of the slide tracheoplasty. Now in the twenty-first century, advances in endoscopic management, balloon dilation, and stenting, along with the advent of external scaffolds and tissue replacement continue to advance pediatric airway surgery.


Asunto(s)
Laringoestenosis/cirugía , Procedimientos Quirúrgicos Reconstructivos/métodos , Procedimientos Quirúrgicos Torácicos/tendencias , Tráquea/cirugía , Estenosis Traqueal/cirugía , Cateterismo , Niño , Manejo de la Enfermedad , Endoscopía , Humanos , Laringoestenosis/diagnóstico , Procedimientos Quirúrgicos Reconstructivos/tendencias , Stents , Ingeniería de Tejidos , Estenosis Traqueal/diagnóstico , Resultado del Tratamiento
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