Laryngotracheal reconstruction using microplates in a porcine model with subglottic stenosis.

Current techniques of laryngotracheal reconstruction require a choice between prolonged stenting (conventional technique) or short-term stenting with maintenance of sedation and paralysis until the airway has stabilized (single-stage laryngotracheal reconstruction). An alternative method is proposed using microplates to provide immediate airway stabilization without stenting. This study was designed to evaluate the long-term effects of microplate repair of stenosis of the subglottis and trachea on the growing larynx. Subglottic stenosis was produced in piglets using a transoral endoscopic technique. Eight animals underwent repair of the stenosis using an anterior cricoid split with microplate distraction and stabilization of the cricoid cartilage and first tracheal ring. The distraction was maintained and airway growth continued for the duration of this study. However, with growth of the larynx the plates migrated away from their original position. In 50% of the animals followed up for 90 days the plates migrated into the airway lumen. This study suggests that rigid distraction of the stenotic airway with microplates is a viable alternative to more traditional methods of repair. However, plate removal at some interval after surgery is required in the growing larynx in order to prevent migration of the plate into the airway.

Pediatric fiberoptic laser rigid bronchoscopy.

Use of the fiberoptic laser for treatment of tracheobronchial lesions in the adult is well established. However, there is a paucity of experience with the fiberoptic laser in the pediatric airway. Tracheal obstruction caused by granulation tissue or stenosis, as is often seen in children, may be effectively treated with this approach. This article documents the successful use as well as the technologic advantage of the flexible fiberoptic laser systems, primarily the potassium titanyl phosphate (KTP) laser, combined with standard pediatric rigid bronchoscopic equipment in 73 procedures involving 52 children (43 children younger than five years. with an average age of 21 months). Visualization was excellent, assisted or spontaneous ventilation was well maintained, and complications were few.

Intranasal endoscopic excision of a juvenile angiofibroma.

Intranasal endoscopic excision of a juvenile nasopharyngeal angiofibroma (JNA) was performed in a 13 year old white male. The patient remains disease-free 24 months after the operation. Although endoscopic surgical techniques have been applied to the therapy of some benign nasal tumors, such as inverting papilloma, endoscopic resection of a documented JNA has not been previously reported. This technique is reserved for tumors which are limited to the nasal cavity and paranasal sinuses with minimal extension into the pterygopalatine fossa.

Porcine model of airway mucosal injury.

PURPOSE: The development of a reliable animal model of laryngeal or tracheal stenosis has been limited by lack of reproducibility, high morbidity and mortality, and cumbersome technique. The small size of previously proposed models has limited the development of innovative reconstructive techniques. MATERIALS AND METHODS: Eleven of 15 post-weanling commercial piglets underwent injury by a sharpened metal rod to the anterior half of the subglottic region at repeated intervals under endoscopic guidance. Four of 15 animals did not undergo injury and served as control for normal subglottic growth over time. Each airway was sized by endotracheal tube (ETT) passage and endoscopic photography over time, and the degree of total stenosis was estimated in comparison to the control animals. RESULTS: The first two animals underwent daily injury and expired from copious granulation tissue. Eight additional animals developed symptomatic subglottic stenosis manifested by audible stridor and intercostal retractions while undergoing injury every third day. Photographs documented the size of the stenosis to be greater than 50% (40% by ETT sizing) with a mean of three injuries in a mean time of 18 days. CONCLUSION: The porcine model shows a high degree of tolerance with minimal morbidity and consistent reliable results in an animal model of airway stenosis that is suitable for further innovative studies.