Airway reconstruction: review of an approach to the advanced-stage laryngotracheal stenosis

Bitar, Mohamad; Barazi, Randa; Barake, Rana

doi:10.1016/j.bjorl.2016.03.012

Cited by 27 publications

(35 citation statements)

References 37 publications

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“…Airway stenosis most frequently occurs in the larynx or the proximal trachea, and diagnosis as well as location of stenosis can be determined by flexible laryngoscope . All subjects in the current study had only one location of stenosis, with a breakdown of 30% subglottic stenosis, 30% glottis stenosis, and 40% tracheal stenosis (Table ).…”

Section: Discussionsupporting

confidence: 92%

“…Airway stenosis most frequently occurs in the larynx or the proximal trachea, and diagnosis as well as location of stenosis can be determined by flexible laryngoscope. 8 All subjects in the current study had only one location of stenosis, with a breakdown of 30% subglottic stenosis, 30% glottis stenosis, and 40% tracheal stenosis (Table I). McCaffrey 60 reported that subglottic stenosis accounted for about 46% of all cases of LTS, followed by both subglottic and glottic stenosis (19%) and both subglottic and tracheal stenosis (18%).…”

Section: Discussionmentioning

confidence: 90%

“…Diagnostic assessment for LTS include flexible laryngoscopy, bronchoscopy, pulmonary function tests, and computed tomography (CT) . Treatment and care for LTS patients cross multiple specialists (e.g., otolaryngologists, thoracic surgeons, and interventional pulmonologists) and involve medical therapy, endoscopic dilation, and airway reconstruction …”

Section: Introductionmentioning

confidence: 99%

“…1,7 Treatment and care for LTS patients cross multiple specialists (e.g., otolaryngologists, thoracic surgeons, and interventional pulmonologists) and involve medical therapy, endoscopic dilation, and airway reconstruction. 3,6,[8][9][10][11] Although these treatments are often sufficient to relieve symptoms of LTS-induced airway obstruction, the rate of recurrence is significant. 4,[12][13][14][15][16][17] There is a lack of consensus regarding preventative treatment and surveillance because interventions for LTS are performed by multiple specialists with variable expertise and understanding of the underlying pathophysiology.…”

Section: Introductionmentioning

confidence: 99%

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Investigating the effects of laryngotracheal stenosis on upper airway aerodynamics

et al. 2017

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Section: Discussionsupporting

confidence: 92%

Section: Discussionmentioning

confidence: 90%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Investigating the effects of laryngotracheal stenosis on upper airway aerodynamics

et al. 2017

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“…2,[4][5][6] T y p i c a l l y , m a n a g e m e n t s t r a t e g i e s a r e determined by the severity of obstruction in the subglottic lumen; the Cotton-Myer grading system is the classification most commonly used to this end: grade 1, < 50 % obstruction; grade 2, 51-70 % obstruction; grade 3, 71-99 % obstruction; and grade 4, complete luminal obstruction. 2,7 In general, mild stenoses (grades 1 and 2) are managed without surgery. In the past, the most severe grades were treated with a tracheostomy or an open surgery.…”

Section: Introductionmentioning

confidence: 99%

Endoscopic treatment of acquired subglottic stenosis in children: Predictors of success 10.5546/aap.2018.eng.422

Cuestas

Rodríguez

Doormann

et al. 2018

Arch Argent Pediatr

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Subglottic stenosis is a congenital or acquired disease characterized by the narrowing of the airways, from the vocal cords to the lower border of the cricoid cartilage. It is one of the main causes of stridor and respiratory distress in children.More than 90 % of laryngeal stenoses are acquired due to prolonged endotracheal intubation. The pediatric management of subglottic stenosis is complex and may be affected by different factors that have an impact on the final outcome. Treatment may involve endoscopic procedures and/or open surgeries.Here we describe our experience in 35 patients with acquired subglottic stenosis who underwent endoscopic treatment with rigid dilation and identify the potential predictors of success of this technique.

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Association Between Red Blood Cell Distribution Width and Outcomes of Open Airway Reconstruction Surgery in Adults

Xie

Rehman

Francis

et al. 2019

JAMA Otolaryngol Head Neck Surg

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aryngotracheal stenosis (LTS) is a life-threatening, fixed, extrathoracic restriction in pulmonary ventilation. It is an umbrella term that encompasses airway compromise at the level of the larynx, subglottis, or cervical trachea and is a common consequence of multiple pathophysiologic processes. 1-3 The goal of surgical treatment is to improve airway caliber to mitigate the patient's dyspnea and achieve prosthesisfree breathing (eg, without tracheostomy, intraluminal stent, or T-tube). 2,4-10 Successful surgical outcomes depend on many factors, including technical expertise, pulmonary function, and patient characteristics. Rates of achieving prosthesis-free breathing after adult open airway reconstruction surgery vary in the literature from 57% to 100%. 10 With few exceptions, 3 all LTS surgical studies have been small, single-institution case series. To date, variables associated with prosthesis-free breathing after LTS surgery include anatomical (eg, degree of luminal compromise, length of stenosis, and laryngeal involvement) 3,5 and patient-specific (eg, diabetes, obstructive sleep apnea, congestive heart failure, and gastroesophageal reflux disease) factors. 4,8 Despite the importance of preoperative risk stratification to minimize postoperative IMPORTANCE Airway reconstruction for adults with laryngotracheal stenosis (LTS) is directed toward improving airway caliber to mitigate the patient's dyspnea and achieve prosthesis-free breathing (ie, without tracheostomy, intraluminal stent, or T-tube). Despite the importance of preoperative risk stratification to minimize postoperative complications, consensus on an objective predictive algorithm for open airway reconstruction is lacking. OBJECTIVE To determine whether the ability to achieve a prosthesis-free airway in adults after open airway reconstruction is associated with red blood cell distribution width (RDW) at the time of surgery. DESIGN, SETTING, AND PARTICIPANTS Case series study investigating 92 consecutive patients 18 years and older with laryngotracheal stenosis who underwent open airway reconstruction at a US tertiary care hospital from January 1, 2006, to January 1, 2017. MAIN OUTCOMES AND MEASURES The main outcome was a prosthesis-free airway (absence of tracheostomy, intraluminal stent, or T-tubes) at last follow-up. Multivariate logistic regression modeling was used to identify independent factors associated with this outcome. RESULTS Of the 92 patients who met inclusion criteria, the median (interquartile range) age was 44 (33.0-60.3) years; 50 (53%) were female, and 82 (89%) were white. In all, 74 patients (80%) were prosthesis free at the last follow-up (mean, 833 days; 95% CI, 10-4229 days). In multivariate analyses, airway decannulation was significantly correlated with reduced RDW (odds ratio [OR], 0.40; 95% CI, 0.19-0.84) and the absence of posterior glottic stenosis (OR, 0.12; 95% CI, 0.04-0.37). CONCLUSIONS AND RELEVANCE These data suggest that surgical success in open airway reconstruction is significantly associated with RDW and whethe...

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Airway reconstruction: review of an approach to the advanced-stage laryngotracheal stenosis

Abstract: The review of our approach to open airway repair/reconstruction showed its efficacy in advanced-stage laryngotracheal stenosis. Good knowledge of a variety of reconstructive techniques is important to achieve good results in a variety of age groups.

Cited by 27 publications

References 37 publications

Investigating the effects of laryngotracheal stenosis on upper airway aerodynamics

Investigating the effects of laryngotracheal stenosis on upper airway aerodynamics

Endoscopic treatment of acquired subglottic stenosis in children: Predictors of success 10.5546/aap.2018.eng.422

Association Between Red Blood Cell Distribution Width and Outcomes of Open Airway Reconstruction Surgery in Adults

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