Clinical, histological and electron microscopic aspects of vocal fold granulomas

Martins, Regina Helena Garcia; Dias, Norimar Hernandes; Santos, Daniela Carvalho dos; Fabro, Alexandre Todorovic; Bráz, José Reinaldo Cerqueira

doi:10.1016/s1808-8694(15)30842-9

Cited by 19 publications

(21 citation statements)

References 16 publications

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“…(5) The presence of the endotracheal tube triggers all the histological phenomena of aggression and defense of the laryngotracheal mucosa, which do not depend on the duration of intubation. Duration of intubation seems to favor only the predominance of destructive injury.…”

Section: Discussionmentioning

confidence: 99%

“…Duration of intubation seems to favor only the predominance of destructive injury. (5) The position of the endotracheal tube in relation to the labial commissure was associated with laryngotracheal injury. Of the 16 (53.3%) patients with clinical signs of laryngotracheal mucosa injury, in 12 (40%), the tube was angled different than 90° during the entire postoperative period.…”

Section: Discussionmentioning

confidence: 99%

“…The data collection instrument was created by the authors exclusively for this study, based on the scientific literature, (1)(2)(3)(4)(5) and submitted to face validation by three expert judges. The instrument is divided into five parts: pre-operative assessment; intraoperative monitoring; assessment 24 hours after extubation; assessment 48 hours after extubation; and assessment 72 hours after extubation.…”

Section: Methodsmentioning

confidence: 99%

“…However, some patients develop injuries even when intubation time is short. (1)(2)(3)(4)(5) Adequate aspiration technique, balloon pressure monitoring, and adequate mobilization of intubated patients, for example, are important activities that fall under the responsibility of the nursing staff. Handling accidental extubation or self-extubation, and all other actions that result from nursing care of patients with artificial airways must be conducted so as to mitigate any injury due to mechanical ventilation and the maintenance of artificial airways.…”

Section: Introductionmentioning

confidence: 99%

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Lesão de mucosa laringotraqueal e fatores associados após extubação endotraqueal: estudo piloto

et al. 2017

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Objective: To describe the clinical signs of laryngotracheal mucosal injuries and associated factors. Methods: This was an observational longitudinal study conducted with patients intubated due to general anesthesia. Assessment was carried out in the preoperative period, intraoperative period and at 24, 48, and 72 hours after extubation. Descriptive and exploratory statistics were used for analysis, in addition to odds ratio. Results: 53.3% of the sample presented at least one clinical sign of laryngotracheal mucosal injury, mainly: hoarseness (43.3%), dysphagia (40%), and odynophagia (33.3%). The following factors were associated: intracuff pressure above 25 cmH 2 O, intubation longer than 120 minutes, and the use of tubes larger than 7.5mm. Conclusion: The most common clinical signs of laryngotracheal mucosal injury among the studied population were hoarseness, dysphagia, and odynophagia, associated with cuff pressure above 25 cmH 2 O, followed by duration of intubation and inadequate endotracheal tube size. ResumoObjetivo: Descrever os sinais clínicos de lesão de mucosa laringotraqueal e seus fatores associados. Métodos: Estudo observacional, longitudinal, em pacientes intubados por ocasião da anestesia geral. Foram realizadas avaliações no pré-operatório, transoperatório, e nas 24, 48 e 72 horas após extubação. Para análise, utilizaram-se estatísticas descritiva e exploratória, e também foi verificada a razão de chances. Resultados: Dentre os pacientes, 53,3% apresentaram pelo menos um sinal clínico de lesão de mucosa laringotraqueal, sendo predominantes: rouquidão (43,3%), disfagia (40%) e odinofagia (33,3%). Estiveram associados aos seguintes fatores: pressão intra-cuff acima de 25cmH 2 O, intubação por mais de 120 minutos e uso de tubos maiores que 7,5mm. Conclusão: Os sinais clínicos de lesão de mucosa laringotraqueal mais frequentes na população deste estudo foram rouquidão, disfagia e odinofagia, associados à pressão do cuff acima de 25 cmH 2 O, seguido do tempo de intubação e tamanho inadequado de tubos endotraqueais.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Lesão de mucosa laringotraqueal e fatores associados após extubação endotraqueal: estudo piloto

et al. 2017

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“…No hay células gigantes, por lo cual el término correcto es "tejido de granulación" y no "granuloma". 11,12 Esta lesión no tiene potencial maligno.…”

Section: Figura 1 a Y B Granuloma Posintubación En La Apófisis Vocaunclassified

Granuloma laríngeo posintubación: una rara complicación de la intubación traqueal en pediatría. Caso clínico

et al. 2017

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Presentación de casos clínicos RESUMENLos granulomas laríngeos son lesiones benignas localizadas en el tercio posterior de la glotis, sobre todo, a nivel de la apófisis vocal del cartílago aritenoides. Típicamente, se asocian a tres factores etiológicos: intubación endotraqueal, uso inapropiado de la voz y/o reflujo gastroesofágico. La formación de un granuloma laríngeo posintubación es una complicación tardía relacionada con la lesión por la intubación. Es poco frecuente en el niño, en especial, si el período de intubación es corto. Generalmente, es unilateral y produce disfonía, sensación de cuerpo extraño faríngeo y tos. El tratamiento consiste en la escisión quirúrgica cuando la lesión es pediculada o causa compromiso respiratorio. Se presenta a una adolescente de 14 años que desarrolló un granuloma laríngeo pediculado después de una intubación orotraqueal de menos de 24 horas, el cual se hizo evidente 3 meses después de una cirugía cardíaca. Se describe la patogenia, las manifestaciones clínicas, el diagnóstico y el tratamiento de esta patología. Palabras clave: granuloma laríngeo, intubación endotraqueal, pediatría. ABSTRACTLaryngeal granulomas are benign lesions located in the posterior third of the glottis, mainly at the level of the vocal apophysis of the arytenoid cartilage. They are typically associated with three etiological factors: endotracheal intubation, inappropriate voice use and/or gastroesophageal reflux. The formation of a post-intubation laryngeal granuloma is a late complication related to intubation injury. It is uncommon in the child, especially if the period of intubation is short. It is usually unilateral and produces dysphonia, pharyngeal foreign body sensation and cough. Treatment consists of surgical removal when the lesion is pediculated or causes respiratory compromise. Granuloma laríngeo posintubación: una rara complicación de la intubación traqueal en pediatría. Caso clínico Post-intubation laryngeal granuloma: a rare complication of tracheal intubation in pediatrics. Case reportWe present a 14-year-old girl who developed a pediculated laryngeal granuloma after orotracheal intubation of less than 24 hours, which was evidenced 3 months after cardiac surgery. We describe the pathogenesis, clinical manifestations, diagnosis and treatment of this pathology.

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Structural and functional vocal fold epithelial integrity following injury

et al. 2014

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Objective An intact epithelium is an important part of vocal fold defense. Damage to the epithelium can compromise vocal fold homeostasis and protection of the host tissue from viral and bacterial invasion. Elucidating the effects of damage on epithelial architectural and barrier integrity provides insight into the role of epithelium in protecting vocal folds. Using an animal model, we evaluated the time course of structural and functional epithelial restoration following injury. Study design Prospective, controlled animal study. Methods Forty rats underwent surgery to remove vocal fold mucosa unilaterally. Larynges were harvested at five time intervals between 3 to 90 days post injury and were prepared for histological and permeability analyses. Results Rapid restoration of structural integrity was demonstrated by return of a multilayerd epithelium, intercellular junctions, and basement membrane at five days post-injury. Atypical epithelial permeability was observed up to five weeks post injury. Conclusion Restoration of epithelial barrier integrity lags epithelial structural restoration. Consequently, epithelial regeneration cannot be equated with return of functional barrier integrity. Rather, ongoing leakiness of regenerated epithelium indicates that vocal folds remain at risk for damage, pathogen invasion and remodeling post injury.

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Clinical, histological and electron microscopic aspects of vocal fold granulomas

Abstract: post intubation granulomas appear in any age and hoarseness is a frequent symptom. Morphological alterations occur in the corion as vessel proliferations, inflammation, and intracytoplasmatic alterations in fibroblasts suggesting cellular dysfunction and damage.

Cited by 19 publications

References 16 publications

Lesão de mucosa laringotraqueal e fatores associados após extubação endotraqueal: estudo piloto

Lesão de mucosa laringotraqueal e fatores associados após extubação endotraqueal: estudo piloto

Granuloma laríngeo posintubación: una rara complicación de la intubación traqueal en pediatría. Caso clínico

Structural and functional vocal fold epithelial integrity following injury

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