Laryngotracheal Reconstruction at Relapsing Polychondritis

Abstract

Relapsing polychondritis (RP) is characterized by chronic, recurrent episodes of inflammation with eventual degeneration of cartilaginous tissues including the ears, nose, larynx, trachea, and so on. Tracheobronchomalacia and airway stenosis may be seen in RP. In this report, we describe 3 female patients presenting with progressive dyspnea owing to laryngotracheal involvement of RP who underwent laryngotracheal reconstruction.

Quantitative Computed Tomography Measurement of Tracheal Cross-Sectional Areas in Relapsing Polychondritis: Correlations with Spirometric Values

“…For example, although we excluded patients with tracheotomy due to unreliable spirometric values, monitoring a stenosis at the trachea and proximal bronchi by chest CT is feasible for RP patients with tracheotomy, which can be used as an alternative examination to spirometry. This can also be expanded to early detection in the progression of the most stenotic point, which should be treated by a more invasive method, such as the insertion of a silicon T-tube, stent placement, or surgical airway reconstruction [23,24,25,26,27]. Furthermore, CT-based airway measurements could be beneficial to screen early-stage and stable patients.…”

Relapsing polychondritis: a review

“…Silicon T-tubes are an effective treatment measure for preserving airway patency in patients with tracheal stenosis due to the disease [97]. Karamen et al [98] described surgical reconstruction of the laryngotracheal region in three patients with extensive respiratory involvement. A case of life-threatening bilateral tension pneumothorax and tension pneumoperitoneum that developed after a tracheal tear during Montgomery T-tube insertion in a patient with tracheal stenosis due to RP has been described [99].…”

Translating tissue-engineered tracheal replacement from bench to bedside

“…Rings of cartilage varying in length, location, and severity [77,78] Tracheomalacia Trachea is floppy due to weakness of the tracheal walls [79] Vascular anomalies Abnormally formed blood vessels leading to tracheo-esophageal compression [80] Tracheoesophageal fistulas Abnormal connection (fistula) between the esophagus and the trachea [81] Tracheal cysts Evaginations of embryologic tracheal buds [82] Trachiectasis Abnormal tracheal bifurcation above the level of the carina [83] Laryngotrachesophageal cleft Defect of the posterior larynx and trachea and the anterior wall of the esophagus [84] Cancer Adeno cystic lung carcinoma Primary malignant tumor, non-small cell lung cancer usually begins in the periphery of the lungs [85] Squamous cell lung carcinoma Primary malignant tumor, usually starts in the bronchial tubes in the central part of the lungs [86] Infection Tuberculosis Caused by Mycobacterium tuberculosis [87] Lemierre's syndrome Nasopharyngitis due to Fusobacterium necrophorum [88] Deep cervical space infections Mixed infections caused by aerobic and anaerobic bacteria [89] Croup Acute viral respiratory illness [90] Bacterial Clinical problem caused by regional ischemic necrosis of the airway [93] Post-tracheotomy Stenosis following tracheostomy [94] Trauma Facial trauma Vehicle accidents [95] Laryngotracheal, inhalation injuries, endotracheal tube Injuries due to thermal and chemical substance and postextubation [96] Foreign-body aspiration Penetration syndrome Foreign bodies migrate through trachea and lodge in bronchi, e.g., food products [97] Autoimmune and associated diseases Wegener's granulomatosis Antineutrophilcytoplasmic antibody (ANCA)-associated vasculitis [98] Sarcoidosis Granulomatous infiltration and obstruction of the upper airways [99] Pulmonary amyloidosis Proteinaceous deposits on tracheal walls [100] Relapsing polychondritis Recurrent episodes of inflammation of cartilaginous tissues [101] Tracheopathiaosteoplastica Benign cartilaginous and osseous metaplasia of tracheobronchial tree [102] [107] many attempts at tracheal replacement that seems to offer any real promise. Regenerative medicine, an emerging novel approach in modern medicine, is based on the ''re-growing'' of living tissue in the labor...…”