Laryngotracheal stenosis: Mechanistic review

Carpenter, Delaney; Hamdi, Osama; Finberg, Ariel M.; Daniero, James J.

doi:10.1002/hed.27079

Cited by 21 publications

(8 citation statements)

References 62 publications

(137 reference statements)

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“…Tracheal stenosis caused by endotracheal intubation primarily results from prolonged intubation, leading to mucosal necrosis, sloughing, and exposure of the cartilage 23 . In some cases, this can even lead to chondritis and chondronecrosis, ultimately causing abnormal healing and subsequent stenosis 24 . Although tracheal stenosis models created by endotracheal intubation best simulate the pathological process seen in clinical tracheal stenosis patients, these models are mostly implemented in large animals such as pigs and dogs 5 , 6 , 22 .…”

Section: Discussionmentioning

confidence: 99%

Comparative evaluation of mechanical injury methods for establishing stable tracheal stenosis animal models

Lin,

Ainiwaer,

Jiang

et al. 2024

Sci Rep

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The study aimed to assess the stability of various mechanical injury techniques in creating tracheal stenosis animal models using endoscopic assistance and investigate the viability of tracheal stoma in this process. Twenty-six healthy adult New Zealand white rabbits were randomly assigned to an experimental and control group. The experimental group underwent tracheal incision followed by steel brush scraping with endoscopic assistance, while the control group received nylon brush scraping. Within the control group, two subgroups were formed: Group A underwent scraping without tracheal stoma, and Group B underwent scraping followed by tracheal stoma. Additionally, a sham operation was performed on a separate group without subsequent scratching, resulting in no stenosis formation. Endoscopic observations were conducted at 7, 14, and 21 days post-scraping, followed by histological examinations of euthanized rabbits on the 21st day. Notably, all rabbits in the non-stoma group survived without complications, whereas Group B rabbits faced mortality post-operation. Histological assessments revealed inflammatory cell infiltration, fibroblast proliferation, and collagen fiber deposition in narrowed tracheal specimens. Steel brush scraping with endoscopic assistance proved more effective in inducing stable tracheal stenosis compared to nylon brush scraping. However, the survival challenges of rabbits with tracheal fistula require further investigation.

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Section: Discussionmentioning

confidence: 99%

Comparative evaluation of mechanical injury methods for establishing stable tracheal stenosis animal models

Lin,

Ainiwaer,

Jiang

et al. 2024

Sci Rep

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“…Trauma to the tracheal mucosa and cartilage causes injury and increases the risk for subsequent tracheal stenosis. The mechanisms for tracheal stenosis for intubated patients are much better described than they are for tracheostomy patients; the highest rates of stenosis are associated with prolonged intubation, high cuff pressures, and correlated to the location of the endotracheal cuff 9,10 . There is great variability regarding the rates of developing tracheal stenosis following tracheotomy procedures, from as low as 0.6% to as high as 85% 11,12 .…”

Section: Discussionmentioning

confidence: 99%

Comparison of Mechanical Forces used in Open Tracheotomy versus Percutaneous Tracheotomy Techniques

et al. 2023

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ObjectiveTo understand the etiology of tracheotomy‐induced tracheal stenosis by comparing the differences in techniques and mechanical force applied with open tracheotomy (OT) versus percutaneous tracheotomy (PCT) placement.MethodsThis study is an unblinded, experimental, randomized controlled study in an ex‐vivo animal model. Simulated tracheostomies were performed on 10 porcine tracheas, 5 via a tracheal window technique (OT) and 5 using the Ciaglia technique (PCT). The applied weight during the simulated tracheostomy and the compression of the trachea were recorded at set times during the procedure. The applied weight during tracheostomy was used to calculate the tissue force in Newtons. Tracheal compression was measured by anterior–posterior distance compression and as percent change.ResultsAverage forces for scalpel (OT) versus trocar (PCT) were 2.6 N and 12.5 N (p < 0.01), with the dilator (PCT) it was 22.02 N (p < 0.01). The tracheostomy placement with OT required an average force of 10.7 N versus 23.2 N (p < 0.01) with PCT. The average change in AP distance when using the scalpel versus trocar was 21%, and 44% (p < 0.01), with the dilator it was 75% (p < 0.01). The trach placement with OT versus PCT had an average AP distance change of 51% and 83% respectively (p < 0.01).ConclusionThis study demonstrated that PCT required more force and caused more tracheal lumen compression when compared to the OT technique. Based on the increased force required for PCT, we suspect there could also be an increased risk for tracheal cartilage trauma.Level of EvidenceN/A Laryngoscope, 2023

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“…Tracheostomy and prolonged intubation are the most common causes of benign acquired tracheal stenosis (AST) 1 . Under the influence of pathogenic factors, pathological repair occurs in the healing process after trachea injury.…”

Section: Introductionmentioning

confidence: 99%

“…Tracheostomy and prolonged intubation are the most common causes of benign acquired tracheal stenosis (AST). 1 Under the influence of pathogenic factors, pathological repair occurs in the healing process after trachea injury. It involves a series of complex pathophysiological changes, including inflammation, cell differentiation and proliferation, extracellular matrix (ECM) accumulation, and tissue structure reconstruction.…”

Section: Introductionmentioning

confidence: 99%

Down‐regulation of miR‐21‐5p by pirfenidone to inhibit fibroblast proliferation in the treatment of acquired tracheal stenosis

Li,

Huang,

Wei

et al. 2023

Clinical Respiratory J

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ObjectiveTreatment options for acquired tracheal stenosis (ATS) are limited due to a series of pathophysiological changes including inflammation and cell proliferation. Micro ribonucleic acid‐21‐5p (miR‐21‐5p) may promote the excessive proliferation of fibroblasts. However, various types of fibrosis can be prevented with pirfenidone (PFD). Currently, the effect of PFD on miR‐21‐5p and its biological function has not been clarified. In this study, PFD was evaluated as a potential treatment for ATS by inducing fibroblast proliferation in lipopolysaccharide (LPS)‐induced fibroblasts by targeting miR‐21‐5p.MethodsFor 48 h, 1 g/ml LPS was used to generate fibroblasts in vitro, followed by the separation of cells into four groups: control, PFD, mimic, and mimic + PFD. The Cell Counting Kit‐8 (CCK‐8) technique was adopted to measure the proliferation of fibroblasts. Real‐time quantitative polymerase chain reaction (RT‐qPCR) and Western blot (WB) were used to measure the relative expressions of tumor necrosis factor‐α (TNF‐α), transforming growth factor‐β1 (TGF‐β1), drosophila mothers against decapentaplegic 7 (Smad7) and collagen type I alpha 1(COL1A1) messenger RNA (mRNA) and proteins, respectively.Results(1) At 0, 24, 48, and 72 h, fibroblast growth was assessed using the CCK‐8 method. Compared with the control group, the mimic group showed the highest fibroblast viability, and the PFD group showed the lowest fibroblast viability. However, fibroblast viability increased in the mimic + PFD group but decreased in the mimic one. (2) RT‐qPCR and WB showed that the mimic group exhibited a significant up‐regulation in the relative expressions of TNF‐α, TGF‐β1, and COL1A1 mRNA and proteins but a down‐regulation in the relative expression of Smad7 mRNA and protein compared with the control one. In the PFD group, the results were the opposite. Nevertheless, the relative expressions of TNF‐α, TGF‐β1, and COL1A1 mRNA and proteins were increased, whereas that of Smad7 mRNA was decreased in the mimic + PFD group. The change was less in the mimic group.ConclusionPFD may have a preventive and curative effect on ATS by inhibiting fibroblast proliferation and the fibrotic process and possibly through down‐regulating miR‐21‐5p and up‐regulating Smad7 and its mediated fibrotic and inflammatory responses.

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Laryngotracheal stenosis: Mechanistic review

Cited by 21 publications

References 62 publications

Comparative evaluation of mechanical injury methods for establishing stable tracheal stenosis animal models

Comparative evaluation of mechanical injury methods for establishing stable tracheal stenosis animal models

Comparison of Mechanical Forces used in Open Tracheotomy versus Percutaneous Tracheotomy Techniques

Down‐regulation of miR‐21‐5p by pirfenidone to inhibit fibroblast proliferation in the treatment of acquired tracheal stenosis

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