Long-term T-tube stenting as definitive treatment of severe acquired subglottic stenosis in children

Zaima, Azusa; Bitoh, Yuko; Morita, Keiichi; Tsugawa, Jiro; Ishii, Tomohiro; Satoh, Shiiki; Nishijima, Eiji

doi:10.1016/j.jpedsurg.2010.02.035

Cited by 10 publications

(6 citation statements)

References 12 publications

(18 reference statements)

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“…The T-tubes in children have an established role in complex cases of laryngeal and sub-glottic stenosis, where there is extensive re-stenosis or granulation tissue following laryngo-tracheo reconstruction (LTR) or in primary cases where surgical reconstruction would be inappropriate [9]. In these cases the T-tube primarily acts as a stent, with the vertical limb sitting above the level of the glottis.…”

Section: Discussionmentioning

confidence: 99%

Montgomery© T-tubes in the management of multilevel airway obstruction in mucopolysaccharidosis

Soni-Jaiswal

Penney

Jones

et al. 2014

International Journal of Pediatric Otorhinolaryngology

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Section: Discussionmentioning

confidence: 99%

Montgomery© T-tubes in the management of multilevel airway obstruction in mucopolysaccharidosis

Soni-Jaiswal

Penney

Jones

et al. 2014

International Journal of Pediatric Otorhinolaryngology

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“…This inflammation often extends to the supraglottic, glottic, and subglottic areas, and successful treatment of the larynx without recurrence due to granulation tissue in the same fashion as CSS remains difficult. We consider that retention of the tracheal opening by TOR at LTP is also important when treating children with acquired subglottic stenosis, and long-term T-tube stenting is recommended as the initial treatment if the stenosis is severe [14]. …”

Section: Discussionmentioning

confidence: 99%

Strategy for surgical treatment of congenital subglottic stenosis in children

et al. 2012

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Background/purposeCongenital subglottic stenosis is a rare anomaly caused by thickened cricoid cartilage. We report our surgical techniques, comprising anterior cricoid split (ACS), laryngotracheoplasty (LTP), KTP laser ablation, and application of a tracheal opening retainer (TOR) into the tracheostomy site.MethodsNine patients have been treated since 1988. Four patients (median age 85 days; range 5 days to 6 months) underwent ACS. Another four patients (median age, 17 months; range, 5–57 months) underwent LTP using costal cartilage grafts, although two had undergone tracheostomy before LTP. One patient underwent LTP, ablation of the projecting part of the cricoid cartilage with KTP laser (LTP + Laser) and, preservation of the tracheal opening by placement of the TOR.ResultsAll ACS and LTP patients were successfully extubated at a median of 32 days (range 23–91 days) and 23 days (range 6–31 days) postoperatively, respectively. The LTP + Laser patient was extubated 35 days after surgery and the TOR was removed asymptomatically 20 days after extubation of the stent tube.ConclusionsAnterior cricoid split is useful for patients ≤6 months old and LTP is useful for patients >6 months old and/or with tracheostomy. KTP laser ablation is effective to remove thickened parts of cricoid cartilage protecting the vocal cords. The tracheal opening preserved by the TOR works as an additional channel to safeguard respiration during the extubation process.

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“…Translaryngeal intubation (TLI) is commonly performed for mechanical ventilation during anesthetic and intensive care settings as well as cardiopulmonary resuscitation. In the current practice, TLI is performed for 2 weeks or even longer in adults [1,2], while TLI is kept for much longer periods in children [3]. As many as 30% of patients requiring prolonged mechanical ventilation (MV) eventually receive a tracheotomy [4].…”

Section: Introductionmentioning

confidence: 99%

Influence of prolonged translaryngeal intubation on airway complications: a retrospective comparative analysis

Shimizu

Mizutani

Hagiya

et al. 2019

Eur Arch Otorhinolaryngol

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Purpose Tracheostomy is usually suggested to facilitate airway management of intensive care unit (ICU) patients requiring prolonged translaryngeal intubation (PTLI). While it is not uncommon for physicians to hesitate and delay to perform it for more than 2 weeks, clinically recognizable airway adverse effects following PTLI are rarely discussed. Therefore, we compared retrospectively the PTLI group with control to assess them in adult patients. Methods During a period of 1991-2012, patients aged older than 15 years that were admitted to University of Tsukuba Hospital ICU, underwent translaryngeal intubation (TLI) for 14 days or longer, were retrospectively studied as Group P. Patients whose tracheas were intubated for 13 days or less were set up as a control group (Group C). Patients were excluded if they had undergone any procedures that might have affected recurrent laryngeal nerves. Results Ninety-eight patients (M:F = 58:40) (group P) and 88 patients (M:F = 58:30) (group C) were included. There were no differences in patients' characteristics. Durations of TLI were 20.8 ± 6.8 days in group P and 3.8 ± 3.0 days in group C. There were no differences in the occurrence rates of severe airway adverse events. Although we found higher incidence rates of dysphagia and dysphonia/hoarseness in group P, the symptoms were mild and they were not prolonged. There were no differences in other signs and symptoms. Conclusions We found no difference in the occurrence rates of severe airway adverse events in both groups. Translaryngeal intubation may be tolerable in adults even if the duration exceeds 2 weeks.

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Long-term T-tube stenting as definitive treatment of severe acquired subglottic stenosis in children

Abstract: T-tube stenting for severe acquired subglottic stenosis is recommended as a best available treatment in postoperative quality of life. T-tube stenting should be performed as the initial treatment because the time to decannulation was shorter than as an additional operation.

Cited by 10 publications

References 12 publications

Montgomery© T-tubes in the management of multilevel airway obstruction in mucopolysaccharidosis

Montgomery© T-tubes in the management of multilevel airway obstruction in mucopolysaccharidosis

Strategy for surgical treatment of congenital subglottic stenosis in children

Influence of prolonged translaryngeal intubation on airway complications: a retrospective comparative analysis

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