Objective Sizing of Upper Airway Stenosis: A Quantitative Endoscopic Approach

Nouraei, S.A.R.; McPartlin, David; Nouraei, Seyed Mahmoud; Patel, Anil; Ferguson, C.; Howard, David; Sandhu, Guri

doi:10.1097/01.mlg.0000186657.62474.88

Cited by 34 publications

(39 citation statements)

References 13 publications

(38 reference statements)

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“…20 Using endoscopic views of the airway to judge changes in stenosis can be unreliable, given the impact of lens distortion and tilt. 21 Methods to eliminate these confounders using mathematical algorithms has been described in an effort to establish a method for quantitative airway sizing. This method is limited to direct laryngoscopic views, whereas our series relies on views obtained using a flexible bronchoscope.…”

Section: Discussionmentioning

confidence: 99%

Airway Management and Endoscopic Treatment of Subglottic and Tracheal Stenosis

Vorasubin

Vira

Jamal

et al. 2014

Ann Otol Rhinol Laryngol

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Objectives The objective is to present clinical outcomes of subglottic and tracheal stenosis treated by flexible bronchoscopic delivery of carbon dioxide (CO2) laser via laryngeal mask airway (LMA). Methods All consecutive, nontracheotomy dependent cases of subglottic and tracheal stenosis treated endoscopically over a 4-year period were retrospectively reviewed. The surgical approach consisted of radial incisions using a flexible fiber-based CO2 laser, balloon dilation, and topical application of mitomycin C. Ventilation during the procedure occurred through the LMA, and the CO2 laser fiber was delivered through the working channel of a flexible bronchoscope passed through the LMA. Number of dilations, period between dilations, and operative times were reviewed. Results Eleven patients who underwent airway intervention during the study period were identified. Average follow-up was 28 months. Etiologies of airway stenosis included intubation injury (6), idiopathic (4), or autoimmune disease (1), requiring an average of 1.3, 1.5, and 3 dilations, respectively. Average operative time was 67 minutes. Autoimmune etiology correlated with more frequent dilations. Conclusion LMA is an effective way to manage ventilation while simultaneously allowing unencumbered flexible bronchoscopic access for laser surgery, balloon dilation, and mitomycin C application for airway stenosis. Long-term success in treating stenosis is achievable using this technique.

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Section: Discussionmentioning

confidence: 99%

Airway Management and Endoscopic Treatment of Subglottic and Tracheal Stenosis

Vorasubin

Vira

Jamal

et al. 2014

Ann Otol Rhinol Laryngol

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“…One of the main shortcomings in the field of adult airway restoration has been the absence of objective and scientific measures of outcome. Over the last 3 yrs, we have been able to develop and validate methods and instruments for assessing patient outcome at anatomical [5], physiological [6] and functional [7] levels. Wegener's granulomatosis leading to acute airway compromise, using intralesional steroid therapy, laser surgery and dilatation.…”

Section: My Winning Poster As Part Of My Research and My Research As mentioning

confidence: 99%

Results of endoscopic surgery and intralesional steroid therapy for airway compromise due to tracheobronchial Wegener's granulomatosis

Nouraei¹,

Obholzer²,

Ind³

et al. 2008

European Respiratory Review

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Background: Upper airway compromise due to tracheobronchial stenosis commonly occurs in patients with Wegener's Granulomatosis (WG). There is at present no consensus on the optimal management of this life-threatening condition.Objective: To assess the results of laryngo-tracheo-bronchoscopy, intralesional steroid therapy, laser surgery, and dilatation in managing obstructive tracheobronchial WG.Methods: Records of eighteen previously-untreated stridulous patients with obstructive tracheobronchial WG, treated between 2004 and 2006 were prospectively recorded on an airway database and retrospectively reviewed. Information about patient and lesion characteristics and treatment details were recorded. Treatment progress was illustrated using a timeline plot, and intervention-free intervals were calculated with actuarial analysis.Results: There were nine males and the average age at presentation was 40 (16) years [range 13-74]. There were thirteen patients with tracheal, and five patients with tracheal and bronchial lesions. The average tracheal lesion height was 8 (3) mm, located 23 (9) mm below the glottis. There were 1, 10 and 7 Myer-Cotton grade I, II and III lesions respectively. Mean intervention-free interval following minimally-invasive treatment was 26 (2.8) months. Following endobronchial therapy the median intervention-free interval was 22 months (p.0.8 vs. tracheal lesions). No patient required a tracheostomy or endoluminal stenting.Conclusions: Intralesional steroid therapy and conservative endoluminal surgery is an effective strategy for treating airway compromise due to active tracheal and bronchial WG, obviating the need for airway bypass or stenting. We recommend the combination of endotracheal dilatation, conservative laser surgery and steroid therapy as the standard of care for treating airway compromise due to obstructive tracheobronchial WG.

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“…It may be possible to further increase feature point recognition by spraying either dye or contrast into the airway. The effect of tilt and centricity still has to be further evaluated but appears less important than in previous works [7].…”

Section: Image Acquisitionmentioning

confidence: 93%

“…A qualitative point cloud model was then created by applying this analysis to each frame in the sequence. In order to achieve a quantitative model an instrument of a known dimension was placed in the airway and the video analyzed as above [5,7]. The known instrument measurements were then used to apply a scale to the rest of the model.…”

Section: Part Imentioning

confidence: 99%