Tracheal Ceramic Rings for Tracheomalacia: A Review After 17 Years

Karaiskaki, Niki; Gerlinger, Imre; Mann, Wolf J.

doi:10.1097/mlg.0b013e31811edd90

Cited by 14 publications

(8 citation statements)

References 14 publications

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“…11 External tracheal stenting has been described with multiple materials, including silastic rings, ceramic rings, and titanium plates. This replacement of the anterior rings appears most amenable to the extrathoracic trachea.…”

Section: Tracheal and Endobronchial Stentsmentioning

confidence: 99%

“…Complications include damage to the recurrent laryngeal nerve and erosion into abutting blood vessels. 11 If titanium plates are used, emergent tracheostomy may be difficult because the rings are not easy to remove. The ceramic rings can be broken and removed without significant problems.…”

Section: Tracheal and Endobronchial Stentsmentioning

confidence: 99%

“…The ceramic rings can be broken and removed without significant problems. 11 External tracheal stenting is extrathoracic and extratracheal, and as such, management with a standard single-lumen endotracheal tube and anesthetic is appropriate. Bronchoscopy may be performed prior to operative repair.…”

Section: Tracheal and Endobronchial Stentsmentioning

confidence: 99%

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Anesthesia for Tracheobronchial Surgery

Wilkey

Alfille

Weitzel

et al. 2012

Semin Cardiothorac Vasc Anesth

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The airway is a crucial dynamic structure that spans different anatomical zones, including the intrathoracic, extrathoracic, tracheal, bronchial, and alveolar zones. Because of its vital role as the sole oxygen-conducting pathway to the alveoli, and hence to the human body, surgery involving any portion requires careful and specific planning by both the surgeon and the anesthesiologist. The review covers essential management points for proximal and distal tracheal procedures, including a discussion of tracheal stenting and tracheoplasty.

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Section: Tracheal and Endobronchial Stentsmentioning

confidence: 99%

Section: Tracheal and Endobronchial Stentsmentioning

confidence: 99%

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Anesthesia for Tracheobronchial Surgery

Wilkey

Alfille

Weitzel

et al. 2012

Semin Cardiothorac Vasc Anesth

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“…The extraluminal stents are configured as C‐shaped rings that are sutured to the abluminal surface of the deficient cartilaginous structures to prevent them from deforming under negative pressure or compression. Extraluminal stents have shown promise for treatment of tracheomalacia in veterinary applications, and limited clinical reports in adults suggest that extraluminal stents are associated with fewer complications compared with intraluminal stents . In both veterinary applications and adult clinical cases, the need for structural support is permanent, so non‐degradable polymers and ceramics have been the materials of choice.…”

Section: Introductionmentioning

confidence: 99%

“…Extraluminal stents have shown promise for treatment of tracheomalacia in veterinary applications, [3][4][5] and limited clinical reports in adults suggest that extraluminal stents are associated with fewer complications compared with intraluminal stents. 6 In both veterinary applications and adult clinical cases, the need for structural support is permanent, so non-degradable polymers and ceramics have been the materials of choice. In the pediatric population, the cartilage deficiency will improve spontaneously so stenting would only be needed for the first 1 to 2 years of life.…”

Section: Introductionmentioning

confidence: 99%

Evaluation of magnesium‐yttrium alloy as an extraluminal tracheal stent

Luffy

Chou

Waterman

et al. 2013

J Biomedical Materials Res

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Tracheomalacia is a relatively rare problem, but can be challenging to treat, particularly in pediatric patients. Due to the presence of mechanically deficient cartilage, the trachea is unable to resist collapse under physiologic pressures of respiration, which can lead to acute death if left untreated. However, if treated, the outcome for patients with congenital tracheomalacia is quite good because the cartilage tends to spontaneously mature over a period of 12 to 18 months. The present study investigated the potential for the use of degradable magnesium-3% yttrium alloy (W3) to serve as an extraluminal tracheal stent in a canine model. The host response to the scaffold included the formation of a thin, vascularized capsule consisting of collagenous tissue and primarily mononuclear cells. The adjacent cartilage structure was not adversely affected as observed by bronchoscopic, gross, histologic, and mechanical analysis. The W3 stents showed reproducible spatial and temporal fracture patterns, but otherwise tended to corrode quite slowly, with a mix of Ca and P rich corrosion product formed on the surface and observed focal regions of pitting. The study showed that the approach to use degradable magnesium alloys as an extraluminal tracheal stent is promising, although further development of the alloys is required to improve the resistance to stress corrosion cracking and improve the ductility.

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Airway stents in children

Nicolaï¹

2008

Pediatric Pulmonology

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Airway obstruction in children is a rare, but difficult clinical problem, with no clear agreement on optimal therapeutic approach. Stenting of the airway has been used successfully in adults, and is an attractive alternative in children. Fundamental differences of pediatric compared to adult use include the benign nature of most stenoses, the narrow and soft airways of children, the required long-term tolerance and adaptation to growth. These differences may significantly alter the therapeutic balance, calling into question the precise role stents play in the treatment of airway obstruction in children. Stent placement can be technically demanding but is not exceedingly difficult. Experience is necessary to select the proper size and type of stent. Metal stents usually achieve airway patency and clinical improvement in the majority of cases, while this is less frequently the case with silicone stents. Some complications such as granulation and secretion retention seem to occur in most children after stent implantation. Unfortunately, severe complications including death have been reported in a significant proportion of children. Stent related mortality can be estimated at 12.9% from published data, but these include complication centered reports. The initial euphoria for airway stents in children has largely abated and most authors agree that they should only be employed in circumstances with no good alternatives. It is crucial that all surgical and medical alternatives are considered and the decision to place a stent is not made because other options are overlooked or not available locally. Stent use in a palliative setting has also been reported and is probably reasonable. Stents will only allow limited adaptation for the growth of pediatric airways by balloon dilatation. All metal stents should be considered as potentially permanent, and removal sometimes may only be possible through a surgical and sometimes risky approach.

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Tracheal Ceramic Rings for Tracheomalacia: A Review After 17 Years

Cited by 14 publications

References 14 publications

Anesthesia for Tracheobronchial Surgery

Anesthesia for Tracheobronchial Surgery

Evaluation of magnesium‐yttrium alloy as an extraluminal tracheal stent

Airway stents in children

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