Tracheomalacia Repair Using Ceramic Rings

Abstract

Tracheomalacia resulting from tracheostomy or compressive thyroid disease often represents a difficult problem in airway management. In an attempt to improve this condition, biocompatible ceramic rings were surgically implanted in 16 patients to restore normal patency of the airway by first expanding the tracheal lumen lateral, and then in an anterior dimension. Preoperatively, patients displayed moderate to severe obstruction with marked restrictions in lifestyle, as confirmed by history, physical examination, and airway resistance studies. Additionally, three of these patients were trach-dependent at the time of implantation. Postoperatively all 16 patients have normal airway resistance parameters with a dramatic improvement in lifestyle, whereas the three with tracheostomy were successfully decannulated. The routine use of these rings has alleviated the need for rib/cartilage grafts, primary resections with anastomosis, prolonged periods of cannulation, and multiple surgeries. Our experience in the use of ceramic rings for tracheomalacia repair will be presented, highlighting selection criteria for their use, intraoperative placement, perioperative complications, and post-operative followup for a minimum of 6 months.

Tracheal Ceramic Rings for Tracheomalacia: A Review After 17 Years

“…However, possible complications, such as granulation tissue formation, stent migration, tracheal fistula, and mucociliary transport impairment, have to be considered 3 . Even considering the advent of internal memory metal stents, our present results underline the previously described positive experience of using aluminum‐oxide rings for external stenting 9 . Because of the rigidity and biocompatibility of the chemically inert aluminum‐oxide rings and their resistance to corrosion, they remain stabile and fail to degrade with time, 10 resulting in sufficient support at long‐term follow‐up, and the predetermined burr holes ensure proper suture placement.…”

“…The variety of recommended surgical techniques for treatment of symptomatic tracheomalacia is an indication of an extremely difficult surgical problem 9 . Results from applying internal tracheal stents are encouraging and pose little strain to the patient.…”

“…Because of the rigidity and biocompatibility of the chemically inert aluminum‐oxide rings and their resistance to corrosion, they remain stabile and fail to degrade with time, 10 resulting in sufficient support at long‐term follow‐up, and the predetermined burr holes ensure proper suture placement. The porosity of biocompatible ceramic rings enhances cellular colonization, resulting in epithelialization in cases of accidental direct contact with the tracheal lumen 9–11 . This is only one reason why external silastic tracheal rings have been abandoned in favor of ceramic rings 12 .…”

“…Using ceramic support frames, satisfactory results of over 90% are reported 8 . Stenting the trachea externally would appear to decrease the possibility of contamination and fistula that occurs with endotracheal foreign bodies 9 . However, when preparing the tracheal wall for placement of the external stents, the recurrent laryngeal nerves may be at risk.…”

Comparison of costal cartilage and Dacron® graft in laryngotracheal reconstruction: an experimental study

“…[3] Many procedures have been described for laryngotracheal reconstruction using ceramic rings, hydroxylapatite, polyethylene, teflon, titanium minipilates, lactosorb, Medpor, and Dacron ®. [4] However these materials are foreign bodies and most alloplasts tolerate infection and exposure poorly. Porous high-density polyethylene terephthalate (Dacron ® graft) is well tolerated by surrounding tissue, its porous structure is rapidly infiltrated by host tissues and it resists infection.…”