Trachéotomie chirurgicale chez l'enfant au centre hospitalier universitaire de Bouaké à propos de 32 cas / Surgical tracheotomy in children at the university hospital center of Bouake about 32 cases

Objectif : déterminer les indications de la trachéotomie chirurgicale chez l'enfant, décrire la technique et les suites opératoires. Matériel et méthode : il s'agit d'une étude descriptive rétrospective portant sur les trachéotomies pédiatriques réalisées au CHU de Bouaké de janvier 2016 à décembre 2022. Les indications de la trachéotomie, la technique opératoire et l'évolution ont été étudiées. Le test exact de Fisher a été utilisé pour évaluer le lien entre le motif de la trachéotomie et les pathologies au seuil α de 5%. Résultats : pendant la période d'étude, 32 enfants ont été trachéotomisés. Leur âge variait entre 9 mois et 15 ans avec un âge moyen de 7,2 ans. Il s'agissait de 22 garçons et 10 filles. L'impossibilité d'intuber le patient (65,62%) et la dyspnée laryngée sévère (25%) constituaient les motifs de la trachéotomie. Les corps étrangers laryngo-trachéaux et la papillomatose laryngée représentaient respectivement 37,5% et 21,87% des pathologies. Nous n'avons pas noté de lien significatif entre le motif de la trachéotomie et les pathologies (p=1,000). L'intervention a été réalisée sous sédation dans 78,12% des cas. L'ouverture trachéale était en forme de « H ¼ et de siège sous-isthmique. Les suites opératoires étaient simples chez 93,75% des patients. La décanulation a été effective dans 24 cas (75%). Conclusion : les principaux motifs de la trachéotomie dans notre expérience sont l'impossibilité d'intuber le patient et la dyspnée laryngée sévère. Les pathologies étaient dominées par les corps étrangers laryngo-trachéaux et la papillomatose laryngée. Les suites opératoires étaient généralement satisfaisantes.

Objective: to determine the indications for surgical tracheotomy in children, to describe the technique and the postoperative course. Material and method: This is a retrospective descriptive study of pediatric tracheotomies performed at the Bouaké University Hospital from January 2016 to December 2022. The indications for tracheotomy, the operating technique and the evolution were studied. Fisher's exact test was used to assess the link between the reason for the tracheotomy and the pathologies at the α threshold of 5%. Results: during the study period, 32 children were tracheotomized. Their age varied between 9 months and 15 years with an average age of 7.2 years. They were 22 boys and 10 girls. The impossibility of intubating the patient (65.62%) and severe laryngeal dyspnea (25%) were the reasons for the tracheotomy. Laryngo-tracheal foreign bodies and laryngeal papillomatosis accounted for 37.5% and 21.87% of pathologies respectively. We did not note any significant link between the reason for the tracheotomy and the pathologies (p=1,000). The intervention was performed under sedation in 78.12% of cases. The tracheal opening was "H" shaped and sub-isthmic. The postoperative course was simple in 93.75% of patients. Decanulation was effective in 24 cases (75%). Conclusion: the main reasons for tracheotomy in our experience are the impossibility of intubating the patient and severe laryngeal dyspnea. The pathologies were dominated by laryngo-tracheal foreign bodies and laryngeal papillomatosis. The postoperative course was generally satisfactory

Avaliação da frequência fundamental em laringes humanas excisadas com diferentes extensões de sinéquia glótica anterior / Fundamental frequency in excised human larynges after the formation of anterior glottic webs of varying extent

Os resultados do aumento da frequência fundamental após diminuição do comprimento da porção vibratória das pregas vocais pela realização de sinéquia na região anterior da glote são variáveis, e não é estabelecida a extensão ideal de tal sinéquia nas técnicas cirúrgicas para aumentar a frequência vocal. Comparou-se neste estudo a elevação da frequência fundamental do som produzido por laringes humanas excisadas de cadáveres após realização de diferentes extensões de sinéquia glótica anterior, correspondentes a » (25%), 1/3 (33%) e ½ (50%) do comprimento da prega vocal. Além disso, verificou-se a correlação entre as frequências fundamentais anterior e posteriores aos experimentos com tais diferentes extensões de sinéquia glótica anterior para formular modelos matemáticos que estimem a frequência fundamental obtida após o procedimento. Os padrões de vibração das pregas vocais foram avaliados qualitativamente por videolaringoscopia e videoquimografia digital com câmera de alta velocidade. MÉTODOS: Realizou-se estudo experimental com 21 laringes humanas excisadas de cadáveres masculinos adultos. O som glótico foi artificialmente produzido com a colocação de ar comprimido pela traqueia, passando pelas pregas vocais. A frequência fundamental e os parâmetros da videoquimografia digital foram obtidos previamente (controle) e após realização de pontos que mimetizaram uma sinéquia glótica anterior de », 1/3 e ½ do comprimento das pregas vocais em todas as laringes, simulando uma das técnicas cirúrgicas para aumento da frequência vocal, a glotoplastia de Wendler. RESULTADOS: A frequência fundamental média foi distinta entre as diferentes extensões de sinéquia glótica anterior (P < 0,001), e observou-se aumento progressivo, significativo a cada ampliação da extensão da sinéquia na glote (P < 0,05), tanto em hertz quanto em semitons. Os modelos de regressão que estimam a frequência fundamental após os procedimentos mostraram melhor...

After anterior glottic web formation to decrease the length of the vibrating portion of the vocal folds, the degree of increase in fundamental frequency is variable. The ideal extent of such a web in surgical approaches aimed at raising the vocal pitch has not been established. This study compared the increase in the fundamental frequency of sound produced by excised human larynges after the formation of anterior glottic webs of varying extents (25%, 33%, and 50% of the length the vocal fold). In addition, the correlation between the fundamental frequencies before and after the experiments with the various extents of anterior glottic web formation was verified in order to create mathematical models designed to estimate the change in fundamental frequency obtained after the procedure. The vibration patterns of the vocal folds were evaluated qualitatively by laryngoscopy and by kymography with a highspeed digital camera. METHOD: We conducted an experimental study on 21 normal larynges excised from adult male human cadavers. Laryngeal vibration was artificially produced and was recorded by high speed videoendoscopy and digital kymography for analysis. The fundamental frequency and digital videokymography parameters were obtained before (as a control) and after the formation of anterior glottic webs occupying 25%, 33%, and 50% of the vocal folds, simulating a surgical technique to increase the vocal frequency, Wendler glottoplasty. RESULTS: The mean fundamental frequency differed among the various extents of anterior glottic web formation (P < 0.001), and there were significant increases from one extent to the next (P < 0.05), in hertz as well as in semitones. Regression models to estimate post-procedure fundamental frequency showed better coefficients of determination (r2) for smaller web extents. There was no aperiodic vibration in any of the experiments. The changes in glottal closure/phase and amplitude symmetry did not follow any...