Surgery of the Trachea

Surgical procedures on the trachea have only been undertaken within the past 50 years. Knowing the unique blood supply of the trachea and how to reduce tension on any anastomosis are key to a successful outcome. Tracheal conditions requiring surgery usually present with shortness of breath on exertion, and preoperative evaluation involves computed tomography and rigid bronchoscopy. Tracheal resection and reconstruction can be safely performed with excellent outcomes by following a well-described technique.

Tracheal Agenesis Reconstruction with External Esophageal Stenting: Postoperative Results and Complications

Tracheal agenesis is an extremely rare and typically lethal congenital disorder. Approximately 150 cases have been described since 1900, and very few cases of survival have been reported. We describe tracheal reconstruction with external esophageal stenting in a patient with Floyd's type II tracheal agenesis. Neither long-term survival nor survival without mechanical ventilation for even a single day has previously been reported in patients with Floyd's type II tracheal agenesis. The infant in the present case survived for almost a year and breathed without a ventilator for approximately 50 days after airway reconstruction using external supportive stents.

Tratamiento de la estenosis traqueal isquémica con Nd-YAG láser / Treatment of ischemic tracheal stenosis with Nd-YAG laser

Introducción: la estenosis traqueal corresponde a una complicación común, secundaria a la intubación o a la traqueotomía. Existen varias modalidades en cuanto a su tratamiento, por eso nos propusimos evaluar los resultados del tratamiento de la estenosis traqueal isquémica mediante fotorresección con Nd-YAG láser. Métodos: se realizó un estudio prospectivo descriptivo en 160 pacientes, con estenosis traqueal isquémica operados en el Servicio de Otorrinolaringología del Centro de Investigaciones Médico-Quirúrgicas, en el período comprendido de enero de 1987 hasta diciembre del 2010. Se clasificó a las estenosis traqueales postintubación, en 5 grupos, según Luis Rocabado y otros. El método diagnóstico empleado fue la broncoscopia. Los pacientes admitidos en el estudio tenían traqueotomía y fueron clasificados en grupo I y II. Como proceder quirúrgico se realizó fotorresección con Nd-YAG láser y colocación de cánula en T de Montgomery. Los enfermos se valoraron clínica y endoscópicamente al alta y posteriormente en consulta externa durante un período de 1 año. Resultados: el mayor porciento de los pacientes corresponde al sexo femenino. El rango de edad fue entre los 30 y 49 años con una desviación estándar de 36,7 ± 5,0 años. Se clasificaron 93 (58,1 por ciento) pacientes en el grupo I y 67 (41,9 por ciento) en el grupo II. La causa más frecuente de intubación endotraqueal prolongada, fue el politrauma. Se complicaron 13 pacientes, con una mortalidad de 2,5 por ciento. El resultado final se evaluó como bueno en 94 pacientes (58,7 por ciento), satisfactorio en 53 (33,2 por ciento) y malo en 9 (5,6 por ciento). Conclusiones: el tratamiento inicial para las estenosis traqueales isquémicas clasificadas como grado I y II debe ser por vía endoscópica con Nd-YAG láser(AU)

Introduction: Tracheal stenosis is a common complication secondary to intubation or to tracheostomy. There are several treatment modalities to face this problem, hence we suggested that the results of the treatment of ischemic tracheal stenosis be evaluated based on photoresection with Nd-YAG laser. Methods: A prospective descriptive study was performed in 160 patients, who suffered ischemic tracheal stenosis and had been operated on at the Otolaryngology Service of the Medical and Surgical Research Center (CIMEQ) in the period from January 1987 to December 2010. Post-intubation tracheal stenosis was classified in five groups, according to Luis Rocabado et al.'s classification. The diagnosing method was bronchoscopy. All the patients included in the study had tracheotomy and were classified into the group I and group II. The surgical procedure performed on patients was photoresection with Nd Yag laser and placement of Montgomery's T- stent. The patients were clinically and endoscopically evaluated at discharge and afterwards at the outpatient service for one year. Results: The highest percentage of patients was females. The age range was 30 to 49 years, with SD= 36.7 ± 5. 0 years. Ninety three (58.1 percent) were classified in group I whereas 67 (41.9 percent) were included in group II. The most frequent cause in extended endotracheal intubation was multiple trauma. Thirteen patients suffered complications; the mortality rate was 2.5 percent. The final result was evaluated as good in 94 (58.7 percent), satisfactory in 53 (33.2 percent) and negative in 9 (5.6 percent) patients. Conclusions: The initial treatment for ischemic tracheal stenoses classified as grade I and II should be endoscopic by using Nd-YAG laser(AU)

Mediastinoscopic Bilateral Bronchial Release for Long Segmental Resection and Anastomosis of the Trachea

The extent of resection and release of the trachea is important for successful anastomosis. Bilateral bronchial dissection is one of the release techniques for resection of the lower trachea. We present the experience of cervical video-assisted mediastinoscopic bilateral bronchial release for long segmental resection and anastomosis of the lower trachea.

Respiratory Support by Performing Percutaneous CardiopulmonarySupport (PCPS) for Tracheal Resection and Reconstruction in Patients withSevere Distal Tracheal Stenosis / 대한흉부외과학회지

Surgery on the distal trachea or the carina presents special problems for maintaining the airway and systemic oxygenation. Cardiopulmonary bypass is an alternative method for respiratory support for the patients with these conditions. Percutaneous cardiopulmonary support (PCPS) applied under local anesthesia has recently been used for respiratory support in tracheal surgery and the outcome is satisfactory. We encountered a patient who had severe distal tracheal stenosis after prolonged intubation. We had a gratifying result with performing tracheal resection and repair under the support of PCPS.

Reconstruction of Tracheobronchial Stenosis due to Endobronchial Tuberculosis : A case report / 대한흉부외과학회지

A 20 year old woman had developed stenosis at the lower part of the trachea, right main bronchus, and right upper lobe bronchus as a complication of endobronchial tuberculosis. The patient had complained of severe dyspnea. Tracheobronchial stenosis was so extensive that we did reconstruction of the trachea and right bronchus with resection of the lower trachea and right main bronchus and right upper lobectomy. She has been doing well without any respiratory symptoms or complications.

Estenosis traqueal congénita, Serie clínica / Congenital tracheal stenosis

Introducción: La estenosis traqueal congénita (ETC) es una entidad clínica infrecuente, que se caracteriza por la presencia de anillos traqueales circulares completos, que determinan estrechez fija del lumen traqueal ocasionando dificultad respiratoria de grado variable. Objetivos: Comunicar 10 pacientes portadores de ETC, sus aspectos clinicos, morfológicos y alternativas en el tratamiento. Pacientes y Método: Se analizó retrospectivamente las formas de manifestación, exámenes diagnósticos y evolución de diez pacientes portadores de ETC diagnosticados entre los años 1998 y 2006. Resultados: Seis pacientes con síntomas respiratorios graves requirieron cirugía correctora de la traquea, uno falleció luego de un año, en el postoperatorio de una intervención cardiovascular. Cuatro pacientes con sintomatología respiratoria menor no requirieron corrección quirúrgica, uno falleció en el postoperatorio de una cirugía cardiaca. Conclusión: La ETC es una malformación potencialmente grave que requiere tratamiento quirúrgico en los pacientes sintomáticos con obstrucción severa de vía aérea. Los pacientes con síntomas leves pueden permanecer en control y no ser sometidos a cirugía correctora.

Congenital tracheal stenosis (CTS) constitutes an uncommon disease, characterized by the presence of complete tracheal rings that determine a fixed narrow tracheal lumen with different levels of respiratory distress. Objective: To expose 10 patients with CTS in relation to their morphological-clinical aspects and treatment alternatives. Method: Retrospective analysis of these patients diagnosed with CTS between 1998 and 2006, in terms of clinical evolution and diagnostic exams. Results: 6 patients with severe respiratory symptoms needed corrective tracheal surgery; one of them died one year later during cardiac surgery. 4 patients with mild respiratory symptoms did not require tracheal surgery; one of them died during cardiac surgery. Conclusion: CTS is a serious malformation that requires surgical treatment in those patients with severe airway obstruction. Patients with mild symptoms are observed closely without the need for surgery.

Modified Tracheostomy for Severe Tracheal Stenosis / 대한흉부외과학회지

When tracheal invasion of a malignant tumor or tracheal stenosis of a benign origin exists at the lower or anterior part of the trachea, tracheal intubation or conventional tracheostomy may be difficult, and in these cases a modified tracheostomy through the lower or lateral part of the trachea would be necessary. We present 6 cases of modified tracheostomy performed with satisfactory results in severe tracheal stenosis that developed in the lower or anterior part of the trachea.

Tracheomalacia Associated with Esophageal Atresia: A case report / 대한흉부외과학회지

Congenital tracheomalacia associated esophageal atresia is a rare foregut anomaly. We report a case of 40-day old male infant with tracheomalacia who has undergone repair of esophageal atresia at his age of 1 day. The patient had progressive dyspnea and stridor after repair of esophageal atresia. His 3-dimensional chest computed tomography showed severe stenosis at the middle of trachea. We underwent resection and end-to-end anastomosis under cardiopulmonary bypass. Histologic examination revealed esophageal tissues indicating congenital origin as well as no cartilage.

Tracheomalacia Associated with Esophageal Atresia: A case report / 대한흉부외과학회지

Congenital tracheomalacia associated esophageal atresia is a rare foregut anomaly. We report a case of 40-day old male infant with tracheomalacia who has undergone repair of esophageal atresia at his age of 1 day. The patient had progressive dyspnea and stridor after repair of esophageal atresia. His 3-dimensional chest computed tomography showed severe stenosis at the middle of trachea. We underwent resection and end-to-end anastomosis under cardiopulmonary bypass. Histologic examination revealed esophageal tissues indicating congenital origin as well as no cartilage.

Formation of an Intestine-Cartilage Composite Graft for Tracheal Reconstruction / 대한흉부외과학회지

BACKGROUND: Tracheal transplantation is necessary in patients with extensive tracheal stenosis, congenital lesions and other oncologic conditions but bears many critical problems compared to other organ transplantations. The purpose of this study was to develop intestine-cartilage composite grafts for potential application in tracheal reconstruction by free intestinal graft. MATERIAL AND METHOD: Hyaline cartilage was harvested from trachea of 2 weeks old New Zealand White Rabbits. Chondrocytes were isolated and cultured for 8 weeks. Cultured chondrocytes were seeded in the PLGA scaffolds and mixed in pluronic gel. Chondrocyte bearing scaffolds and gel mixture were embedded in submucosal area of stomach and colon of 3 kg weighted New Zealand White Rabbits under general anesthesia. 10 weeks after implantation, bowels were harvested for evaluation. RESULT: We identified implantation site by gross examination and palpation. Developed cartilage made a good frame for shape memory. Microscopic examinations included special stain s howed absorption of scaffold and cartilage formation even though it was not fully matured. CONCLUSION: Intestine-cartilage composite graft could be applicable in the future as tracheal substitute and should be further investigated.

Tratamento cirúrgico do schwannoma traqueal / Surgical treatment of tracheal schwannoma

Schwannoma is a rare benign tumor of the proximal tracheobronchial tree. The aim of the present study is to report a case of tracheal schwannoma causing airway obstruction. A 16-year-old woman complained of cough, wheezing and dyspneia. Bronchoscopy and computerized tomography showed a polypoide intratracheal mass obstructing approximately 80 percent of the lumen. The treatment consisted of tracheal resection and primary anastomosis. Histological analysis revealed a tracheal schwannoma. The postoperative course was uneventful and the patient remains well twelve months after surgery.