Lesiones laringotraqueales por ahorcamiento fallido / Laryngotracheal lesions by near-hanging

Introducción: La lesión por ahorcamiento se inscribe dentro del traumatismo cerrado de la tráquea cervical. Objetivo: Presentar seis enfermos tratados por secuelas de un intento fallido de ahorcamiento y revisión la literatura sobre los métodos diagnósticos y terapéuticos. Métodos: Se realizó un estudio descriptivo de seis pacientes tratados entre 1989 y 2011 en el Hospital "Hermanos Ameijeiras". Todos fueron remitidos de diferentes hospitales, con una traqueostomía para el control de la vía respiratoria. Las variables estudiadas fueron: sexo, edad, diagnóstico definitivo, técnicas quirúrgicas empleadas, evolución posoperatoria, complicaciones y mortalidad. Resultados: Todos los pacientes fueron del sexo masculino, con edad entre 16 y 66 años (mediana 28,5). Cuatro tenían menos de 30 años, uno 38 y el último 66. El diagnóstico se hizo mediante traqueoscopia flexible y tomografía axial computarizada. La lesión se localizó en subglotis (2) y tráquea (4). Dos pacientes fueron operados antes de la remisión: resección traqueal (1) y laringotraqueal (1). El tratamiento definitivo, en nuestro centro, consistió en resección traqueal (4) y subglótica (2). No se presentaron complicaciones ni fallecidos. Durante el seguimiento postoperatorio (7 a 26 meses), cinco lesionados tuvieron resultados excelentes y uno satisfactorio, asociado con voz débil. Conclusiones: El traumatismo traqueal por ahorcamiento fallido es muy raro. El tratamiento oportuno y adecuado puede reducir las complicaciones y la mortalidad. Un equipo quirúrgico con experiencia puede lograr resultados satisfactorios en un grupo importante de lesionados. La traqueostomía, con anestesia local, es el método de elección para controlar la VR en pacientes con traumatismo cervical(AU)

Introduction: The hanging injury is considered a closed trauma of the cervical trachea. Objective: To present the cases of six patients treated for sequelae after failed hanging attempt, and to review the literature about diagnostic and therapeutic methods. Methods: A descriptive study was carried out of six consecutive patients treated between 1989 and 2011 at Hermanos Ameijeiras Hospital. All were referred from different hospitals, with a tracheostomy for controlling the airway. The variables studied were sex, age, definitive diagnosis, surgical techniques used, postoperative evolution, complications and mortality. Results: All patients were male, aged between 16 and 66 years (median: 28.5). Four were less than 30 years old; one, 38; and the last, 66. The diagnosis was made by flexible tracheoscopy and computerized axial tomography. The injury was located in the subglottis (2) and the trachea (4). Two patients were operated on before referral, through tracheal (1) and laryngotracheal (1) resection. Definitive treatment in our center consisted of tracheal (4) and subglottic (2) resection. There were no complications or deaths. During the postoperative follow-up (7-26 months), five injured patients had excellent outcomes and one had satisfactory outcomes, associated with a weak voice. Conclusions: Tracheal trauma after failed hanging is very rare. Timely and appropriate managment can reduce complications and mortality. An experienced surgical team can achieve satisfactory outcomes in a large group of injured people. Tracheostomy, under local anesthesia, is the method of choice for controlling the airways in patients with cervical trauma(AU)

Manejo quirúrgico de cáncer papilar de tiroides con invasión traqueal: Reporte de dos casos en Servicio de Otorrinolaringología de Hospital Carlos Van Buren

Resumen La invasión traqueal corresponde al tercer sitio más común de extensión extratiroidea del cáncer de tiroides. Se debe sospechar en caso de disnea, disfonía, estridor y hemoptisis, sin embargo, hasta un 30% de los pacientes se pueden presentar de forma asintomática, pesquisándose al momento de la cirugía. La nasofibroscopía de rutina, una alta sospecha y una planificación quirúrgica adecuada, serán fundamentales para lograr una resección tumoral completa y mejorar tanto el pronóstico como el control local. A continuación, presentamos dos casos clínicos manejados con resección cricotraqueal con anastomosis términoterminal en el Servicio de Otorrinolaringología del Hospital Carlos Van Buren.

Abstract Tracheal invasion is the third most common site of extrathyroideal invasión of thyroid cancer, recognized as a por prognostic indicator. It should be suspected in case of dyspnea, dysphonia, stridor, and hemoptysis. However, up to 30% of cases are asymptomatic, detected at the time of surgery. Routine nasofibroscopy, thorough examination and surgical planning are essential to ensure a complete tumoral resection, improvement in prognostic and local control of disease. We present two cases with cricotracheal resection and end-to-end anastomosis in Otholaringology Service from the Carlos Van Buren Hospital.

Pedicled latissimus dorsi myocutaneous flap for treatment of acquired tracheo-esophageal fistula combined with tracheocutaneous fistula: A case report / 中国胸心血管外科临床杂志

@#We reported a patient intubated for more than 30 d following brain injury, transferred to our department with tracheocutaneous fistula and a 2 cm fistula between the trachea and the esophagus. We performed tracheal resection and esophageal closure with a latissimus dorsi myocutaneous flap interposed between suture lines. The patient continued mechanical ventilation after surgery and the tracheotomy was achieved 14 d after the beginning of surgical treatment. The patient was started oral feeding and discharged on the 10 d after tracheotomy and referred to a neuromotor recovery clinic for treatment of post-traumatic sequelae.

Advanced laryngotracheal stenosis patients in a tertiary provincial government hospital: A prospective case series

@#<p style="text-align: justify;"><strong>OBJECTIVE:</strong> To describe the clinical profiles, interventions, and surgical outcomes of patients with advanced (grade III and IV) laryngotracheal stenosis prospectively seen over a 2-year period.  </p><p style="text-align: justify;"><strong>METHODS:</strong></p><p style="text-align: justify;">           <strong>Design:</strong>           Prospective Case Series</p><p style="text-align: justify;">          <strong>Setting:</strong>           Tertiary Provincial Government Hospital</p><p style="text-align: justify;"><strong>          Participants:</strong>  Five (5) patients with advanced laryngotracheal stenosis confirmed by laryngoscopy and/or tracheoscopy.</p><p style="text-align: justify;"><strong>RESULTS:</strong> Five (5) patients (4 males, 1 female), aged 23 to 31years (mean 27-years-old) diagnosed with advanced laryngotracheal stenosis between June 2016 to June 2018 were included in this series. Four resulted from prolonged intubation (14 - 60 days) while one had a prolonged tracheotomy (13 years). Presentations of stenosis included dyspnea on extubation attempt (n=3), failure to extubate (n=1) and failure to decannulate tracheotomy (n=1). Stenosis length was 3 cm in two, and 1.5 cm in three. Of the five (5) patients, three had grade IV stenosis while two had grade III stenosis based on the Cotton-Myer Classification System. Two of those with grade IV stenosis and both patients with grade III stenosis had undergone prolonged intubation. The stenosis involved the subglottis in three, and combined subglottic and tracheal stenosis in two. Prolonged intubation was present in all three with subglottic stenosis, and in one of the two with combined subglottic and tracheal stenosis. Two patients underwent open surgical approaches while three underwent endoscopic dilatation procedures. Four patients were successfully decannulated while one is still on tracheostomy. None of them had post-operative complications.</p><p style="text-align: justify;"><strong>CONCLUSION:</strong>  Advanced laryngotracheal stenosis is a challenging entity that results from heterogenous causes. Categorizing stenosis and measuring stenosis length may help in treatment planning and predicting surgical outcome.</p><p style="text-align: justify;"> </p>

The experience of anesthesia and operation of complicated resection of the trachea / 中华胸心血管外科杂志

Objective To introduct the experience of anesthesia and operation of complicated resection of the trachea,and promote techniques of anesthesia and operation of the tracheal resection and reconstruction. Methods Reviewing the anesthetic and operative process of 5 cases of tracheal resection and reconstruction,dis-close difficulties with corresponding methods,postoperative follow-up,summarizing suitable measures for succeed of large-segment resection and reconstruction of the trachea. Results In 4 cases of patients with benign stricture of the trachea,3 cured with good quality of life in 2 - 5 years follow-up, 1 case of resection of 6 cm trachea with one-stage reconstruction dead from anastomotic fistula and infection of mediastinum. One case with malignancy re-section of 8 cm trachea and reconstructed with Zhao's artificial trachea dead from remote metastasis one and a half year later. Conclusion The complexity of tracheal operation is with big different from case to case,therefore, preoperative precisely evaluation with careful individually protocol of anesthesia and operation,and good coopera-tion between surgeon and anesthesiologist are critical.

Resección traqueal y anastomosis primaria en traumatismo traqueo esofágico por arma de fuego / Tracheal resection and primary anastomosis in tracheoesophagueal gunshot trauma

Introduction: even though tracheoesophagueal lesions due to cervicothoracic gunshot wound are infrecuent, they should always be considered in a lesion of this kind, based on the proximity of the structures in this area, as well as the rapid compromise and deterioration that can develop these patients if the air way or vascular structures are damaged. Clinical case: we present a patient with a tracheoesophageal gunshot trauma and the surgical repair.

Introducción: las lesiones traqueo esofágicas secundarias a heridas de bala en cuello, a pesar de ser infrecuentes, siempre deben descartarse frente a un mecanismo de este tipo, no sólo por la proximidad de las estructuras sino también por el importante compromiso y rápido deterioro que pudieran presentar estos pacientes si la vía aérea o estructuras vasculares se vieran comprometidas. Caso clínico: se presenta en este trabajo un paciente con lesión traqueo esofágica secundaria a herida de bala, además de la técnica de reparación utilizada.

Post-Intubation Tracheoesophageal Fistula with Posterior Glottic Web

Tracheoesophageal fistula (TEF) after prolonged intubation could present as chronic aspiration and could be mistaken as unilateral or bilateral vocal fold palsy, especially when there was combined posterior glottic synechia. We present a case of post-intubation TEF which was successfully treated with tracheal resection and anastomosis with primary esophageal closure. The accompanying posterior glottic web was treated by endoscopic technique of web lysis, with topical application of mitomycin C solution.

Proseal Laryngeal Mask Airway for the Resection of a High Grade Upper Tracheal Stenosis: A case report / 대한마취과학회지

Laryngeal mask airways (LMAs) have several advantages compared with conventional endotracheal tube (ETT) in tracheal surgery. LMAs cannot penetrate the airway below the level of the glottis, but enable the access to the larynx and tracheobronchial tree while avoiding airflow impairment, tracheal stimulation, trauma, and the interference of tracheal mucosal blood flow. Moreover, LMAs have lower airway resistance than ETTs. We describe the use of a proseal laryngeal mask airway (PLMA) in patients with high grade upper tracheal stenosis. We suggest that PLMA might have advantages over the classic LMA by preventing aspiration and by allowing the evacuation of air from the stomach in high-grade upper tracheal stenosis.

Anesthetic Management using Laryngeal Mask Airway during Reconstructive Surgery of Trachea Cancer: A case report / 대한마취과학회지

The laryngeal mask airway (LMA) is new method for maintaining the airway and has many advantages such as easy insertion without muscle relaxant, decreasing cardiovascular change, decreasing damage of pharynx and larynx and useful in difficult intubation. It has being increasingly used in the management of difficult airway problems, but has not been widely used in tracheal surgery. A 59 year old woman with tracheal stenosis due to tracheal tumor was admitted for tracheal reconstruction. The stenotic lesion was 5 cm above the carina and the length of the stenotic segment was 2 cm. Anesthetic management should be focus on maintenance of the airway and adequate ventilation with the number 3 sized LMA during the tracheal resection. The tracheal segmental resection and primary end-to-end anastomosis were performed without serious hypoxia and hypercarbia. We discuss the advantages and limitations of the LMA in tracheal surgery.