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1.
Artigo em Inglês | WPRIM | ID: wpr-761390

RESUMO

Posterior glottic stenosis (PGS) is frequently caused by prolonged intubation complications, which may limit the movement of the vocal cords and obstruct airway obstruction. Despite of a life-threatening condition, it might be overlooked in asymptomatic individual. A 63-year-old female was scheduled for arthroscopic rotator cuff repair. The patient had experienced 2 times of intubation and organophosphate poisoning for suicide. Both of 7.0- and 6.5-mm inner diameter endotracheal tubes could not be passed vocal cords. After two failed attempts at intubation, adhesion of posterior part of vocal cord was revealed. We stopped the tracheal intubation and called the otolaryngologist, and adhesiolysis was performed under direct laryngosope. Thereafter, endotracheal intubation was performed successfully with 6.5-mm endotracheal tube.


Assuntos
Feminino , Humanos , Pessoa de Meia-Idade , Manuseio das Vias Aéreas , Obstrução das Vias Respiratórias , Constrição Patológica , Intubação , Intubação Intratraqueal , Intoxicação por Organofosfatos , Manguito Rotador , Suicídio , Prega Vocal
2.
Artigo em Coreano | WPRIM | ID: wpr-786186

RESUMO

Injuries of the larynx are common in patients with a history of inhalation burns. When anesthesia is performed in such patients, the possibility of tracheal intubation should be thoroughly checked in advance, and preparation should be made in case of possible failure. 73-year-old woman who underwent laser cordotomy due to posterior glottic stenosis due to inhalation burn. Her height and weight were 140 cm and 58.9 kg. We proceeded anesthesia, because preoperative fiberoptic laryngoscopy and otolaryngology consultation showed that tracheal intubation was possible. However, the intubation failed and the manual ventilation was not performed afterwards, so the cricothyroidotomy was performed as an emergency. Anesthesia in patients with posterior glottic stenosis due to inhalation burns requires a great deal of attention and, above all, thorough evaluation in order to confirm the possibility of tracheal intubation. If this is not possible, you should look for alternatives and be prepared, and even if you think it's possible, try anesthesia with thorough preparation for the possible failure.


Assuntos
Idoso , Feminino , Humanos , Anestesia , Queimaduras por Inalação , Constrição Patológica , Cordotomia , Emergências , Inalação , Intubação , Laringoscopia , Laringe , Otolaringologia , Ventilação
3.
Artigo | IMSEAR | ID: sea-184795

RESUMO

BACKGROUND: Traumatic injuries of the larynx are diverse, uncommon, and potentially life threatening. Laryngotracheal trauma can be oadly divided into External trauma , which can be blunt or penetrating trauma , and internal trauma , which can be iatrogenic , thermal , caustic and foreign body injuries .external trauma which can be blunt trauma caused by motor vehicle accidents , suicidal or homicidal strangulation and penetrating trauma caused by suicidal or homicidal cut throat injuries . Iatrogenic injuries are most common cause of internal trauma . If not adequately treated these injuries lead to significant morbidity such as dysphonia , airway stenosis , aspiration and sometimes may lead to death . Laryngotracheal trauma is often associated with concomitant cervical or intracranial trauma or with multisystem poly trauma . External laryngeal trauma is rare. It has a population incidence of 1 in 137,000 in adults and accounts for 0.5% of trauma admissions in children. Incidence of postintubation laryngotracheal stenosis requiring surgical correction is 1 in 204,000 in adults and 4.9 in 100,000 in children.Laryngeal webs , intubation granulomas , laryngeal injuries while intubation , inhalational and ingestion injuries are very rare in incidence 1 . MATERIALS AND METHODS: 20 patients who presented with external and internal laryngotracheal trauma to casualty department in Government general hospital, Kakinada, Andhra Pradesh state , during the period between June 2015 to September 2017. A detailed history was taken with emphasis on trauma.Clinical features were noted and patients were appropriately investigated . RESULTS: The age of patients in present study varied from 12-70 years . Majority of patients are present in 26-40 years age group (55%) . Among the 20 cases in our study 13 cases were males (65%) and 7 cases were females (35%). In our study of 20 patients 14 patients sustained injuries due to external trauma(70%) and 6 patients presented with internal trauma of larynx(30%) due to prolonged intubation . In our study 6 of the 20 patients presented with laryngeal stenosis due to prolonged intubation among them 3 patients presented with subglottic stenosis 2 with glottic stenosis and 1 tracheal stenosis. Amongst them 9 of 14 patients were due to penetrating neck injuries(64.3%) and 5 of 14 are due to blunt neck trauma (35.7%) . 7 of 9 patients knife infected wounds and 2 due to motor vehicle accident. 2 of 5 patients in blunt trauma are due to hanging 2 are due to strangulation and one is due to bullgore injury. Most commonly presented with pain (70%) , dyspnoea (50%) , hoarseness (45%) . stridor was present mostly in laryngeal stenosis patients. The present study 15 of 20 patients airway was initially managed with the help of tracheostomy in 3 of 20 patients with intubation and 2 patients were under observation. There was a recurrence in one case of subglottic stenosis and endoscopic laser exicision was done again .In further followup there was no recurrence. CONCLUSION: In conclusion, we believe that the management of injuries to the larynx and trachea can be individualized based on the clinical presentation and mechanism of injury. Early diagnosis and stratification of treatment based on the initial history, physical findings has improved outcomes. Our goal remains preservation of life with restoration of a normal airway and voice. Patients with blunt injuries can often be managed conservatively with close monitoring in the intensive care unit. Penetrating injuries will often have associated injuries or airway compromise that will mandate operative exploration.

4.
Frontiers of Medicine ; (4): 301-306, 2018.
Artigo em Inglês | WPRIM | ID: wpr-772753

RESUMO

Transoral microresection for treatment of vocal cord lesions involving the anterior commissure may result in anterior glottic webs. In this study, we retrospectively reviewed 54 patients who underwent microsurgery for bilateral lesions involving the anterior commissure and categorized them into two groups. The keel placement and control groups received endoscopic keel placement and mitomycin C, respectively. During the follow-up of at least 1 year, the laryngeal web formation rate significantly decreased in the keel placement group compared with that in the control group (18.6% versus 54.5%, P < 0.05). Furthermore, the voice handicap index-10 scores for patients without web formation decreased in both the keel placement and control groups (P < 0.0001 and P < 0.001, respectively). A pseudomembrane covering the vocal cords was detected in 16.3% (7 of 43) cases after keel removal. A total of 100% (7 of 7) of these cases and 2.8% (1 of 36) of the other cases formed laryngeal webs (P < 0.0001). Endoscopic keel placement could be an effective method for preventing anterior glottic webs after surgery for bilateral vocal cord diseases involving the anterior commissure. The pseudomembrane observed at the time of keel removal may imply a high risk of web formation.


Assuntos
Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Adulto Jovem , Laringoscopia , Laringoestenose , Diagnóstico , Cirurgia Geral , Laringe , Anormalidades Congênitas , Cirurgia Geral , Estudos Retrospectivos , Elastômeros de Silicone
5.
Artigo em Coreano | WPRIM | ID: wpr-654855

RESUMO

A 64-year-old woman presented with Gullain-Barre Syndrome and prolonged intubation. The patient had undergone a decannulation earlier, after which she developed symotoms of hoarseness, dyspnea, and repeated aspiration. Bilateral vocal cord immobility with type 1 posterior glottic stenosis (PGS) was identified under laryngoscope. During operation, direct laryngoscopic finding and histologic finding revealed interarytenoid ossification. We present a rare case of PGS with a calcified interarytenoid band.


Assuntos
Feminino , Humanos , Pessoa de Meia-Idade , Constrição Patológica , Dispneia , Rouquidão , Intubação , Laringoscópios , Prega Vocal
6.
Rev. MED ; 20(2): 30-37, jul.-dic. 2012. ilus, tab
Artigo em Espanhol | LILACS | ID: lil-681738

RESUMO

La estenosis glótica es una afección poco frecuente, secundaria a inmovilidad bilateral de cuerdas vocales, debida principalmente a parálisis de origen neurogénico o a fibrosis cicatricial y en la cual se presenta una incapacidad, generalmente severa, para el paso de aire hacia los pulmones a través de la glotis. Lo anterior hace que con frecuencia se deba recurrir a la realización de una traqueostomía como medida transitoria para asegurar la vía aérea. Para corregir la estenosis y recuperar la permeabilidad glótica, estos pacientes deben ser sometidos a una cirugía cuyo objetivo es separar las cuerdas vocales, para permitir de nuevo el paso de aire a la vía aérea inferior. Sin embargo, el hecho de abrir el espacio glótico separando las cuerdas vocales, va a llevar ineludiblemente a grados variables de alteración en la calidad de la voz, lo cual debe ser siempre informado al paciente antes de su intervención. En el presente estudio se realiza una revisión descriptiva, retrospectiva de los casos tratados por el autor mediante cordectomía posterior y aritenoidectomía parcial entre febrero de 2008 y marzo de 2011. Se reporta en ellos la percepción subjetiva de la afectación en su voz utilizando una versión española del índice de incapacidad vocal adaptada de la versión en inglés del "Voice Handicap Index"-10 (VHI-10). De un total de 32 pacientes sometidos a cirugía por estenosis glótica obstructiva, 28 (17 mujeres y 11 hombres) con edades comprendidas entre los 24 y 79 años cumplieron los criterios de inclusión. A todos los pacientes se les pudo corregir la estenosis y retirar la traqueostomía recuperando la capacidad de respirar por la vía natural. Como resultado se encontró que el índice promedio de incapacidad vocal posterior a la cirugía fue de 10.4 en 18 pacientes, cuya causa era una parálisis bilateral y de 14.2 en 6 pacientes con fibrosis cicatricial como factor desencadenante de la estenosis. En otros 4 pacientes con causas diferentes, el índice promedio fue similar a los anteriores. Estos valores reflejan una percepción de incapacidad vocal leve. En conclusión, la percepción de incapacidad vocal posterior a la cirugía para recuperar la permeabilidad glótica es leve, generándose así un valor agregado al éxito terapéutico, al lograr recuperar la vía aérea natural en los pacientes sin alterar sustancialmente su calidad vocal.


Glottic stenosis is a rare condition secondary to bilateral vocal cord immobility due primarily to paralysis of neurogenic origin or scarring fibrosis with subsequently disability, often severe, for the passage of air into de lungs through the glottis. This means that often we must resort to performing a tracheostomy as a temporary measure to secure the airway. To recover the glottal patency these patients should undergo surgery which aims to separate the vocal cords to again allow the passage of air into the lower airway. However, the fact of opening de glottic space separating the vocal cords inevitably produces varying degrees of alteration in voice quality. In the present study we make a retrospective descriptive review of cases treated by the author with posterior cordectomy and partial arytenoidectomy between February 2008 and March 2011, and we reported their subjective perception of involvement in their voice using a Spanish version of vocal disability index adapted from the English version of the "Voice Handicap Index" -10 (VHI-10). Of a total of 32 patients undergoing surgery for obstructive glottic stenosis, 28 (17 women and 11 men) aged between 24 and 79 years met the inclusion criteria. In all patients it was possible to remove the tracheostomy recovering the ability to breathe by the natural route and the resulting vocal disability index was in average 10.4 in 18 patients with bilateral paralysis, 14.2 in 6 patients with cicatricial fibrosis. In the other 4 remaining patients the average rate was similar to the previous ones. These values reflect a perception of mild vocal inability. In conclusion, in our series the vocal perception of disability following surgery to regain glottal permeability is slight thus creating added value to therapeutic success at recovering the natural airway in these patients.


A estenose glótica é uma afecção pouco frequente, secundária à imobilidade bilateral das cordas vocais, devida principalmente a paralisia de origem neurogênica ou à fibrose cicatricial na qual se apresenta uma incapacidade, geralmente severa, para a passagem do ar aos pulmões através da glote. Isso faz com que com frequência se deva recorrer à realização de uma traqueostomia como medida transitória para garantir a via aérea. Para corrigir a estenose e recuperar a permeabilidade glótica, estes pacientes devem ser submetidos a uma cirurgia cujo objetivo é separar as cordas vocais, para permitir de novo a passagem do ar à aérea inferior. Porém, o fato de abrir o espaço glótico separando as cordas vocais, vai levar inevitavelmente a graus variáveis de alteração na qualidade da voz, isso deve ser sempre informado ao paciente antes de sua intervenção. No presente estudo realiza-se uma revisão descritiva, retrospectiva dos casos tratados pelo autor mediante cordectomia posterior e aritenoidectomia parcial entre fevereiro de 2008 e março de 2011. Reporta-se neles a percepção subjetiva da afetação na sua voz utilizando uma versão espanhola do índice de incapacidade vocal adaptada da versão em inglês do "Voice Handicap Index"-10 (VHI-10). De um total de 32 pacientes submentidos à cirurgia por estenose glótica obstrutiva, 28 (17 mulheres e 11 homens) com idades compreendidas entre 24 e 79 anos cumpriram os critérios de inclusão. A todos os pacientes foi possível corrigir a estenose e retirar a traqueostomia recuperando a capacidade de respirar pela via natural. Como resultado encontrou-se que o índice médio de incapacidade vocal posterior à cirurgia foi de 10.4 em 18 pacientes, cuja causa era uma paralisia bilateral e de 14.2 em 6 pacientes com fibrose cicatricial como fator desencadeante da estenose. Em outros 4 pacientes com causas diferentes, o índice médio foi similar aos anteriores. Estes valores refletem uma percepção de incapacidade vocal leve. Em conclusão, a percepção de incapacidade vocal posterior à cirurgia para recuperar a permeabilidade glótica é leve, gerando-se dessa forma um valor agregado ao sucesso terapêutico, ao conseguir recuperar a via aérea natural nos pacientes sem alterar substancialmente sua qualidade vocal.


Assuntos
Humanos , Adulto , Pessoa de Meia-Idade , Idoso , Constrição Patológica , Prega Vocal , Traqueostomia
7.
Artigo em Coreano | WPRIM | ID: wpr-653939

RESUMO

BACKGROUND AND OBJECTIVES: Posterior glottic stenosis (PGS) is a disabling disease and most commonly induced by trauma from endotracheal intubation. We performed a randomized, controlled study with three animal groups to investigate the preventive effect of mitomycin-C on the posterior glottis undergone laser injury. MATERIALS AND METHOD: Twenty rabbits were available for evaluation. Group 1 (n=7) and 2 (n=6) were treated with topical mitomycin-C of 0.4 and 1.0 mg/ml, respectively, with the group 3 (n=7) used as the control. All animals underwent laser injury of 6 W, continuous mode on the posterior glottis. Group 1 and 2 were treated by a single topical use of cottonoid soaked in mitomycin-C solution on the injured posterior glottis for 5 minutes and the group 3 by saline. The posterior glottis of all groups was evaluated by telescopic examinations under direct laryngoscopy 2 months after the injury and was harvested for histological staining with hematoxylin-eosin and Masson trichrome. RESULTS: The scar, granulation tissue and synechia formation of the posterior glottis was clearly induced by laser injury. Microscopic examinations showed increased collagen content and fibroblast proliferation in the region. Topical use of mitomycin-C significantly decreased the incidence of such gross and microscopic changes of the posterior glottis (p<.05). CONCLUSION: Mitomycin-C prevents PGS via its anti-proliferative effect on fibroblasts. The use of Mitomycin-C is warranted for patients with a history of prolonged intubation or for those who have undergone surgery of the posterior glottis.


Assuntos
Animais , Humanos , Coelhos , Cicatriz , Colágeno , Constrição Patológica , Fibroblastos , Glote , Tecido de Granulação , Incidência , Intubação , Intubação Intratraqueal , Laringoscopia , Laringe , Mitomicina
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