Estenosis traqueal postintubación después de neumonía grave por coronavirus / Postintubation Tracheal Stenosis after Severe Coronavirus Pneumonia

Introducción: La rápida propagación del SARS­CoV­2 ha provocado una pandemia mundial. Si bien puede salvar vidas, la intubación traqueal presenta el riesgo inherente de inducir daño en la mucosa traqueal con estenosis, con una incidencia estimada de 4,9 casos por millón cada año. Objetivo: Caracterizar la presentación de una estenosis traqueal por intubación prolongada en un paciente que sufrió neumonía grave por coronavirus. Presentación del caso: Se asiste a un paciente de 55 años que sufrió neumonía grave por coronavirus y necesitó intubación orotraqueal prolongada. Una vez recuperado comienza con disnea de empeoramiento progresivo. Se diagnostica una estenosis traqueal y se decide tratamiento quirúrgico donde se realiza resección y anastomosis. El paciente no presentó complicaciones y evolucionó satisfactoriamente. Conclusiones: La estenosis traqueal debe reconocerse como una complicación potencial, aun cuando los pacientes se recuperan de una neumonía grave por COVID-19. El diagnóstico definitivo de estenosis traqueal se realiza mediante fibrobroncoscopia. La resección traqueal con anastomosis entre tráquea y tráquea es el procedimiento más comúnmente realizado(AU)

Introduction: The rapid spread of SARS-CoV-2 has resulted in a global pandemic. Although tracheal intubation can save lives, it presents the inherent risk of inducing tracheal mucosal damage with stenosis, with an estimated annual incidence of 4.9 cases per million. Objective: To characterize a case of tracheal stenosis due to prolonged intubation in a patient with severe coronavirus pneumonia. Case presentation: A 55-year-old patient who suffered severe coronavirus pneumonia and required prolonged orotracheal intubation was attended. Once recovered, the patient began with progressively worsening dyspnea. Tracheal stenosis was diagnosed and surgical treatment was decided, in which resection and anastomosis were performed. The patient did not present any complications and evolved satisfactorily. Conclusions: Tracheal stenosis should be recognized as a potential complication, even when patients recover from severe COVID-19 pneumonia. A definitive diagnosis of tracheal stenosis is made by fibrobronchoscopy. Tracheal resection with anastomosis between trachea is the most commonly performed procedure(AU)

Asociación del complejo ring-sling con pig bronchus: a propósito de un caso pediátrico / Ring-sling complex association with pig bronchus: a pediatric case report

El complejo ring-sling es una asociación entre el sling de la arteria pulmonar y la estenosis traqueal congénita por anillos traqueales completos. El sling de la arteria pulmonar es una forma rara de anillo vascular dentro de las cardiopatías congénitas. Se presenta el caso clínico de un niño con estridor laríngeo asociado a dificultad respiratoria evaluado en otro centro, donde se realizó endoscopia respiratoria y se observó compresión traqueal extrínseca. Ante la sospecha clínica de anillo vascular, se solicitó angiotomografía computada (angioTC) y se confirmó diagnóstico de sling de arteria pulmonar. Fue derivado a nuestro hospital y durante la intervención quirúrgica se realizó nueva endoscopia respiratoria y traqueobroncografía. Se llegó al diagnóstico de estenosis traqueal congénita con bronquio derecho accesorio (pig bronchus) y anillos vasculares completos, ambos reparados en el mismo acto quirúrgico.

The ring-sling complex is an association between pulmonary artery sling and congenital tracheal stenosis. Pulmonary artery sling is a rare form of vascular ring in congenital heart disease. The clinical case of a child with inspiratory laryngeal stridor associated with respiratory distress is presented, evaluated in another center where respiratory endoscopy was performed, observing extrinsic tracheal compression. Given the clinical suspicion of a vascular ring, CT angiography was requested, confirming the diagnosis of pulmonary artery sling. He was referred to our hospital and during the surgical intervention a new respiratory endoscopy and tracheobronchography were performed, reaching the diagnosis of congenital tracheal stenosis, right accessory bronchus (pig bronchus) and complete vascular rings, both repaired in the same surgical act.

Sling de la arteria pulmonar en paciente preescolar con compromiso de la vía aérea / Pulmonary artery sling in preschool patient with airway compromise

Resumen Introducción: El sling de la arteria pulmonar izquierda es una rara malformación congénita del arco aórtico en la que la rama pulmonar izquierda se origina a partir de la arteria pulmonar derecha. Generalmente se sitúa entre la tráquea y el esófago, que frecuentemente la comprimen. Dependiendo del grado de compromiso de la vía aérea, el esófago y las anomalías cardíacas asociadas, las manifestaciones clínicas varían. El tratamiento de esta malformación es quirúrgico; con el paso de los años, este abordaje ha mejorado, y se ha logrado una disminución de la morbilidad y mortalidad en esta condición. Caso clínico: Se presenta el caso de una paciente preescolar con hallazgo de sling de la arteria pulmonar izquierda con compromiso de la vía aérea. Conclusiones: Después de la corrección quirúrgica, se logró una respuesta clínica favorable y una mejoría significativa en la vía aérea, evidenciada en los hallazgos en la fibrobroncoscopia, sin necesidad de intervenciones adicionales.

Abstract Background: Left pulmonary artery sling is a rare congenital malformation of the aortic arch in which this artery originates from the right pulmonary artery and courses over the trachea and the esophagus. Clinical manifestations vary depending on the degree of airway compromise, the esophagus and associated cardiac anomalies. The treatment for this malformation is surgical; over the years, this approach has improved, achieving a decrease in morbidity and mortality in this condition. Case report: A preschool patient with incidental finding of sling of the left pulmonary artery with compromise of the airway is presented. Conclusions: After the surgical procedure, a favorable clinical outcome was observed and a significant improvement in the airway was shown by a fibrobronchoscopy, without any additional intervention.

Estenoses benignas da via aérea: tratamento endoscópico / Benign airway stenosis: endoscopic treatment

O objetivo do presente trabalho é uma revisão do tratamento endoscópico das estenoses laringotraqueais benignas. O tratamento de eleição para este tipo de estenose é a ressecção com anastomose primária. Entretanto, nem sempre essa situação pode ser alcançada devido a natureza, extensão e localização das estenoses. O tratamento endoscópico é uma alternativa em casos nos quais a ressecção não é possível ou após complicações ou insucessos nas ressecções prévias. O tratamento endoscópico inclui dilatações, ressecção endoscópica com eletrocautério, laser, argon plasma coagulation, crioterapia, braquiterapia e a utilização de endopróteses. Todos esses métodos de dilatação mecânica produzem um resultado imediato satisfatório, com aumento da via aérea e melhora dos sintomas clínicos, mas a durabilidade da terapia continua problemática. Em poucos dias ou semanas retornam os sintomas que obrigam repetidas reintervenções. As endopróteses são divididas em: silicone rígido e metálico autoexpansível. As endopróteses de silicone são as mais utilizadas na literatura e com o maior seguimento em longo prazo. As endopróteses metálicas autoexpansíveis foram introduzidas mais recentemente, e, devido à facilidade de aplicação, ocorreram abusos na utilização com diversas complicações. Mais recentemente, as endopróteses chamadas “híbridas” congregam componentes metálicos autoexpansíveis com uma cobertura de silicone.

This review focuses on endoscopic treatment of benign laryngotracheal stenoses. The standard treatment for laryngotracheal stenoses is surgical resection and reconstruction of the primary airway. However, when surgical resection is not feasible due to the nature, extent, or location of the stenosis, endoscopy presents an alternative for treating complications and for the management of previous unsuccessful resections. Endoscopic treatment includes electrocauterization, laser resection, argon plasma coagulation, cryotherapy, brachytherapy,and stent placement. Although endoluminal approaches have been shown to improve luminal patency, none have produced consistent results and the durability of their effects remains problematic, resulting in a high rate of repeat interventions. There are two basic types of stents: silicon stents; and self-expandable metal stents. Silicon stents are less expensive, more widely available, and still the most often studied. However, the newer, metal stents are easier to insert and position. Therefore, metal stents have been overused, resulting in complications. Recently, “hybrid” stents, such as one composed of a metal scaffold and a silicon coating with self-expandable capabilities, have been introduced.

rare early complication of tracheostomy

A polytrauma patient on ventilator was admitted to ICU with open tracheostomy, GCS 8/15 and unequal pupils. After 10 days, he was weaned from the ventilator. The patient had respiratory problems i.e. expiratory stridor, shortness of breath, dysphonia and dyspnea on closing tracheostomy. It was diagnosed as a case of asthma, and the patient responded to salbutamol nebulization and intravenous steroid therapy. However, after some time, he desaturated and a plan for rapid sequence intubation was made. Endotracheal tube could not be negotiated beyond vocal cords, so an unprepared tracheostomy without proper equipment had to be immediately done by an anesthetist to save the patient's life. CT scan revealed tracheal stenosis. This case demonstrates that patients with a short 15-days history of previous tracheostomy may have tracheal stenosis

Evaluation of tracheal narrowing post tracheostomy by plain X-ray

The objective of this work is to recognize the incidence and severity of narrowing of the trachea in the head and neck surgical patients who had undergone tracheostomy by doing lateral cervical X-ray. This is a prospective study of 24 adult patients with consecutive tracheostomies conducted in the period from January 2008 to January 2009 in E.N.T Department, Al- Yarmouk Teaching Hospital. Twenty of them [83.3%] had emergency tracheostomy and 4 of them [16.6%] had elective tracheostomy. Analysis was performed with respect to age, sex, time of decannulation, symptoms and the type of operation whether emergency or an elective procedure. The diagnosis of tracheal narrowing after decannulation depends on lateral soft tissue X-ray of the neck. Diameter of the trachea above the stoma [around 2 cm below the cricoid ring that can be clearly seen in lateral X-ray] was taken as control. The study revealed that 83.3% of patients developed narrowing of the trachea post-tracheostomy, however, all the narrowing cases was less than 50%. Very early decannulation of tracheostomy tube showed minimum or no narrowing at all. There is gradual narrowing in patients in whom decannulation were performed after 2 weeks. Male patients had earlier decannulation time compared to female patients. Tracheostomy as live saving procedure results in minimum asymptomatic tracheal stenosis

Estenose traqueal após intubação orotraqueal / Tracheal stenosis after endotracheal intubation

A causa benigna mais comum de estenose das vias aéreas superiores, em todas as faixas etárias, é a lesão traqueal pós-intubação, que ocorre em 1% a 4% dos pacientes submetidos à ventilação mecânica por longo período. Não tratada, a estenose das vias aéreas cursa com significativa morbidade pulmonar e pode conduzir ao óbito devido ao comprometimento do aparelho respiratório. Dentre as lesões conseqüentes à intubação endotraqueal, é incomum a ocorrência de manifestações clínicas de estenose traqueal. Relata-se o caso de um paciente masculino de 56 anos, que desenvolveu estenose traqueal após ser submetido à intubação endotraqueal por 10 dias, descrevendo seus aspectos patogênicos, clínicos, diagnósticos e terapêutica (AU)

The most common benign cause of upper airway stenosis in all age groups is postintubation tracheal injury, which occurs in 1% to 4% of patients submitted to long-term ventilation. If untreated, airway stenosis causes significant pulmonary morbidity and can progress to life-threatening airway compromise. Among postintubation tracheal lesions, the occurrence of clinical symptoms of tracheal stenosis is uncommon. Here we present the case of a 56-year-old male who developed tracheal stenosis after being submitted to endotracheal intubation for 10 days, describing the physiopathology and clinical aspects of the case as well as its treatment (AU)

[Congenital tracheal stenosis about a case report]

The congenital tracheal stenosis is a very rare malformation in the child and it is potentially lethal. The diagnosis is difficult and we note the absence of therapeutic standardisation. We report a new observation of a 4 months old child, presenting since the birth a wheezing with accesses of polypnea and cyanosis, with progressive aggravation. He was hospitalized for acute respiratory distress. The physical examination found an eutrophic infant, with a fever at 38°C, polypnea, and a stridor with sibilants at the pulmonary sounding. The initial diagnosis was a severe bronchiolitis and the child had a symptomatic treatment with respiratory kinesitherapy. The evolution was marked by the persistence of an intense dyspnea with expiratory stridor. A laryngotracheoscopy found a larynx of normal aspect but presence of a tight tracheal stenosis located at 1cm of the hull and extended on 1 cm heigh. A helicoid thoracocervical CT scan confirmed the tracheal stenosis and eliminated an extrinsic compression tracheal. The initial therapeutic attitude consisted on several attempts of installation of a tube T of Montgomery but without success. The child was maintained in artificial ventilation by tracheotomy for 3 months. A surgical treatment [resection anastomosis of the tracheal stenosis] was made in front of the absence of other therapeutic alternatives. A control by CT scan [3 mois post operative] didn't show any abnormalities. The congenital tracheal stenosis requires an early diagnosis and a multidisciplinary treatment

Ultrasonographic evaluation of tracheal collapse in dogs

Tracheal ultrasonography was performed to measure the width of the tracheal ring shadow and to assess the clinical relevance of these measurements for identifying tracheal collapse. The first tracheal ring width (FTRW) and thoracic inlet tracheal ring width (TITRW) were measured on both expiration and inspiration. The mean of the FTRW width (129 dogs) was greater in expiration (10.97 +/- 1.02 mm, p = 0.001) than that in inspiration (9.86 +/- 1.03 mm). For 51 normal dogs, the mean of the TITRW width was greater in expiration (9.05 +/- 1.52 mm, p = 0.001) than in inspiration (8.02 +/- 1.43 mm). For 78 tracheal collapse dogs, the mean of the TITRW width was greater in expiration (15.89 +/- 1.01 mm, p = 0.001) than in inspiration (14.85 +/- 1.17 mm). The TITRW/FTRW ratio of the normal dogs was higher (p = 0.001) in expiration (0.81 +/- 0.09) than that in inspiration (0.79 +/- 0.10). When compared between the normal and tracheal collapse dogs, the TITRW/FTRW ratio was also increased (p = 0.001) both in expiration (1.54 +/- 0.09) and inspiration (1.47 +/- 0.08), respectively. Based on these results, the cutoff level of the TITRW/FTRW ratio was statistically analyzed according to the receiver operating characteristic curve and it could be set at 1.16 in expiration and at 1.13 in inspiration. We have demonstrated that tracheal ultrasonography is a useful technique for the evaluation of tracheal collapse and it can be a supportive tool together with the radiographic findings for making the correct diagnosis.

Innominate artery compression of trachea.

Innominate artery may cross the trachea and cause airway obstruction is a rare cause of vascular obstruction of airway. We describe a child with stridor, inability to extubate in whom the diagnosis was suspected on fluoroscopy and confirmed by angiography. Reimplantation of the innominate artery resulted in excellent results with longterm follow up. Variantions of this condition and modalities for confirmation of diagnosis are discussed.

Nasolaringoscopia ou laringotraqueoscopia: qual o melhor exame para avaliação da via aérea infantil? / Nasolaryngoscopy or laryngotracheoscopy: which is the best exam for assessing the airways of children?

É comum crianças com quadro de desconforto respiratório alto, sendo importante uma avaliação através de endoscopia da via aérea. OBJETIVO: Avaliar qual o melhor exame para via aérea infantil. MATERIAIS E MÉTODOS: Estudo retrospectivo com 16 crianças do ambulatório de via aérea infantil do Setor de Otorrinolaringologia Pediátrica da UNICAMP, com história de stress respiratório, submetidas à nasolaringoscopia e laringotraqueoscopia de março de 2001 a março de 2004. Dados coletados foram equiparados e comparados. RESULTADOS: Foram avaliadas 16 crianças, sendo a indicação mais comum do exame avaliação de traqueotomia prolongada em 10 pacientes (62 por cento), seguida de avaliação de estenose subglótica em três casos (31,3 por cento). Em 44 por cento dos exames houve falha da NL em mostrar lesões em subglote. CONCLUSÃO: A avaliação endoscópica da via aérea infantil em crianças com dificuldade respiratória é essencial para o diagnóstico. Concluímos que todas as crianças com patologia de via aérea superior devem ser submetidas à nasolaringoscopia inicialmente, a qual é um exame barato, de fácil execução e que fornece dados importantes inclusive a respeito da funcionalidade da laringe. No entanto, se houver suspeita de patologia subglótica ou traqueal, ou ainda quando os dados nasolaringoscopia não são condizentes com exame físico, é essencial a realização da laringotraqueoscopia.

It is not uncommon to find children with respiratory distress. In these cases airway endoscopy is usually required. Doubts about which examination should be used are frequent. AIM: to establish which examination is the best to assess the airways of children. MATERIAL AND METHODS: a retrospective study assessing 16 children with a history of respiratory distress at the Children Airway Unit of the Pediatric Otolaryngology Department at UNICAMP. All patients underwent nasolaryngoscopy and laryngotracheoscopy between March 2001 and March 2004. Data was analyzed and compared. RESULTS: during this study 16 children were assessed; the most frequent indication of exams were: evaluation of prolonged tracheostomy in 10 patients (62 percent), and subglottic stenosis (31.3 percent). CONCLUSION: assessing airways in children with respiratory distress is essential for a diagnosis. In our study, we concluded that all children with upper airway disease must undergo nasolaryngoscopy, an easy, economic and useful exam that provides information about larynx function. However, if subglottic or traqueal disease issuspected, or if nasolaryngoscopy findings are in conflict with the physical examination, laryngotracheoscopy should be undertaken.

Incidência e características endoscópicas de lesões das vias aéreas associadas à intubação traqueal em crianças / Incidence and endoscopic characteristics of airway injuries associated with endotracheal intubation in children

OBJETIVO: Descrever a incidência e características endoscópicas de lesões das vias aéreas em crianças submetidas à intubação. MÉTODOS: Durante o período de dois anos (outubro/99 a outubro/01) foi conduzido estudo prospectivo no qual todo paciente intubado, excetuando-se aqueles que evoluíram para óbito e recém-nascidos (RN) com peso inferior a 1.250g, foi submetido à endoscopia respiratória na extubação. Achados endoscópicos foram classificados em leves, moderados ou graves. Descrições foram realizadas por meio de proporções e medianas, comparações feitas por teste qui-quadrado para proporções. RESULTADOS: Foram estudados 61 RN e 154 crianças. Em 89,8 por cento dos pacientes, sendo 55 RN e 138 crianças (p=0,89), foi detectada pelo menos uma lesão somando 507. Pacientes com lesões leves corresponderam a 54,8 por cento (IC95 por cento: 48,1-61,5), aqueles com lesões moderadas foram 24,2 por cento (IC95 por cento: 18,5-30,0) enquanto as graves ocorreram em 10,7 por cento dos pacientes (IC95 por cento: 6,6-14,8). Locais principalmente acometidos foram glote (48,1 por cento das lesões) e subglote (34,9 por cento das lesões). Erosões foram as mais incidentes em ambos os grupos etários (p=0,88). Edema de prega vocal foi a principal lesão moderada em ambos os grupos (p=0,96), seguida por ulcerações (p=0,92). Nódulos fibrosos em pregas vocais e sinéqüias foram as principais lesões graves em ambos os grupos etários (p=0,12). Estenose subglótica foi detectada em 2,8 por cento da população sem diferença entre as faixas etárias (p=0,35). CONCLUSÕES: Verificou-se elevada incidência de lesões em vias aéreas, sem diferença significante entre os grupos etários com relação à incidência e características das lesões. Houve predomínio de lesões leves, lesões na glote e caracterizadas por erosões, edema e ulcerações.

Role of multidetector CT virtual bronchoscopy in the evaluation of post-tracheostomy tracheal stenosis--a preliminary study.

AIM: To study the technique and utility of virtual bronchoscopy (virtual reality endobronchial simulation, VRES) as a tool to evaluate post-tracheostomy tracheal stenoses and to correlate the findings of virtual and invasive bronchoscopy and to follow-up treated lesions or those currently under treatment that were initially diagnosed with VRES. METHODOLOGY: This prospective study comprised nine patients in the age group 13 to 65 years presenting with breathlessness and stridor following one or multiple tracheostomies. They underwent plain CT using a multidetector CT (MDCT) scanner (Siemens Volume Zoom) using narrow (1 mm) collimation. These thin slice images were post-processed using an Irix-based workstation with a 'Fly-Through' endoscopy application. These patients also underwent a rigid (three patients) or fiberoptic (six patients) bronchoscopy. RESULTS: Of the nine patients that underwent VRES, five were found to have stenoses, three had obstructing granulation tissue, one had an obstructing membrane and one had synechiae. The invasive bronchoscopic findings supported the VRES diagnosis in all but one case of stenosis, one of granulation tissue and the case with synechiae. Membranes and synechiae were relatively difficult to diagnose without the corresponding axial and multiplanar images. VRES achieved a higher sensitivity, while invasive bronchoscopy a higher specificity. CONCLUSIONS: VRES proved to be comparable to invasive bronchoscopy in the depiction of post-tracheostomy tracheal stenoses, with a notable advantage in critical stenoses in that the airway distal to the stenosis could be assessed with VRES but not with invasive bronchoscopy. A preliminary VRES was found to be of assistance in the selection of patients for the more invasive therapeutic procedures such as laser ablation of granulation tissue and its follow-up.

Estenosis laringotraqueal: estudio retrospectivo / Laringotraqueal stenosis: retrospective review

El manejo de la estenosis laringotraqueal permanece como uno de los problemas más desafiantes para el otorrinolaringólogo, un estudio retrospectivo fue realizado a 27 pacientes tratados en el Servicio de Otorrinolaringología y Cirugía de Cabeza y Cuello del Hospital Central Militar entre 1990 y 1998. La mayor parte fueron adultos, la edad promedio fue 36.2 años, de éstos, 14 mujeres y 13 hombres, con un promedio de 10.8 días de intubación, 21 pacientes fueron traqueotomizados, el sitio más frecuente de estenosis fue la subglotis, en relación a la severidad, el grado III de Cotton fue el de mayor incidencia, procedimientos endoscópicos se realizaron con éxito en estenosis grado I-II de Cotton, y las técnicas externas fueron más efectivas para estenosis complejas, laringotraqueoplastía con injerto de costilla más conformador interno fue el procedimiento que tuvo mayor éxito en estenosis subglóticas y la resección de la estenosis con anastomosis término-terminal para estenosis traqueales.

Estenosis traqueal: estudio preliminar / Tracheal stenosis: preliminary study

Se realizó un estudio retrospectivo y descriptivo con la utilización de los expedientes clínicos de 5 pacientes con estenosis traqueal, mayoritariamente como consecuencia de intubación prolongada, y en el que se tuvo en cuenta aspectos relacionados con el diagnóstico, el tratamiento y las complicaciones. Existió un predominio del sexo femenino y edad media de 44,6 años. La intubación prolongada de origen diverso fue la causa de la estenosis en 4 de los 5 pacientes y en 1 fue posterior a la reparación de lesión traqueal yatrógena. La instalación de la estenosis tuvo lugar entre 8 días y 3 meses. La tomografía lineal en 3 pacientes y en 2 la radiografía simple de tráquea anteroposterior y lateral verificaron el diagnóstico. La endoscopia traqueobronquial preoperatoria fue de utilidad en la caracterización de la estenosis. En todos los pacientes se realizó tratamiento quirúrgico al resecar el área estenótica con posterior anastomosis terminoterminal y fijación del cuello en flexión durante 8 días como promedio. Dos pacientes mostraron granulomas en el nivel de la línea de sutura, los cuales fueron tratados por vacuolización con láser. No se reportó mortalidad en la muestra estudiada(AU)

A retrospective and descriptive study was conducted by using the medical histories of 5 patients with tracheal stenosis, mostly as a result of prolongued intubation. Aspects connected with the diagnosis, treatment and complications were taken into account. It was observed a predominance of females and an average age of 44.6. Prolongued intubation of different origin was the cause of stenosis in 4 of the 5 patients, whereas in the other it occurred after the reparation of the tracheal and athrogenous lesion. The installation of stenosis took place between 8 days and 3 months. Lineal tomography in 3 patients and anteroposterior and lateral simple X-ray of the trachea in 2 confirmed the diagnosis. Preoperative tracheobronchial endoscopy was useful to characterize stenosis. All patients underwent surgical treatment with resection of the stenotic area by posterior terminoterminal anastomosis and fixation of the neck in flexion during 8 days as an average. 2 patients that had granulomas at the level of the suture line were treated with nuclear vacuolization. No mortality was reported in the studied sample(AU)

Unusual association of pulmonary artery sling with right aortic arch and aberrant left subclavian artery

We present an unusual case of vascular sling, tracheal stenosis by complete cartilaginous ring, and aberrant left subclavian artery with right aortic arch that underwent successful surgical repair for the sling. These abnormalities were suspected from unusual multiple indentations found on esophagogram. Complete preoperative diagnosis was established with chest computerized tomogram combined with angiography.

Estenosis traqueal congénita: reparación con injerto de pericardio, en by pass cardiopulmonar: reporte de caso clínico / Congenital tracheal stenosis: repaired using cardiopulmonar bypass and pericardial graft: case report

Se describe el caso clínico de un recién nacido portador de estenosis traqueal congénita. La lesión estenótica compromete la tráquea ampliamente, en la región intratorácica y ocasiona una insuficiencia respiratoria grave que requiere cirugía reparadora de emergencia. La tráquea es reparada con parche de pericardio, con el apoyo de by pass cardiopulmonar. Posteriormente se instala un stent metálico intraqueal para dar sustentación al injerto de pericardio

Estenosis laringotraqueal. Etiología y tratamiento en el Hospital Central Militar / Laringo-tracheal stenosis. Ethiology and treatment in the Military Central Hospital

Se realizó un estudio retrospectivo, observacional y descriptivo en el periodo comprendido entre enero de 1992 y mayo de 1997 en el Hospital Central Militar, en el que se buscaron los casos de pacientes con estenosis laringotraqueal congénita o adquirida que acudieron a consulta por ese motivo al Servicio de Otorrinolaringología y Cirugía de Cabeza y Cuello, de ambos sexos y de cualquier edad. Se estudiaron 38 pacientes en los que se identificó el sitio de la estenosis, la causa, el resultado del tratamiento, las complicaciones piscológicas y el número de casos por año que acudieron a consulta al Hospital Central Militar; 18 pacientes (47 por ciento) presentaron estenosis subglótica y 4 (10 por ciento), estenosis combinada. La causa más común (76 por ciento) fue trauma laríngeo interno por intubación endotraqueal, seguida de trauma laríngeo externo por accidentes automovilísticos y riñas (10 por ciento), congénitas (5 por ciento), infecciosas (5 por ciento) e idiopáticas (2 por ciento). El tratamiento primario incluyó resección del tejido de granulación con LASER o dilatación con broncoscopio, fue satisfactorio en 24 pacientes (63 por ciento), y no satisfactorio en 4 pacientes (10.5 por ciento). Las complicaciones psicológicas se presentaron en 7 (18 por ciento). La frecuencia promedio por año fue de 6 casos

Estenosis traqueales: manejo quirúrgico a propósito de tres casos / Estenosis traqueales: surgical handling with regard to three cases

Analiza que las estenosis traqueales (ET) son complicaciones frecuentes dentro de las enfermedades tributarias de la cirugía cardiotorácica; la causa más común es la intubación endotraqueal, sigue en menor porcentaje la traqueotomía, escleroma respiratorio, carcinoma de tiroides con invasión a traque y finalmente el traumatismo extrínsecos de cuello. La técnica quirúrgica mas idónea en la actualidad es la anastomosis término terminal de la traquea. (ATT). Se estudian los 3 únicos casos de ET que fueron operados en el período: ene./91-ago./96 en el HCAM, tuvieron como causas desencadenantes la intubación endotraqueal, el tiempo de intubación fue de 30 minutos, 12 días y 7 días, se hallaron obstrucciones del 50xciento, 80xciento y 100xciento; a todos se los practicó ETT, se describe el tratamiento de estos pacientes y se demuestran los resultados ç, que fueron satisfactorios desde el punto de vista anatómico y funcional...