Outcomes of newborns with tracheostomy: single center experience.

BACKGROUND: Babies with severe bronchopulmonary dysplasia (BPD) are discharged with the support of a home-type mechanical ventilator, after opening a tracheostomy. In addition, although rare, tracheostomy is required in the neonatal period in congenital airway malformations. Early tracheostomy is appropriate to prevent complications due to prolonged intubation. We aimed to find the appropriate time for tracheostomy by examining the tracheostomy opening and closing times, complications and demographic characteristics of the patients, who were hospitalized and underwent tracheostomy in our neonatal intensive care unit. METHODS: This retrospective study involved infants admitted to the neonatal intensive care unit between January 2014 and 2019 and discharged following tracheostomy. Information acquired from hospital data was enrolled. The protocol was registered with ClinicalTrials.gov identifier NCT04497740. RESULTS: Twenty-six neonates with median 27.5 weeks gestational age and birth weight 885 gr were enrolled in the study. The mean opening time for tracheostomy was 54 ± 24 days, and the postmenstrual age (PMA) was 36 ± 3 weeks. The mean time to closure of tracheostomy in newborns with a tracheostomy was 387 ± 164 days. The duration of accidental decannulation developed as an early complication in 8 patients was mean 11 ± 8 days. Aspiration pneumonia in 2, subglottic stenosis in 5, accidental decannulation in 2, suprastomal collapse in 7, tracheocutaneous fistula in 8 and granulation tissue in 2 patients were found to be late complications, which occurred within median 90 days. CONCLUSIONS: If there is no evidence that breathing has improved and the patient is still using a mechanical ventilator at high pressures and high oxygen concentration, a tracheostomy placement should be considered within two months.

Pharyngocutaneous fistula after salvage laryngectomy.

CONCLUSION: Preoperative chemoradiotherapy (CRT) was associated with a significantly higher rate of pharyngocutaneous fistula (PCF). OBJECTIVE: PCF is the most frequent complication following total laryngectomy. Although organ-preserving radiotherapy (RT) or CRT offer good locoregional control, many patients still require salvage laryngectomy. The aim of this study was to evaluate the factors that predispose patients to PCF, with a focus on preoperative RT, induction chemotherapy (ICT), and CRT. METHODS: This was a retrospective case series; 151 patients who underwent TL were reviewed. Preoperative RT, ICT, CRT, and some surgical parameters were analyzed as potential risk factors. RESULTS: The overall PCF rate was 13%. CRT was the only preoperative treatment that had a significant effect on PCF (35.3%, p = 0.004, odds ratio (OR) = 10.75). Surgery extended to the pharynx (p = 0.005, OR = 8.34) and vacuum drain duration (p = 0.012, OR = 5.16) were observed to be associated with PCF.

Laryngomalacia: patient outcomes following aryepiglottoplasty at a tertiary care center.

Laryngomalacia is the most common cause of stridor in neonates and infants. Most cases are mild and resolve spontaneously without treatment. Only severe cases with intolerable symptoms require surgical intervention; in such cases, supraglottoplasty is considered the treatment of choice. The aim of this study was to review and present the outcomes in patients with laryngomalacia who underwent aryepiglottoplasty-a type of supraglottoplasty. The medical records of children diagnosed as laryngomalacia who were followed up at Hacettepe University Hospital, Department of Otorhinolaryngology, between 2007 and 2012 were reviewed retrospectively. The study included 16 children who required surgical intervention. The mean age of the 16 children included in the study was 133 days (range: 7 days-48 months). Among the patients, 9 (56%) were male and 7 (44%) were female. In all, 7 patients (44%) had a comorbid condition. Laryngomalacia diagnoses were as follows: type I: n = 2, 13%; type II: n = 13, 81%; type III: n= 1, 6%. Stridor completely resolved in 10 of the children who underwent aryepiglottoplasty. Three patients required tracheotomy and 3 required revision supraglottoplasty; these six cases were considered as failed surgical treatment. The aryepiglottoplasty success rate was 63%. None of the patients had any intraoperative or postoperative complications. Despite the primarily benign nature of laryngomalacia, comorbid conditions can exacerbate symptoms and negatively affect the prognosis. Aryepiglottoplasty can be performed with high success and low complication rates in properly selected patients.