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Objective@#To assess the outcomes of partial cricotracheal resection (CTR) and extended cricotracheal resection (ECTR) for severe laryngotracheal stenosis.@*Methods@#From November 2009 to September 2017, 18 patients underwent CTR and ECTR at the Department of Otorhinolaryngology Head and Neck Surgery, Tangdu Hospital, Air Force Medical University for severe laryngotracheal stenosis were reviewed retrospectively. There were 12-male and 6-female patients, with the age ranged from 4 to 56 years (median 25 years). The causes were postintubation in 11 cases, cervical trauma in 4, idiopathic in 3. The stenosis located in subglottic and tracheal (n=12), glottic and subglottic and tracheal (n=3), subglottic (n=2), and glottic and subglottic (n=1). Two patients had concurrent unilateral vocal cord palsy.One patient had undergone previous endoscopic balloon dilation and 8 patients had previous laryngotracheal reconstruction. The stenosis was graded according to modified Myer-Cotton classification as follows: Ⅲb (n=1), Ⅲc(n=1), Ⅳa (n=2), Ⅳb (n=12), Ⅳc (n=2). The surgical outcomes and complications were recorded.@*Results@#Among 18 patients,11 of the 12 patients undergoing CTR were decannulated. Five of the 6 patients undergoing ECTR were decannulated. Resected airway length ranged from 1.5 to 4.0 cm (median 2.8 cm). Surgical complications included infection of incision wound in 2 cases, anastomotic granulation in 2, cervical subcutaneous emphysema in 1, aspiration in 1, and unilateral arytenoid prolapse in 1. No recurrent laryngeal nerve injury or tracheoesophageal fistula occurred. The median follow up was 11 months.@*Conclusions@#CTR is efficient for severe subglottic and upper tracheal stenosis while ECTR is efficient for subglottic stenosis extended to the glottis. Both procedures also provide a salvage therapy for patients with previous failed treatments.
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Objective@#The aim of this study is to o explore the diagnosis, treatment and prognosis of idiopathic subglottic stenosis （ISS） @*Method@#The clinical data of 15 patients with idiopathic subglottic stenosis treated in our department were analyzed retrospectively. The degree of stenosis was classified by the Cotton Airway grading system of Myer, with 8 cases of gradeⅡ, 4 cases of grade Ⅲ and 3 cases of grade Ⅳ. @*Result@#The time of follow-up of HTSS was 0.5-10 years. All 15 patients were successfully extubated without asphyxia, decannulation and wound nonunion. @*Conclusion@#For patients with idiopathic subglottic stenosis in the non-progressive stage, active surgical treatment strategy should be adopted and treated individually. The prognosis is satisfactory.
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The aim of this study is to o explore the diagnosis, treatment and prognosis of idiopathic subglottic stenosis （ISS） The clinical data of 15 patients with idiopathic subglottic stenosis treated in our department were analyzed retrospectively. The degree of stenosis was classified by the Cotton Airway grading system of Myer, with 8 cases of gradeⅡ, 4 cases of grade Ⅲ and 3 cases of grade Ⅳ. The time of follow-up of HTSS was 0.5-10 years. All 15 patients were successfully extubated without asphyxia, decannulation and wound nonunion. For patients with idiopathic subglottic stenosis in the non-progressive stage, active surgical treatment strategy should be adopted and treated individually. The prognosis is satisfactory.
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Objective@#To explore the application value of thyroid alar cartilage(TAC) in the laryngotracheal reconstruction of subglotticstenosis in the paediatric population.@*Methods@#Twelve patients(7 males,5 females; range from 2.3 to 12.0 years) with subglotticstenosis who had undergone laryngotracheal reconstruction procedures at our hospital fromSeptember 2016 to July 2018 were analyzed retrospectively.The degree of stenosis was classified according to Myer-Cotton classification system:grade Ⅱ(n=4),grade Ⅲ(n=6) and grade Ⅳ(n=2). The stenosis planes were subglotticbut did not exceed the 3rd tracheal cartilage ring.@*Results@#Of all 12 patients, 11 were decannulated and 1 failed. All patients with grade Ⅱ and Ⅲ patients were decannulated at one procedure. There were no severe complications such as tube dislogement,asphyxia and unhealed wound.@*Conclusions@#The TAC for widening laryngotracheal lumen is relatively simple and reliable for laryngotracheal reconstruction in the pediatric population with subglottic stenosis. This would′t cause any structural damage to the laryngeal cavity.
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The length of tracheal defect or stenosis exceeded 5 cm could not be treated by simple resection and end-to-end anastomosis of the remaining trachea. Various ways of tracheal replacement had appeared sequentially, such as radial forearm free flap with cartilage grafts, tracheal tissue-engineering and tracheal allotransplantation. Among these methods, tracheal allotransplantation displayed a better long-term result. In this review, we are focused on recent advances in tracheal allotransplantation, particularly on revascularization and reepithelialization of graft, as well as on the application of immunosuppressive agents.
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To study the effectiveness of laryngotracheal reconstruction with rib cartilage graft for complex laryngotracheal stenosis and/or anterior neck defect, 62 patients with complex laryngotracheal stenosis and/or anterior neck defect underwent laryngotracheal reconstruction with autogenous rib cartilage graft. The surgical procedures were laryngotracheotomy with rib cartilage graft interposition and silicon-tube stent placed in the region of laryngotracheal stenosis and/or anterior neck defect for the period of between 10 days and 12 months. Three patients with complex subglottic stenosis and anterior neck defects underwent a single-stage reconstruction with a combined rib cartilage graft interposition and fasciocutaneous flap reparation. One patient with a complex subglottic and superior thoracic tracheal stenosis underwent a staged operation. Of the 62 patients, 46 patients (74.1%) were successfully decannulated. One patient had combined subglottic stenosis, which was healed, and superior thoracic tracheal stenosis, which is undergoing treatment. 15 patients (24.2%) had failure in decannulation due to either wound infection followed by rib cartilage necrosis, or granulation tissue formation and restenosis. Of these 15 patients, ten required revision operations and delayed healing. The duration of follow-up ranged from 1 to 10 years. Of 46 patients, who were successfully decannulated, 36 had a satisfactory airway and a functional voice; two had restenosis due to partial laryngectomy for laryngocarcinoma recurrence 1 year after decannulation; eight were lost to follow-up after successfully decannulated. We conclude that this method can provide effective treatment for complex laryngotracheal stenosis and/or anterior neck defects. It is relatively simple with a high decannulation rate in selected patients.
Subject(s)
Cartilage/transplantation , Laryngostenosis/surgery , Plastic Surgery Procedures/methods , Ribs , Tracheal Stenosis/surgery , Tracheotomy , Adenocarcinoma/surgery , Adolescent , Adult , Aged , Carcinoma/surgery , Child , Child, Preschool , Cohort Studies , Female , Humans , Laryngeal Neoplasms/surgery , Laryngectomy , Male , Middle Aged , Papilloma/surgery , Stents , Surgical Flaps , Thyroid Neoplasms/surgery , Transplantation, Autologous , Treatment Outcome , Young AdultABSTRACT
@#China Partner Network (CPN) training project would train professionals for better management of children rehabilitation, including advanced theory and manipulation in treatment and functional assessment of children with cerebral palsy, psychological education,and orthotics as well as operation and non-operation protocols. Domestic status quo in this area and some other relevant experiences were also compared with CPN.
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OBJECTIVE@#To discuss the function and operative method of silicon T tube in laryngotracheal reconstruction.@*METHOD@#Two hundred and ninety-seven patients of laryngotracheal stenosis were operated with laryngotracheal reconstruction in our department. All of patients were tracheostomy dependent before reconstruction and were placed a silicon T-tube stenting for 3 to 6 months after reconstruction.@*RESULT@#Two hundred and eighty-nine patients (97.3%) were successfully decannulated with good airway patency and effective phonation. They were followed up from 1 to 10 years, and no recurrence was found.@*CONCLUSION@#Silicon T-tube is an effective and safe stent for laryngotracheal reconstruction. Paying attention to some application details may avoid the complication and obtain a satisfactory effect.
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Adolescent , Adult , Child , Female , Humans , Male , Middle Aged , Young Adult , Laryngostenosis , General Surgery , Plastic Surgery Procedures , Methods , Silicon , Tracheal Stenosis , General SurgeryABSTRACT
Objective:To investigate the effect of the musculo-periosteum flap of the sternocleidomastoideus with clavicular periosteum on the reconstruction of extensiveness laryngotracheal defect. Method: Retrospectively studied 49 patients, who admited in our department from 1996 to 2005 years for severe laryngotracheal defect. There were 28 males and 21 females aged from 15 to 69 years old (mean age was 47 years old). The causes of laryngotracheal defect were laryngotracheal stenosis(31 cases) and surgery for thyroid carcinoma invading trachea (18 cases). All of 49 cases were treated with the graft of musculo-periosteum flap of the sternocleidomastoideus with clavicular periosteum and placed a silicon T-tube stenting for 3 to 6 months. Result; All of 49 cases were successfully decannulated with recuperative normal airway patency and effective phonation. The follow up ranged from 2 to 10 years, and the effect of operation was steady. Conclusion:The musculo-periosteum flap of the sternocleidomastoideus with clavicular periosteum is an ideal graft for the reconstruction of cervical extensiveness tracheal defect.
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OBJECTIVE@#To investigate the effect of the musculo-periosteum flap of the sternocleidomastoideus with clavicular periosteum on the reconstruction of extensiveness laryngotracheal defect.@*METHOD@#Retrospectively studied 49 patients, who admitted in our department from 1996 to 2005 years for severe laryngotracheal defect. There were 28 males and 21 females aged from 15 to 69 years old (mean age was 47 years old). The causes of laryngotracheal defect were laryngotracheal stenosis (31 cases) and surgery for thyroid carcinoma invading trachea (18 cases). All of 49 cases were treated with the graft of musculo-periosteum flap of the sternocleidomastoideus with clavicular periosteum and placed a silicon T-tube stenting for 3 to 6 months.@*RESULT@#All of 49 cases were successfully decannulated with recuperative normal airway patency and effective phonation. The follow up ranged from 2 to 10 years, and the effect of operation was steady.@*CONCLUSION@#The musculo-periosteum flap of the sternocleidomastoideus with clavicular periosteum is an ideal graft for the reconstruction of cervical extensiveness tracheal defect.
Subject(s)
Adolescent , Adult , Aged , Female , Humans , Male , Middle Aged , Young Adult , Laryngostenosis , General Surgery , Periosteum , Transplantation , Plastic Surgery Procedures , Methods , Retrospective Studies , Surgical Flaps , Trachea , General SurgeryABSTRACT
OBJECTIVE@#To investigate the effect of the anteroposterior cricoid split on cartilage growth.@*METHOD@#The rabbits were killed 8 months after the surgery of anteroposterior cricoid split. The larynxes were harvested and the cross-sectional area of the cricoid cartilage were calculated.@*RESULT@#There was no significant difference in the cross-sectional area of the cricoid cartilage of these three groups.@*CONCLUSION@#The anteroposterior cricoid split might have no adverse effect on subsequent growth of cricoid cartilage.
Subject(s)
Animals , Rabbits , Cricoid Cartilage , General Surgery , Laryngostenosis , General SurgeryABSTRACT
OBJECTIVE To investigate the clinical characteristics,treatment and prognosis of laryngotracheal stenosis due to relapsing polychondritis (RP).METHODS The clinical data of 6 patients with laryngotracheal stenosis due to RP were reviewed retrospectively.RESULTS From 1996 to 2006,6 patients with laryngotracheal stenosis due to RP were managed in our hospital.Respiratory tract lesions were diffuse and extensive.Of them,4 patients accepted laryngotracheal reconstruction using surgical flaps with or without pedicle,2 accepted dilation of trachea in thoracic segments.Five patients were cured without recurrence.CONCLUSION Treatment of laryngotracheal stenosis due to RP is very difficult.If the surgical opportunity and methods were selected correctly according to each patient,good results can also be obtained.
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Objective To observe the feasibility of using bone marrow-derived mesenchymal stem cells (MSCs) as seed cells for tissue-engineering in Otolaryngology. Method MSCs were isolated from bone marrow of human rib and purified by centrifuge and cultured in vitro. The proliferation and growth characteristics of MSCs were observed in primary and passage culture. Result Human bone marrow-derived MSCs showed active proliferation capacity in vitro in primary and passage cultures. Conclusion Human bone marrow-derived MSCs have relatively young biologic age and they can be used as the seed cells for tissue engineering.
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Laryngeal conservation surgery trys for more laryngeal function reservation in precondition of radical cure,and presently has been the main method of treating larygeal carcinoma.The article discusses the moral principle that should be followed in the course of developing conservation laryngeal surgery on the point of view of medical ethics.To get curative effect,the surgeons should possess high responsibility and masterly skill,and highly regard multi-discipline cooperation and multimodality therapies.
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Objective To explore the electronystagmography (ENG) changes and their clinical significance in aged patients with vertebro-basilar insufficiency (VBI). Methods Sixty aged patients with VBI were selected as experimental group for testing of visuo-oculomotor system reaction, spontaneous nystagmus, caloric test and positional nystagmus. Forty normal aged persons as control group. Results In the experimental group, there were 11 cases (18.3%) who had spontaneous nystagmus and 46 cases (76.6%) with positional nystagmus. The positional nystagmus intension in those patients was 7.76?6.05?/s, which was much higher compared to the control group (P
