Adenoid cystic carcinoma rarely occurs within the subglottic larynx. In this study, a case of subglottic adenoid cystic carcinoma was reported. A 54 year-old Chinese woman developed a sudden onset of chest distress an...Adenoid cystic carcinoma rarely occurs within the subglottic larynx. In this study, a case of subglottic adenoid cystic carcinoma was reported. A 54 year-old Chinese woman developed a sudden onset of chest distress and cough worsening after physical exertion, and was diagnosed with, and treated as, bronchial asthma. Regular anti-asthmatic therapy did not improve the symptoms. Until a sudden dyspnea, a cervicothoracic computerized tomography （CT） revealed that her upper airway was obstructed by a laryngeal tumor. The patient was diagnosed with a subglottic adenoid cystic carcinoma and treated with complete surgical excision and adjuvant radiation therapy. Follow-up endoscopy and laryngeal magnetic resonance imaging （MR1） at six months showed no recurrence of the tumor. The diagnosis of subglottic adenoid cystic carcinoma should be considered in patients who are characterized by dyspnea, cough, and stridor, but do not respond to regular anti-asthmatic therapy.展开更多
Tracheal intubation through a supraglottic airway device(SAD)is recommended for difficult airway management.However,specific tracheal tubes for SAD-guided intubation are not always available in emergencies,necessitati...Tracheal intubation through a supraglottic airway device(SAD)is recommended for difficult airway management.However,specific tracheal tubes for SAD-guided intubation are not always available in emergencies,necessitating the use of non-specific tubes such as polyvinyl chloride(PVC)and reinforced tracheal tubes.Although successful intubation with these tubes has been reported,clinicians often face difficulties passing them through the SAD,increasing the risk of airway injury even with correct SAD placement.展开更多
Objective:Subglottic stenosis(SGS)is commonly treated with endoscopic dilations or tracheal resection.Since office-based serial intralesional steroid injections(SILSI)were first reported in 2017,they have been establi...Objective:Subglottic stenosis(SGS)is commonly treated with endoscopic dilations or tracheal resection.Since office-based serial intralesional steroid injections(SILSI)were first reported in 2017,they have been established as an effective,less invasive treatment alternative or adjunct.The aim of this study is to add to the literature investigating the efficacy of office-based SILSIs for idiopathic and post-intubation SGS patients,specifically studying surgery-free intervals(SFIs)and discussing our experience with SILSI treatment order and stenosis grade.Methods:This study is a retrospective case series of 14 patients with subglottic stenosis treated with in-office serial intralesional steroid injections as a primary or adjuvant treatment from 2018 to 2022 in an academic tertiary care center.Results:Of seven patients with calculable SFI,a mean SFI increase of 481.28 days was observed following SILSI treatment(p=0.042).Ten patients in our cohort presented with idiopathic or post-intubation grade 2 SGS and were managed successfully with a combination of endoscopic dilation and SILSI.Two patients with post-intubation grade 1 SGS were managed successfully with SILSI as their primary treatment.Two patients with post-intubation grade 3 SGS required a tracheal resection and did not benefit from SILSI.Conclusions:We have found that SFI significantly increased following SILSI initiation.Although statistical power was limited given the small sample size,our findings suggest that SILSI may be an effective primary treatment in low-grade stenosis.SILSI as an adjuvant to endoscopic dilation may be most effective in intermediate-grade stenosis.SILSI may not be effective in high-grade stenosis patients who failed prior endoscopic treatment.展开更多
Importance:Post-intubation subglottic stenosis(SGS)in children can be life threatening.Definitive treatment varies and lacks a universally accepted approach.Objective:We performed a prospective study to assess the saf...Importance:Post-intubation subglottic stenosis(SGS)in children can be life threatening.Definitive treatment varies and lacks a universally accepted approach.Objective:We performed a prospective study to assess the safety and feasibility of holmium laser combined with cryotherapy delivered via flexible bronchoscopy for the treatment of post-intubation SGS in children.Methods:This study involved all patients with post-intubation SGS seen at the Interventional Pulmonology Department of Beijing Children's Hospital between July 2014 and December 2016.Holmium laser treatment and cryotherapy was then performed under flexible bronchoscopy,whose parents refused to accept the alternative standard treatment of tracheotomy and balloon dilation under direct laryngoscopy.results:Sixteen patients with post-intubation SGS were included in this study.Ages ranged from 2 months to 12.25 years old.According to the Cotton-Myer grading system,three cases were Grade II,12 cases were Grade III,and one case was Grade IV.According to the McCaffrey system,eight cases were Stage 1,two cases were Stage 2,and six cases were Stage 3.The average number of procedures was 4.88.Fifteen of the 16 patients achieved clinical cure.One patient achieved clinical improvement.The average treatment course duration was 55.31 days.No severe complications were seen.Post-treatment clinical symptoms,endoscopic findings and quality of life showed marked improvement.Interpretation:Our study supports the conclusion that holmium laser treatment combined with cryotherapy via flexible bronchoscopy appears to be a safe and feasible treatment for post-intubation SGS in children.展开更多
Tracheal stenosis or tracheal injury is a distressing condition. The silicone tracheal T-tube presents a substitute for stent of this complicated disease. We have come across a case of tracheal perforation in which tr...Tracheal stenosis or tracheal injury is a distressing condition. The silicone tracheal T-tube presents a substitute for stent of this complicated disease. We have come across a case of tracheal perforation in which tracheoplasty was planned. After traceoplasty silicone tracheal T-tube was placed as a stent. We were not able to connect silicone tracheal T-tube with Bain circuit with ET TUBE No. 8.5, 8, 7.5, 7 connector and it was difficult to ventilate the patient now. We have tried other ET TUBE connector and finally we succeeded to connect ET TUBE No. 5.5 connector with Bain circuit and we were able to ventilate the patient.展开更多
An updated approach in the management of 50 patients with foreign body inhalation is presented. Certain risk factors that lead to complications and mortality due to endoscopic extraction of foreign bodies and thus det...An updated approach in the management of 50 patients with foreign body inhalation is presented. Certain risk factors that lead to complications and mortality due to endoscopic extraction of foreign bodies and thus determine prognosis were identified. Remedial measures to reduce morbidity and mortality due to bronchoscopic removal of foreign bodies are suggested. Fifty patients of suspected foreign body inhalation presented to a Unit of the Department of ENT, Head and Neck Surgery of Government Medical College associated SMHS Hospital Srinagar, Kashmir from March 2007 to June 2017. Of these, 49 patients were subjected to rigid tube bronchoscopy for removal of the aspirated foreign bodies and one coughed out the foreign body spontaneously during admission for bronchoscopy. History of foreign body inhalation was positive in 90% of patients and remaining was mostly referred from Paediatric Units with un-resolving collapse-consolidation of the lung. Whereas plain radiography of the chest and the soft tissues of neck were the primary imaging modality used in this study to detect the inhaled foreign bodies or their effects there are reports of virtual bronchoscopy being done with a multidetector computed tomography scanner in 3D image generation from axial cuts of the internal walls of the tracheobronchial tree in the management of patients suspected with foreign body aspiration. Bronchoscopy is a difficult and potentially hazardous procedure in the infant and young child. Telescopes and telescopic forceps were used during bronchoscopy to facilitate extraction of a foreign body inhaled. The type of a foreign body, site of its enlodgement and the complications encountered during its extraction were noted. During bronchoscopy the patients were connected to an ECG monitor and a pulse oximeter. 80% of the patients with foreign body inhalation were children in the age group of 0 - 5 years. There was a definite history of choking over the foreign body in 88% of the patients leading to acute respiratory distress in 46%. Cough alone or along with other symptoms occurred in most of the patients (96%). Persistent fever with respiratory symptoms unresponsive to treatment occurred in 38% of the patients with or without a positive history of foreign body inhalation. Right main bronchus was the commonest site of enlodgement of foreign body. In the present study, bean and peanut were the commonest types of foreign bodies inhaled (34%). Radiological findings in these patients include atelectasis with or without pneumonitis in 46.65% of the patients, normal chest/soft tissues of the neck in 24.45%, obstructive emphysema on the affected side in 24.45%, foreign body seen in the respiratory tract in 8.90% and bronchopneumonia in 2.22%. Complications associated with the endoscopic extraction of foreign bodies and the risk factors that lead to complications and mortality in patients with aspirated foreign bodies were identified in this study and the measures to reduce these complications and mortality rate to very low levels were suggested. Transient hypoxia, hypoxic bradycardia, transient cardiac arrest, bronchial perforation and death, laryngospasm, bronchospasm, subglottic oedema, reflex bradycardia and pneumothorax were among the few complications which occurred with the rigid endoscopic extraction of foreign bodies in the present study. Among the risk factors associated with the complications were prolonged bronchoscopy, semi-blind procedure, a vegetable foreign body, improper size and positioning of a bronchoscope and some other important factors which are detailed in the text of this paper to follow. Remedial measures on the basis of complications and the risk factors are suggested so as to decrease the morbidity and mortality due to endoscopic extraction of foreign bodies inhaled into the tracheobronchial tree.展开更多
Benign laryngotracheal stenosis (LTS) is a debilitating and potentially life-threatening condition that is commonly caused by iatrogenic events as a result of endotracheal intubation or tracheostomy. Numerous cases ar...Benign laryngotracheal stenosis (LTS) is a debilitating and potentially life-threatening condition that is commonly caused by iatrogenic events as a result of endotracheal intubation or tracheostomy. Numerous cases are being published for patients with coronavirus disease 2019 (COVID-19) who end up with severe LTS after prolonged intubation or tracheostomy. Here, we presented two cases of LTS due to prolonged intubation after severe COVID-19 pneumonia. The characteristic of these two cases is that both of them needed second time intubation and were readmitted because of severe dyspnoea and all the workup for post-COVID-19 complications were investigated except the LTS which was later diagnosed after one month of suffering of these patients.展开更多
Background:A recent innovation in the management of tracheostomy-dependent patients with laryngotracheal stenosis(LTS)has been the customizable laryngotracheal stent,made by dividing a T-tube in half("L stent&quo...Background:A recent innovation in the management of tracheostomy-dependent patients with laryngotracheal stenosis(LTS)has been the customizable laryngotracheal stent,made by dividing a T-tube in half("L stent").These L stents can be placed into the subglottis as well as the posterior glottis to prevent rapid re-stenosis following surgery,and they are easily removed in the office.We sought to review our experience with these stents and analyze patterns of success and failure.Methods:Retrospective chart review was performed of all tracheostomy-dependent patients who underwent L stent placement from January 2019 through February 2024.Clinical and demographic data were reviewed,with decannulation as the primary endpoint.Patients were assessed as having comorbid conditions(diabetes,coronary artery disease,morbid obesity,prior radiation)or not.Results:A total of 16 patients underwent stent placement.Six patients had posterior glottic stenosis(PGS),six had subglottic stenosis(SGS),and four had multilevel stenosis.Of these 16 patients,9 were ultimately decannulated(56.2%).Three of the successes were PGS(33.3%),four were SGS(44.4%),and two had both SGS and PGS(22.2%).Patients who were decannulated were statistically less likely to have comorbid conditions than patients who failed decannulation(p=0.0350).Conclusion:For tracheostomy-dependent patients who have failed first-line therapy,endoscopic surgery paired with L stent placement offers a reasonable alternative to open airway reconstruction or more destructive arytenoidectomy or cordotomy procedures.As with most airway surgeries,patient selection is important,as the presence of multilevel stenosis and/or comorbid conditions can predict a higher failure rate.展开更多
Objective: To identify the incidence of laryngotracheal stenosis (LTS) in burn pa-tients requiring mechanical ventilation at a regional academic burn center. Methods: A retrospective review of all burn patients requir...Objective: To identify the incidence of laryngotracheal stenosis (LTS) in burn pa-tients requiring mechanical ventilation at a regional academic burn center. Methods: A retrospective review of all burn patients requiring endotracheal intubation or tra-cheostomy for airway management between 2003 and 2009 was performed. A group of trauma patients requiring similar airway instrumentation during the same period of time was used as a control. Results: None of the trauma patients and 2 of the burn patients developed LTS. Both presented with stridor and were diagnosed within 2—5 weeks after extubation. One patient underwent successful carbon dioxide laser radial incision and dilation and continues to do well. The other patient failed endoscopic treatment and required T-tube placement. The incidence of LTS in burn patients requiring mechanical ventilation was 2.98％ overall and 4.76％ among those with inhalational injury. Conclusions: Patients become symptomatic within weeks of the initial injury. Treatment is challenging and multiple surgical procedures are often required. A larger study is necessary to determine if the incidence is higher among burn patients.展开更多
文摘Adenoid cystic carcinoma rarely occurs within the subglottic larynx. In this study, a case of subglottic adenoid cystic carcinoma was reported. A 54 year-old Chinese woman developed a sudden onset of chest distress and cough worsening after physical exertion, and was diagnosed with, and treated as, bronchial asthma. Regular anti-asthmatic therapy did not improve the symptoms. Until a sudden dyspnea, a cervicothoracic computerized tomography （CT） revealed that her upper airway was obstructed by a laryngeal tumor. The patient was diagnosed with a subglottic adenoid cystic carcinoma and treated with complete surgical excision and adjuvant radiation therapy. Follow-up endoscopy and laryngeal magnetic resonance imaging （MR1） at six months showed no recurrence of the tumor. The diagnosis of subglottic adenoid cystic carcinoma should be considered in patients who are characterized by dyspnea, cough, and stridor, but do not respond to regular anti-asthmatic therapy.
基金Capital Health Improvement and Research(No.2018-4-1116)Beijing Municipal Natural Science Foundation(No.7214221)
文摘Tracheal intubation through a supraglottic airway device(SAD)is recommended for difficult airway management.However,specific tracheal tubes for SAD-guided intubation are not always available in emergencies,necessitating the use of non-specific tubes such as polyvinyl chloride(PVC)and reinforced tracheal tubes.Although successful intubation with these tubes has been reported,clinicians often face difficulties passing them through the SAD,increasing the risk of airway injury even with correct SAD placement.
文摘Objective:Subglottic stenosis(SGS)is commonly treated with endoscopic dilations or tracheal resection.Since office-based serial intralesional steroid injections(SILSI)were first reported in 2017,they have been established as an effective,less invasive treatment alternative or adjunct.The aim of this study is to add to the literature investigating the efficacy of office-based SILSIs for idiopathic and post-intubation SGS patients,specifically studying surgery-free intervals(SFIs)and discussing our experience with SILSI treatment order and stenosis grade.Methods:This study is a retrospective case series of 14 patients with subglottic stenosis treated with in-office serial intralesional steroid injections as a primary or adjuvant treatment from 2018 to 2022 in an academic tertiary care center.Results:Of seven patients with calculable SFI,a mean SFI increase of 481.28 days was observed following SILSI treatment(p=0.042).Ten patients in our cohort presented with idiopathic or post-intubation grade 2 SGS and were managed successfully with a combination of endoscopic dilation and SILSI.Two patients with post-intubation grade 1 SGS were managed successfully with SILSI as their primary treatment.Two patients with post-intubation grade 3 SGS required a tracheal resection and did not benefit from SILSI.Conclusions:We have found that SFI significantly increased following SILSI initiation.Although statistical power was limited given the small sample size,our findings suggest that SILSI may be an effective primary treatment in low-grade stenosis.SILSI as an adjuvant to endoscopic dilation may be most effective in intermediate-grade stenosis.SILSI may not be effective in high-grade stenosis patients who failed prior endoscopic treatment.
基金Special Fund of the Pediatric Medical Coordinated Development Center of Beijing Municipal Administration,No.XTZD20180105.
文摘Importance:Post-intubation subglottic stenosis(SGS)in children can be life threatening.Definitive treatment varies and lacks a universally accepted approach.Objective:We performed a prospective study to assess the safety and feasibility of holmium laser combined with cryotherapy delivered via flexible bronchoscopy for the treatment of post-intubation SGS in children.Methods:This study involved all patients with post-intubation SGS seen at the Interventional Pulmonology Department of Beijing Children's Hospital between July 2014 and December 2016.Holmium laser treatment and cryotherapy was then performed under flexible bronchoscopy,whose parents refused to accept the alternative standard treatment of tracheotomy and balloon dilation under direct laryngoscopy.results:Sixteen patients with post-intubation SGS were included in this study.Ages ranged from 2 months to 12.25 years old.According to the Cotton-Myer grading system,three cases were Grade II,12 cases were Grade III,and one case was Grade IV.According to the McCaffrey system,eight cases were Stage 1,two cases were Stage 2,and six cases were Stage 3.The average number of procedures was 4.88.Fifteen of the 16 patients achieved clinical cure.One patient achieved clinical improvement.The average treatment course duration was 55.31 days.No severe complications were seen.Post-treatment clinical symptoms,endoscopic findings and quality of life showed marked improvement.Interpretation:Our study supports the conclusion that holmium laser treatment combined with cryotherapy via flexible bronchoscopy appears to be a safe and feasible treatment for post-intubation SGS in children.
文摘Tracheal stenosis or tracheal injury is a distressing condition. The silicone tracheal T-tube presents a substitute for stent of this complicated disease. We have come across a case of tracheal perforation in which tracheoplasty was planned. After traceoplasty silicone tracheal T-tube was placed as a stent. We were not able to connect silicone tracheal T-tube with Bain circuit with ET TUBE No. 8.5, 8, 7.5, 7 connector and it was difficult to ventilate the patient now. We have tried other ET TUBE connector and finally we succeeded to connect ET TUBE No. 5.5 connector with Bain circuit and we were able to ventilate the patient.
文摘An updated approach in the management of 50 patients with foreign body inhalation is presented. Certain risk factors that lead to complications and mortality due to endoscopic extraction of foreign bodies and thus determine prognosis were identified. Remedial measures to reduce morbidity and mortality due to bronchoscopic removal of foreign bodies are suggested. Fifty patients of suspected foreign body inhalation presented to a Unit of the Department of ENT, Head and Neck Surgery of Government Medical College associated SMHS Hospital Srinagar, Kashmir from March 2007 to June 2017. Of these, 49 patients were subjected to rigid tube bronchoscopy for removal of the aspirated foreign bodies and one coughed out the foreign body spontaneously during admission for bronchoscopy. History of foreign body inhalation was positive in 90% of patients and remaining was mostly referred from Paediatric Units with un-resolving collapse-consolidation of the lung. Whereas plain radiography of the chest and the soft tissues of neck were the primary imaging modality used in this study to detect the inhaled foreign bodies or their effects there are reports of virtual bronchoscopy being done with a multidetector computed tomography scanner in 3D image generation from axial cuts of the internal walls of the tracheobronchial tree in the management of patients suspected with foreign body aspiration. Bronchoscopy is a difficult and potentially hazardous procedure in the infant and young child. Telescopes and telescopic forceps were used during bronchoscopy to facilitate extraction of a foreign body inhaled. The type of a foreign body, site of its enlodgement and the complications encountered during its extraction were noted. During bronchoscopy the patients were connected to an ECG monitor and a pulse oximeter. 80% of the patients with foreign body inhalation were children in the age group of 0 - 5 years. There was a definite history of choking over the foreign body in 88% of the patients leading to acute respiratory distress in 46%. Cough alone or along with other symptoms occurred in most of the patients (96%). Persistent fever with respiratory symptoms unresponsive to treatment occurred in 38% of the patients with or without a positive history of foreign body inhalation. Right main bronchus was the commonest site of enlodgement of foreign body. In the present study, bean and peanut were the commonest types of foreign bodies inhaled (34%). Radiological findings in these patients include atelectasis with or without pneumonitis in 46.65% of the patients, normal chest/soft tissues of the neck in 24.45%, obstructive emphysema on the affected side in 24.45%, foreign body seen in the respiratory tract in 8.90% and bronchopneumonia in 2.22%. Complications associated with the endoscopic extraction of foreign bodies and the risk factors that lead to complications and mortality in patients with aspirated foreign bodies were identified in this study and the measures to reduce these complications and mortality rate to very low levels were suggested. Transient hypoxia, hypoxic bradycardia, transient cardiac arrest, bronchial perforation and death, laryngospasm, bronchospasm, subglottic oedema, reflex bradycardia and pneumothorax were among the few complications which occurred with the rigid endoscopic extraction of foreign bodies in the present study. Among the risk factors associated with the complications were prolonged bronchoscopy, semi-blind procedure, a vegetable foreign body, improper size and positioning of a bronchoscope and some other important factors which are detailed in the text of this paper to follow. Remedial measures on the basis of complications and the risk factors are suggested so as to decrease the morbidity and mortality due to endoscopic extraction of foreign bodies inhaled into the tracheobronchial tree.
文摘Benign laryngotracheal stenosis (LTS) is a debilitating and potentially life-threatening condition that is commonly caused by iatrogenic events as a result of endotracheal intubation or tracheostomy. Numerous cases are being published for patients with coronavirus disease 2019 (COVID-19) who end up with severe LTS after prolonged intubation or tracheostomy. Here, we presented two cases of LTS due to prolonged intubation after severe COVID-19 pneumonia. The characteristic of these two cases is that both of them needed second time intubation and were readmitted because of severe dyspnoea and all the workup for post-COVID-19 complications were investigated except the LTS which was later diagnosed after one month of suffering of these patients.
文摘Background:A recent innovation in the management of tracheostomy-dependent patients with laryngotracheal stenosis(LTS)has been the customizable laryngotracheal stent,made by dividing a T-tube in half("L stent").These L stents can be placed into the subglottis as well as the posterior glottis to prevent rapid re-stenosis following surgery,and they are easily removed in the office.We sought to review our experience with these stents and analyze patterns of success and failure.Methods:Retrospective chart review was performed of all tracheostomy-dependent patients who underwent L stent placement from January 2019 through February 2024.Clinical and demographic data were reviewed,with decannulation as the primary endpoint.Patients were assessed as having comorbid conditions(diabetes,coronary artery disease,morbid obesity,prior radiation)or not.Results:A total of 16 patients underwent stent placement.Six patients had posterior glottic stenosis(PGS),six had subglottic stenosis(SGS),and four had multilevel stenosis.Of these 16 patients,9 were ultimately decannulated(56.2%).Three of the successes were PGS(33.3%),four were SGS(44.4%),and two had both SGS and PGS(22.2%).Patients who were decannulated were statistically less likely to have comorbid conditions than patients who failed decannulation(p=0.0350).Conclusion:For tracheostomy-dependent patients who have failed first-line therapy,endoscopic surgery paired with L stent placement offers a reasonable alternative to open airway reconstruction or more destructive arytenoidectomy or cordotomy procedures.As with most airway surgeries,patient selection is important,as the presence of multilevel stenosis and/or comorbid conditions can predict a higher failure rate.
文摘Objective: To identify the incidence of laryngotracheal stenosis (LTS) in burn pa-tients requiring mechanical ventilation at a regional academic burn center. Methods: A retrospective review of all burn patients requiring endotracheal intubation or tra-cheostomy for airway management between 2003 and 2009 was performed. A group of trauma patients requiring similar airway instrumentation during the same period of time was used as a control. Results: None of the trauma patients and 2 of the burn patients developed LTS. Both presented with stridor and were diagnosed within 2—5 weeks after extubation. One patient underwent successful carbon dioxide laser radial incision and dilation and continues to do well. The other patient failed endoscopic treatment and required T-tube placement. The incidence of LTS in burn patients requiring mechanical ventilation was 2.98％ overall and 4.76％ among those with inhalational injury. Conclusions: Patients become symptomatic within weeks of the initial injury. Treatment is challenging and multiple surgical procedures are often required. A larger study is necessary to determine if the incidence is higher among burn patients.
