MyMedR

Fulltext Management of severe subglottic stenosis secondary to trauma: case to case comparison of resection anastomosis versus cartilage augmentation

Asha'ari ZA, Islah W, Ahmad R, Suzina SA

Med J Malaysia, 2010 Jun;65(2):157-9.

PMID: 23756806 MyJurnal

We studied two similar cases of severe subglottic stenosis secondary to trauma with different treatment modalities. One had laryngotracheal reconstruction with cartilage augmentation and the other had laryngotracheal resection anastomosis. We wish to compare the two popular choices of surgery for laryngotracheal stenosis from two cases with similar nature and severity thus highlighting the complexity of managing severe subglottic stenosis in adult.

Matched MeSH terms: Laryngostenosis*

Glottic and subglottic stenosis following intubation during surgery

Liew PC

Med J Malaysia, 1976 Mar;30(3):241-2.

PMID: 958056

Matched MeSH terms: Laryngostenosis/etiology*

Fulltext Endoscopic treatment of glottic stenosis secondary to caustic injury with silastic keel placement: a case report

Balachandran R, Rahmat O

Med J Malaysia, 2011 Jun;66(2):152-3.

PMID: 22106701

The use of an endoscopic approach for the division of glottic webs or stenosis has been reported in the literature and has been mainly confined to the anterior commisure. We report a rare case of caustic injury to the upper aerodigestive tract that resulted in extensive web formation along the membranous vocal cord which was successfully treated with endoscopic lysis of the adhesions and the use of a silastic sheet keel as a stent.

Matched MeSH terms: Laryngostenosis/etiology*; Laryngostenosis/pathology; Laryngostenosis/therapy*

Fulltext Neonatal post-intubation subglottic stenosis

Loi HDK, Parhr AS, Subramaniam SK, Choo KE, Ng HP

Med J Malaysia, 2004 Mar;59(1):126-8.

PMID: 15535351

Acquired subglottic stenosis is a compication or neonatal endotracheal intubation. Although it is rare, it contributes significantly to the morbidity and physical well being of post extubated neonates. A 20-day old neonate, ventilated for meconium aspiration syndrome and persistent fetal circulation, presented with marked stridor and respiratory embarrassment. A stenosed subglottic area was found on rigid bronchoscopy. Anterior cricoid split was performed to relieve the obstruction. He is asymptomatic post operatively.

Matched MeSH terms: Laryngostenosis/etiology*

Fulltext Paediatric airway reconstruction: a preliminary study

Amin Z, Suzina SA

Med J Malaysia, 2008 Dec;63(5):369-72.

PMID: 19803292 MyJurnal

To set the foundation for developing a centre for airway reconstruction, we performed a retrospective database review of patients operated at a tertiary-care university hospital. Over the past 3-year period from 2004 onwards, five paediatric cases of airway reconstruction procedures were performed. All cases had a two stages laryngotracheal reconstruction (TSLTR) for laryngotracheal stenosis (LTS). All patients were children below 15 years and the mean age was 9 years. Only one patient had a Grade IV Myer-Cotton stenosis, the rest all had Grade III stenosis. Three out of four of the Grade III stenosis patients were successfully decannulated within one year, the other one died of causes unrelated to LTS. The grade IV patient was still under followup and surgery was done only recently. This paper highlights the complexity of managing LTS in the paediatric age group and recommends the use of LTR with rib graft as a choice for the management of LTS.

Matched MeSH terms: Laryngostenosis/diagnosis; Laryngostenosis/surgery*

Fulltext Partial Cricotracheal Resection (PCTR), a Rewarding Outcome for Paediatric Subglottic Stenosis: An Early Experience

Goh BS, Roopesh S, Marina MB, Abdullah SM

Med J Malaysia, 2014 Feb;69(1):13-5.

PMID: 24814622

This is a retrospective study examining the outcome of paediatric patients with subglottic stenosis who underwent partial cricotracheal resection (PCTR) as a primary open procedure from 2004 to 2012. There were 5 patients identified aged from 3 to 18 years old. All the subglottic stenosis were acquired type. All of them were secondary to prolonged intubation. Three patients were classified as Myer-Cotton grade III and the other two were Myer-Cotton grade IV. Two of the patients had concomitant bilateral vocal cord immobility. All patients underwent two staged PCTR . All patients underwent two staged PCTR, and one patient underwent posterior cordectomy apart from partial CTR at different setting. All patients were successfully decannulated at various durations postoperatively. Although this is an early experience in our institution, PCTR has shown to be effective and safe procedure in patients with subglottic stenosis especially those with Myer-Cotton grade III and IV.

Matched MeSH terms: Laryngostenosis

Tracheal T-tube: a novel endoscopic insertion technique

Rahimah AN, Shahfi FI, Masaany M, Gazali N, Siti SH

J Laryngol Otol, 2016 Oct;130(10):967-968.

PMID: 27774924

Laryngotracheal stenosis is a complex condition of airway compromise involving either the larynx or trachea, or both.

Matched MeSH terms: Laryngostenosis/surgery*

Fulltext Iatrogenic aspiration of custom-made keel: a case report

Sharouny H, Omar RB

Iran Red Crescent Med J, 2014 Dec;16(12):e17066.

PMID: 25763237 DOI: 10.5812/ircmj.17066

INTRODUCTION: Laryngeal stenosis has various causes and treatment options. Endoscopic resection of the stenotic part with CO2 laser is one of the treatment options of laryngotracheal stenosis. Keels are useful for preventing adhesion formation, restenosis and web formation, which may happen during the later stage. They can be put in place either via the endoscopic approach or through a micro thyroidotomy and are held in place with a heavy suture through cricothyroid and thyrohyoid membranes. They are left in place for two to four weeks, and then removed through the endoscopic approach under general anesthetics.

CASE PRESENTATION: We report on a case of anterior glottis stenosis with keel aspiration for two weeks, after endoscopic CO2 laser resection of the stenotic section and keel placement. The patient was admitted to our center, where bronchoscopy was performed and the keel was removed. A new custom-made silastic keel was properly placed in raw areas and fixed to the skin with suture through the cricothyroid and thyrohyoid membranes. The keel was removed three weeks later.

CONCLUSIONS: Endoscopic keel placement should be done with heavy suture through cricothyroid and thyrohyoid membranes. Surgeons should suture the keel to the anterior laryngeal wall with specially designed Lichtenberger's needle-carriers to prevent complications such as keel aspiration, adhesion formation and imposing a second trip under general anesthetics, which put the patient at increased risk. The false vocal cord microflaps, as biological keels and a relatively new method may replace silastic keel placement in the future.

Matched MeSH terms: Laryngostenosis

Fulltext Balloon dilatation of laryngotracheal stenosis: Hospital Ampang experience

Loo, L.Y., Mawaddah, A., Shahrul, H., Khairullah, A.

International Medical Journal Malaysia, 2017;16(2):113-116.

MyJurnal

The upper airway is a crucial structure. It becomes a grave problem should it be narrowed. Several methods
of treatment were rendered for patients with laryngotracheal stenosis. We share our experience with the
combination total intravenous anaesthesia and apneic pause technique with or without steroid injection.
Four cases of laryngotracheal stenosis were observed in Hospital Ampang: two adult and two paediatric
cases. Age, gender, causative factor, stenosis segment length, grade or severity were observed before and
after dilatation, number of dilatation were observed and compared. The outcome measures are
decannulation and avoidance of tracheostomy. All cases had improvement of symptoms. Half or 50% of the
patient required repeated balloon dilatations. The paediatric cases successfully avoided tracheostomy while
the adult cases successfully decannulated with no complication from the procedure. Balloon dilatation by
total intravenous anaesthesia coupled with apneic method is a safe and effective method of treatment for
the narrowed airway.

Matched MeSH terms: Laryngostenosis

Fulltext Aetiological profile of paediatric stridor in a Malaysian tertiary hospital

Lum SG, Noor Liza I, Priatharisiny V, Saraiza AB, Goh BS

Malays Fam Physician, 2016;11(1):2-6.

PMID: 28461841 MyJurnal

BACKGROUND: Conditions causing stridor in paediatric patients can range from minor illnesses to life-threatening disorders. Proper evaluation and correct diagnosis are essential for timely intervention. The objective of this study was to determine the aetiological profiles and the management of paediatric patients with stridor referred to the Otorhinolaryngology Department of Hospital Serdang.

METHODS: Medical records of all paediatric patients presenting with symptom of stridor from January 2010 to February 2015 were reviewed retrospectively. The patients' demographic data, clinical notes, laryngoscope findings, diagnosis and management were retrieved and analysed.

RESULTS: Out of the total 137 patients referred for noisy breathing, 121 patients had stridor and were included in this study. There were 73 males and 48 females-most were of Malay ethnicity (77.7%). The age of presentation ranged from newborn to 10 years, with a mean of 4.9 months. Eighteen patients (14.9%) had associated congenital pathologies. The majority were congenital causes (90.9%), in which laryngomalacia was the commonest (78.5%), followed by subglottic stenosis (5.0%), vallecular cyst (2.5%) and congenital vocal fold paralysis (2.5%). Twelve patients (9.9%) had synchronous airway lesion. The majority of the patients were managed conservatively. Thirty-one patients (25.6%) required surgical intervention, of which only one needed tracheostomy.

CONCLUSION: Laryngomalacia was the commonest cause of stridor among paediatric patients. A synchronous airway lesion should be considered if the child has persistent or severe symptoms. The majority of the patients were managed conservatively.

Matched MeSH terms: Laryngostenosis

Fulltext Management experience of subglottic stenosis by endoscopic bougie dilatation with mitomycin C and review of literature: case series

Liew YT, Yong DJ, Somasundran M, Lum CL

Indian J Otolaryngol Head Neck Surg, 2015 Mar;67(Suppl 1):129-33.

PMID: 25621268 DOI: 10.1007/s12070-014-0801-8

The aim of the study was to examine and analyze the epidemiology and outcome of treatment for paediatric acquired subglottic stenosis treated with endoscopic bougie dilatation and topical mitomycin C. There were 15 patients identified from 2008 until 2013. All of them had acquired subglottic stenosis due to history of intubation. Majority of the patients had grade III stenosis, with the total of seven. Three patients had grade IV; three were grade II and two were grade I. All of the patients with severe stenosis (grade III and IV) needed tracheostomy while only one in mild stenosis group (grade I and II) required it for prolonged ventilation rather than obstruction due to subglottic stenosis. All of them underwent direct laryngoscopy under general anesthesia followed by endoscopic dilatation with bougie and topical mitomycin C 0.4 mg/ml for 5 min. Aim of success in our study was decannulation of tracheostomy or absence of symptoms at exertion. We achieved 6 (60 %) successful decannulation out of 10 patients with tracheostomy (excluded the patient with tracheostomy in grade I stenosis due to prolonged ventilation). As for those without tracheostomy, 3 (75 %) out of 4 patients were asymptomatic even at exertion. Average number of dilatation was 3.1 times, with mean duration of 28 min. No complications were reported in our series. One patient with grade I stenosis passed away due to severe pneumonia unrelated to the stenosis or dilatation, and she did not have any dilatation before she passed away. Multiple related risk factors were identified such as intubation, prematurity, movement of endotracheal tube, respiratory infection, traumatic intubation and gastroesophageal reflux disease. Experience of open surgical method was very limited in our centre in Sabah in East Malaysia. Endoscopic technique plays an important role in treatment of subglottic stenosis with adjunct like mitomycin C possibly booster the successful rate.

Matched MeSH terms: Laryngostenosis

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