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1.
Objective
An operative technique is described as a salvage treatment for severe subglottic and supraglottic laryngeal stenosis. In addition to expansion of the laryngeal framework with an anterior cartilage graft, as used in a classical laryngotracheal reconstruction, the scar tissue obliterating the airway lumen is excised and a mucosal graft is placed to reconstruct the inner lining of the airway. The graft is harvested from buccal mucosa.Methods
The operative technique is outlined. Three cases, 2 paediatric and one adult, with complete or near complete laryngeal stenosis are presented where this operative technique was employed. In all patients several surgeries had been performed previously which were unsuccessful.Results
In all 3 patients a patent airway was achieved with decannulation of the tracheostomy in the 2 paediatric patients.Conclusions
In patients with severe subglottic or supraglottic airway stenosis where other surgeries have failed, excision of endoluminal scar tissue and placement of a buccal mucosal graft, in addition to conventional laryngotracheal reconstruction, is a promising technique. In revision cases of subglottic stenosis cricotracheal resection might not be an option because of scarring from previous surgeries. This operation is an alternative, which allows an increase in the airway lumen by excising the scar tissue then re-lining the exposed internal lumen. The buccal mucosa reduces granulation formation and re-stenosis. 相似文献2.
Matthew A. Powers Pamela Mudd Jane Gralla Bryan McNair Peggy E. Kelley 《International journal of pediatric otorhinolaryngology》2013
Objective
Examine outcomes of varied postoperative sedation management in pediatric patients recovering from single stage laryngotracheal reconstruction.Design
Retrospective review of 34 patients treated with single stage laryngotracheal reconstruction from 2001 through 2011.Setting
Tertiary children's hospital.Methods
Patients were divided into 2 groups: those managed postoperatively with sedation, with or without paralysis (group 1), and those managed awake with narcotic pain medication as needed for primary management (group 2). Outcomes were measured as a function of sedation management. Outcomes investigated focused on those related to the success of the airway reconstruction, and those related to sedation management.Results
Out of 68 cases of laryngotracheal reconstruction reviewed from 2001 to 2011, 34 were single stage reconstructions. Nineteen patients were sedated postoperatively (group 1) and fifteen patients were left awake (group 2). There were no significant differences between groups in airway-related outcomes, including risk of accidental decannulation, revision rates, and need for secondary airway procedures such as balloon dilation. Sedation-related outcomes, specifically focusing on differences in medical management, showed significant increases in rates of withdrawal (p < 0.0001), nursing concerns of withdrawal (p < 0.0001) and sedation level (p < 0.0001), pulmonary complications (OR 7.7, p = 0.008), and prolonged hospital stay due to withdrawal (p = 0.0005) in patients managed with sedation with or without paralysis. Multivariable regression analysis revealed that duration of sedation was the primary risk factor for increased postoperative morbidity, while younger age, lower weight, and use of a posterior graft were also significant variables assessed.Conclusion
Avoiding sedation as the standard for postoperative management of single stage laryngotracheal reconstruction airway patients leads to an overall decreased risk of morbidity without increasing risk of airway-specific morbidity. This is specifically as related to withdrawal, pulmonary complications, concerns about sedation level and prolonged hospital course, all of which increase significantly with increased level and duration of sedation. 相似文献3.
Schmidt RJ Shah G Sobin L Reilly JS 《International journal of pediatric otorhinolaryngology》2011,75(12):1585-1588
Objective
To review outcomes of pediatric laryngotracheal stenosis treated by single-stage laryngotracheal reconstruction with anterior and posterior cartilage grafts and compare decannulation rate for single-stage laryngotracheal reconstruction with rates published at larger (>200 beds) pediatric tertiary care hospitals.Methods
A 4-year retrospective chart review (2004–2008) of all patients undergoing procedures coded with 2008 CPT codes 31582 (laryngoplasty for laryngeal stenosis with graft or core mold, including tracheotomy) and 31587 (laryngoplasty, cricoid split) for a pediatric, tertiary-care hospital. Interventions were single-stage laryngotracheal reconstruction with anterior and posterior cartilage grafts, and the main outcome measure was the decannulation rate after single-stage laryngotracheal reconstruction.Results
We identified 44 patients with subglottic stenosis, of whom 13 underwent single-stage laryngotracheal reconstruction with anterior and posterior cartilage grafts. The mean age at surgery was 2.2 years (range, 5 months to 4 years). Twelve of 13 children had Cotton-Myer grade III stenosis. Ninety-two percent (12 of 13) of children remain decannulated. The mean follow up was 52 months.Conclusions
Single-stage laryngotracheal reconstruction with anterior and posterior cartilage grafts appears to be a safe and effective technique for managing patients with high-grade subglottic stenosis at intermediate size children's hospitals. Our overall decannulation rate of 92% compares favorably to that reported in the literature (84–96%). 相似文献4.
Objectives
To describe our management of complex glottic stenosis in tracheotomy dependent children with severe recurrent respiratory papillomatosis.Methods
Retrospective chart review at a tertiary care children's hospital.Results
Three children with complex glottic stenosis secondary to severe recurrent respiratory papillomatosis were treated at our institution since 2011. Two patients had complete stenosis, and the third had near-complete stenosis. Two patients were managed using balloon dilation alone, and the third also underwent laryngotracheal reconstruction with posterior costal cartilage grafting. Two patients have been successfully decannulated and the third has been tolerating continuous tracheotomy capping for greater than twelve months. All three patients underwent aggressive debridement of papillomatosis and balloon dilation every 4–6 weeks until their burden of disease was controlled. In two patients, the glottic airway was patent, and the third continued to have complete restenosis between procedures and required laryngotracheoplasty with multiple post-operative dilation procedures to establish an adequate glottic airway.Conclusions
Severe laryngeal stenosis is a well-described complication of recurrent respiratory papillomatosis, but its management is not well-defined. Aggressive management of papillomatosis with frequent debridement is critical in successfully managing laryngeal stenosis. Balloon dilation alone may be surprisingly effective in these patients, and laryngotracheoplasty can be used as an adjunct procedure in those patients who fail balloon dilation. Given the quality of life issues and concerns regarding distal spread of disease with tracheotomies in these patients, we feel that aggressive management and early decannulation is in the patient's best interest. 相似文献5.
Zakaria Soliman Mohammad Mobashir Waleed M. Basha Sherif Askar Ismail Elnashar Abd ElRaof Said 《Auris, nasus, larynx》2013
Objective
Scleroma is a chronic specific granulomatous disease of the upper respiratory tract caused by Klebsiella Rhinoscleromatis. It usually affects the subglottic region and upper trachea resulting in various degrees of stenosis. Patients with laryngotracheal stenosis may present with stridor, shortness of breath or exercise intolerance and may be tracheostomy dependent. In this work, we presented the experience of our Institute in the management of patients with scleromatous laryngotracheal stenosis using the already designed procedures for traumatic laryngotracheal stenosis.Patients and methods
The study was a non controlled prospective study. It was conducted in Oto-Rhino-Laryngology and Head and Neck Surgery Department of Zagazig University Hospitals, Egypt. It included 38 patients with scleromatous subglottic stenosis and/or upper tracheal stenosis. The patients were classified into four grades according to Myer–Cotton's scale. The surgical treatment modalities included endoscopic CO2 laser surgery with dilatation, laryngotracheal reconstruction, and partial cricotracheal resection with thyrotracheal anastomosis.Results
The average follow-up period was 32.1 months. Twenty four patients (63%) had an excellent outcome. Nine patients (24%) had a good outcome. Five patients (13%) were still tracheostomy dependent. Eleven patients (29%) developed postoperative granulation tissue. The overall success rate was 87%.Conclusion
Scleromatous laryngotracheal stenosis is considered a challenging surgical problem. It requires a multidisciplinary approach by well-trained personnel. The surgical techniques designed for cases of laryngotracheal stenosis of a traumatic etiology can be applied for cases of scleroma with approximately the same success rates. 相似文献6.
Alan T.L. Cheng Edward J. Beckenham 《International journal of pediatric otorhinolaryngology》2009,73(7):945-949
Four children with severe congenital anterior glottic webs required surgical reconstruction of their laryngeal airway to either avoid a tracheotomy or allow tracheotomy decannulation. The technique of re-establishing a glottic inlet allows both normal respiration, good cough and a satisfactory voice outcome. It utilizes an autogenous graft with perichondrium acting as an overlay keel to minimize glottic web reformation. All children were found to have Shprintzen syndrome.
Objective
The objective of this case series was to document the method of surgically using this perichondrial keel for airway reconstruction. It also examined the subsequent outcome and associated complications that were encountered.Methods
A prospective analysis of four cases from 2001 to 2008 created a database of information. All cases were classified using the Cohen staging system. They were treated with the same surgical technique using auricular or costal cartilage graft with attached perichondrium, but the postoperative course was tailored to each individual case.Results
All four children were successfully treated with removal or avoidance of a tracheostomy. All had an associated subglottic stenosis treated, and had no major complication requiring revision tracheotomy. They did not have any respiratory complications, and they produce a satisfactory voice albeit still slightly husky.Conclusion
All four cases had Shprintzen syndrome, and confirms the need to screen for VCFS in children with an anterior glottic web. Tracheotomy is still the gold standard of treatment in severe congenital anterior glottic webs. The described technique offers another good option to the paediatric airway surgeon in managing this condition. 相似文献7.
Objective
To review the outcomes of pediatric patients with laryngotracheal stenosis treated by single-stage laryngotracheoplasty.Methods
A single surgeon personal series retrospective review of 15 children undergoing single-stage laryngotracheoplasty for laryngeal stenosis over 4-year period (2004–2008).Results
15 patients (9 boys and 6 girls), with ages ranging from 1 month to 18 years, were operated. Using the Myer–Cotton grading system, 2 patients were diagnosed with grade 4 stenosis, 6 patients with grade 3 and 7 patients with grade 2. In10 cases, an LTP with anterior costal cartilage graft was performed; in one case an anterior and posterior LTP; in one case a partial cricotracheal resection and in 3 cases an anterior cricoids split. The overall success rate was 94%.Conclusion
Single stage laryngotracheoplasty is a safe and effective method for laryngotracheal stenosis in children. 相似文献8.
Y. Bajaj D. TweedieS. Ifeacho R. HewittA. Lloyd-Thomas D.M. Albert 《International journal of pediatric otorhinolaryngology》2011,75(5):624-626
Objective
Posterior glottic stenosis is a well recognised though rare condition. A wide range of treatment options have been proposed including endoscopic laser techniques and open techniques with grafting. The objective of this study was to present our experience of single stage laryngotracheal reconstruction with endoscopic technique of placement of posterior graft in isolated posterior glottic stenosis.Methods
This study was conducted at the Department of Paediatric Otolaryngology at Great Ormond Street Hospital, London. The senior authors (ALT, DMA) were involved in the management of two children with isolated posterior glottic stenosis operated on as single stage reconstruction.Results
The two children in this small series had isolated posterior glottic stenosis. The aetiology in both the cases was previous prolonged intubation. Both patients underwent a successful placement of the posterior graft endoscopically, though it was a challenging task because of space constraints. None of these children required an intra-operative or post-operative tracheostomy. There were no complications in these patients. At follow up endoscopic examinations, both these patients have had their airway widened successfully.Conclusion
Single stage laryngotracheal reconstruction with endoscopic placement of posterior graft in cases with isolated posterior glottic stenosis is a good alternative to open surgical techniques, although is technically a challenging procedure. 相似文献9.
B. Pullens L.J. Hoeve M.K. Timmerman M.P. van der Schroeff K.F.M. Joosten 《International journal of pediatric otorhinolaryngology》2014
Introduction
To describe the characteristics and surgical outcome of 98 infants and children treated for an acquired laryngeal stenosis after intubation for respiratory support.Material and methods
We retrospectively reviewed our data from the last 18 years (1994–2013) concerning infants and children with an acquired laryngotracheal stenosis who were treated in our hospital with a laryngotracheal reconstruction or a cricotracheal resection. Outcome was defined by decannulation ratio.Results
Of the 98 infants and children who were studied, 54% were preterm, 18% neonates, 13% infants and 14% children. Ninety-one SS-LTR’s, two DS-LTR’s and five CTR’s were performed as primary surgery; three revision operations were performed (DS-LTR). Seventy-seven children had a tracheostomy prior to surgery; decannulation ratio was 93% after primary surgery and 95% after inclusion of revision surgery. For SS-LTR, the decannulation ratio was 93%, including grade III stenosis with comorbidities. Male sex and glottic involvement of the stenosis are correlated to failure of decannulation. Intubation in the term neonatal period is correlated to complicated post-operative course after SS-LTR.Conclusions
Excellent results of surgery for acquired laryngotracheal stenosis can be obtained with a high decannulation rate. Even for higher grades of stenosis with comorbidities and glottic involvement, an SS-LTR is an effective surgical treatment for acquired laryngeal stenosis. 相似文献10.
Objective
To report our experience with “loop overlay” tympanoplasty, a modified overlay technique with a superiorly based skin flap, for the reconstruction of anterior, subtotal or total tympanic membrane (TM) perforations.Methods
Retrospective review of patients undergoing loop overlay tympanoplasty from March 1998 to February 2007 was performed. Four hundred and twenty-nine patients who underwent loop overlay tympanoplasty and then follow-up visits a minimum of 6 months later were included in this study. Hearing test results were reported using a four-frequency (0.5, 1, 2, and 3 kHz) pure tone average air–bone gap. The outcome was considered successful if the TM was intact without lateralization or anterior blunting after the follow-up visit.Results
There was a 98.8% success rate. There was no graft lateralization, anterior blunting, neocholesteatoma, or sensorineural hearing loss. The mean preoperative to postoperative four-tone air–bone gap improved from 23.5 to 8.1 dB, which is a mean gain of 15 dB; this was statistically significant (p < 0.001, paired sample t-test).Conclusion
The loop overlay graft method is a safe and effective technique for reconstruction of anterior, subtotal or total TM perforations, with excellent graft take and significant improvement of hearing. It provides a precise replacement of the flap and a preserved healing plane. 相似文献11.
The experience with laryngotracheal reconstruction in 20 children in Chicago is reviewed. Nine of the 20 children (45%) operated upon had congenital subglottic stenosis. Ten (50%) had acquired stenosis. One child was classified as having combined types. All patients underwent laryngotracheal reconstruction with autogenous costal cartilage grafts. Eight patients had both anterior and posterior costal cartilage grafts with stent insertion. One had a posterior costal cartilage graft only. Sixteen of the 20 children (80%) have been decannulated. Midtracheal or lower tracheal disease concomitant with laryngotracheal stenosis is an indication that endoscopic management of severe subglottic stenosis is likely to fail. Early laryngotracheal reconstruction is indicated for patients with a high likelihood of failure of endoscopic management and for those with severe cricoid cartilage deformities. Our results support the use of laryngotracheal reconstruction as an alternative to conservative (endoscopic) management of severe subglottic stenosis in carefully selected patients. 相似文献
12.
Ashish Vashishth Neeraj Narayan MathurSantosha Ram Choudhary Abhishek Bhardwaj 《Auris, nasus, larynx》2014
Objective
To compare the post-operative outcomes in using temporalis fascia and full thickness broad cartilage palisades as graft in type I tympanoplasty.Methods
This study, conducted at a tertiary referral institute, included 90 consecutive patients with mucosal type chronic otitis media requiring type I tympanoplasty with a 60/30 distribution of cases with fascia and cartilage palisades, respectively. The fascia group consisted of primary cases in adults and excluded revision cases, near-total or total perforations and pediatric cases. The cartilage group included pediatric, revision cases and near-total or total perforations. The fascia group utilized the underlay technique for grafting, whereas the cartilage group used tragal full thickness broad cartilage palisades with perichondrium attached on one side placed in an underlay or over-underlay manner. Post-operative graft take-up and hearing outcomes were evaluated after 6 months and 1 year with subjective assessment and pure tone audiometry.Results
The graft take-up rate was 83.3% in the fascia group and 90% in the cartilage palisade group. The mean pure tone air–bone gaps pre- and post-operatively in the fascia group were 30.43 ± 5.75 dB and 17.5 ± 6.94 dB, respectively, whereas for the cartilage group, these values were 29 ± 6.21 dB and 7.33 ± 3.88 dB, respectively.Conclusion
Cartilage grafting with full thickness palisades is more effective than fascia as graft material, particularly in “difficult” tympanoplasties fraught with higher failure rates otherwise. 相似文献13.
Guangbin Sun Haihong Tang Alicia J. Sprecher Julia K. MacCallum Na Sun Qin Fang Gengtian Liang Shuimiao Zhou 《Auris, nasus, larynx》2010
Objective
To present laser surgery techniques to address anterior commissure involvement and evaluate recovery.Methods
Twelve canines were divided into three groups. In group A the right ventricular band and vocal fold, the anterior third of the left vocal fold, and anterior commissure were cauterized. In group B cauterization was extended to the thyroid cartilage and a 5 mm × 5 mm area of the anterior commissural to half the cartilage thickness. In group C the 5 mm × 5 mm window was extended through the thyroid cartilage. Surgical lesions were observed after surgery and at 1 and 4 weeks post-surgery.Results
Post-operative gross examination confirmed target scopes. One week after surgery, the lesions in group A were completely covered by neo-mucosa, while group B and C wounds were only partially covered. After 4 weeks, a laryngeal web was seen at the anterior commissure and the vocal fold length was shortened. Lesions in all three groups were completely covered by neo-mucosa. Collagen proliferation was most prominent in group C with limited scarring in group A. There were no major complications.Conclusions
The three operative methods demonstrated satisfactory outcomes; the lesions recovered well over the course of 4 weeks, and no severe complications occurred. The laser surgery protocol was successfully extended into the thyroid cartilage. 相似文献14.
Polubothu S Blackmore KJ Kubba H 《International journal of pediatric otorhinolaryngology》2011,75(3):425-429
Reconstructive laryngeal surgery has been very successful in the treatment of laryngotracheal stenosis. Traditionally authors have used survival and decannulation rates as markers of success.
Objective
To evaluate the outcome of paediatric laryngotracheal surgery from the parents perspective.Method
Retrospective audit of all children undergoing laryngotracheal reconstruction or cricotracheal resection for laryngotracheal stenosis in a three year period at the Royal Hospital for Sick Children, Glasgow. An open-ended questionnaire was used to assess parental concerns regarding their child's airway, post-operative results and the current status of their voice, breathing and swallowing.Results
30 patients were eligible for the inclusion of which there were 17 responses (56%). The most common concerns pre-operatively were difficulty breathing, tracheostomy and survival. Post-operatively parents felt that breathing, voice and a reduction in the number of lower respiratory tract infections were the main improvements. We also identified the high level of importance that the parents assigned to their child's independence and ability to lead a normal life.Conclusion
This study has given us a unique insight into the concerns of parents who have children with laryngotracheal stenosis. It has also allowed us to evaluate our post-operative results from a qualitative perspective through the eyes of the parents. 相似文献15.
Yoo Seob Shin Bum Hee Lee Jae Won Choi Byoung-Hyun Min Jae Won Chang Soon Sim Yang Chul-Ho Kim 《International journal of pediatric otorhinolaryngology》2014
Objectives
Tracheal reconstruction with tissue-engineering technique has come into the limelight in the realm of head and neck surgery. We intended to evaluate the plausibility of allogenic chondrocytes cultured with porcine cartilage-derived substance (PCS) scaffold for partial tracheal defect reconstruction.Methods
Powder made from crushed and decellularized porcine articular cartilage was formed as 5 mm × 12 mm (height × diameter) scaffold. Chondrocytes from rabbit articular cartilage were expanded and cultured with PCS scaffold. After 7 weeks culture, the scaffolds were implanted on a 5 mm × 10 mm artificial tracheal defect in six rabbits. Two, four and eight weeks postoperatively, the sites were evaluated endoscopically, radiologically, histologically and functionally.Results
None of the six rabbits showed any sign of respiratory distress. Endoscopic examination did not show any collapse or blockage of the reconstructed trachea and the defects were completely covered with regenerated respiratory epithelium. Computed tomography showed good luminal contour of trachea. Postoperative histologic data showed that the implanted chondrocyte successfully formed neo-cartilage with minimal inflammatory response and granulation tissue. Ciliary beat frequency of regenerated epithelium was similar to those of normal adjacent mucosa.Conclusions
The shape and function of reconstructed trachea using allogenic chondrocytes cultured with PCS scaffold was restored successfully without any graft rejection. 相似文献16.
Liu Zhi Wu Wenli Gao Pengfei Cui Pengcheng Chen Wenxian Luo Jiasheng Sun Yongzhu 《European archives of oto-rhino-laryngology》2014,271(2):317-322
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. 相似文献
17.
Kazumichi Yamamoto Philippe MonnierFlorence Holtz Yves Jaquet 《International journal of pediatric otorhinolaryngology》2014
Background
The management of pediatric laryngotracheal stenosis (LTS) can be challenging, and laryngotracheal reconstruction (LTR) with cartilage interposition grafting remains the mainstay of surgical treatment for pediatric LTS in most experienced centers. The purpose of this study was to report the results of this procedure in a center where primary cricotracheal resection is frequently performed.Methods
A retrospective chart review was performed on 45 patients who underwent LTR in our hospital between October 1997 and July 2012. Demographic characteristics and information on the preoperative status, stenosis, and operation were collected. Primary outcomes were measured as overall (ODR) and operation-specific (OSDR) decannulation rates and secondary outcomes as morbidity, mortality, and postoperative functional results.Results
ODR and OSDR were 86.7% (39/45) and 66.7% (30/45), respectively. Re-stenosis was observed in 11/45 (24%) patients, all of whom were endoscopically or surgically treated. Revision surgery was performed in 10 patients, 6 for re-stenosis and 2 for peristomial tracheomalacia. Two children died of mucous obstruction of tracheostomy tube at 3 and 6 months postoperatively (4.4%). Respiratory, voice, and swallowing functions were excellent or good in 86, 75, and 84% of patients, respectively.Conclusions
LTR for pediatric LTS has high decannulation rates with acceptable morbidity and mortality in selected patients. Most LTR procedures were double-stage for lower grade subglottic stenoses associated with glottic involvement that required stenting. Careful preoperative evaluation and adequate surgical indications are extremely important to achieve high decannulation rates. 相似文献18.
Nirupan Vipulananthan Timothy Cooper Manisha Witmans Hamdy El-Hakim 《International journal of pediatric otorhinolaryngology》2014
Objective
To document the mode and age of primary aerodigestive presentation of Pierre Robin sequence/complex (PRS/C) children to the otolaryngologist and to explore predictive factors of upper airway type and management.Methods
This is a retrospective cohort study conducted in a tertiary pediatric referral center. A prospective surgical database was searched for children who were diagnosed with PRS/C. Demographics, presenting complaint, secondary diagnoses, type of upper airway obstruction, secondary airway lesions, presence of cleft palate, and airway interventions were collected. Multiple linear regression analysis was performed to predict upper airway obstruction type and intervention.Results
Seventy-seven potentially eligible patients were identified. Forty-six were included (20 females). Mean age at presentation was 20.4 ± 36.9 months (range 1–191.25 months). Twenty-three primarily presented with respiratory failure, 14 with sleep disordered breathing, and nine with swallowing dysfunction. Children with presentations other than respiratory failure were older (p = 0.004). Nineteen were syndromic. Overt cleft palate was more common in those presenting with respiratory failure (p = 0.01). The type of airway obstruction encountered and use of tracheostomy were positively predicted by the primary presenting feature of respiratory failure (p < 0.05) and male gender (p < 0.05).Conclusion
A substantial number of PRS/C patients present later than the neonatal period with presentations other than respiratory failure. Both male gender and presentation with respiratory failure predicted a more severe airway obstruction type and the need for trachesotomy. 相似文献19.
Tsuguhisa Nakayama Tetsuhi Okushi Shuchi Yamakawa Akihito Kuboki Shin-ichi Haruna 《Auris, nasus, larynx》2014
Objective
Septoplasty is usually performed with a Killian incision in Japan. However, the major drawback of the Killian incision is the inability to correct deviations of the caudal part of the septum. For patients with mild deviation of the caudal part of the septum but with a straight caudal end, we performed a modified Killian incision and used a batten graft to correct the deviated cartilage under endoscopy. The aim of this study was to evaluate the usefulness of our surgical technique for these cases.Methods
We prospectively collected data of 17 patients who underwent endoscopic septoplasty with a batten graft. Objective assessment by computed tomography and subjective assessment by questionnaire were performed before and 3 months after the surgery.Results
On computed tomography, the ratio of the area of the convex side to that of the concave side in the anterior portion of the nasal cavity was significantly improved after surgery (p < 0.001). Subjective assessment revealed a significant improvement in nasal obstruction (p = 0.002). There were no complications in this study.Conclusion
The herein-described septoplasty with a batten graft is technically easy and considered to be useful for deviation of the caudal part of the septum in selected cases. 相似文献20.
Sabri Baki Eren Selahattin Tugrul Berke Ozucer Remzi Dogan Orhan Ozturan 《American journal of otolaryngology》2014