Thyroid tumors invading the larynx and trachea

Thyroid tumors may involve the airway. Eight patients with such invasion are reported; five with invasion of the larynx and three of the trachea. The symptoms varied: five of the eight patients had stridor and hemoptysis, one had hoarseness, and two had no symptoms at all. Endoscopic and radiologic examinations were performed in all patients including computed tomography in six. Six patients underwent total thyroidectomy and two patients, one with paraganglioma and one with hemangiopericytoma, had a hemithyroidectomy. Three patients had a total laryngectomy, one a partial laryngectomy and one a laryngofissure procedure. Tracheal resection was performed in two patients and one had laser excision of the endotracheal tumor involvement. Three patients received postoperative external irradiation. Six of the eight patients are alive with follow-up of 39 to 85 months.     

Reconstruction of the larynx and trachea

This article involves an analysis of 43 patients who underwent 64 reconstructive procedures for laryngeal and/or tracheal defects at The Ohio State University (Columbus). The purpose of this report is to analyze the results of a variety of reconstructive techniques in order to formulate a recommended therapeutic approach. Utilizing this therapeutic approach, 77% of the reconstructions were totally successful in providing an airway not requiring a tracheotomy tube and a voice capable of communication. Another 16% of the reconstructions were considered partially successful, requiring a permanent airway tube due to limitations created by coexisting health problems. There have been no patients where airway reconstruction was totally unsuccessful. A generalized approach to reconstruction is presented.     

分化型甲状腺癌侵犯喉气管临床分析

目的　探讨甲状腺癌累及喉、气管时的外科处理方法。方法　2000年1月～2010年12月在我院手术治疗晚期分化型甲状腺癌24例,根据肿瘤侵犯喉、颈段气管的范围及程度分别行肿瘤削除术和气管袖状切除端端吻合术;喉部分切除胸锁乳突肌或颈阔肌皮瓣修复术。结果　24例患者均接受根治性手术切除,喉、气管缺损修复重建。术式：肿瘤削除术8例,气管袖状切除8例,喉部分切除术8例。吻合方式：气管端端吻合8例,胸锁乳突肌皮瓣修复4例,颈阔肌皮瓣修复4例。本组患者肿瘤复发率为8.3%,5年累积生存率为91.6%。结论　对侵犯喉、气管的分化型甲状腺癌患者应采取更为积极的外科治疗,以减少术后复发,提高生存率。     

累及喉气管的晚期甲状腺癌一期手术整复

目的：探讨晚期甲状腺癌累及喉、气管时的一期手术整复方法。方法：对18例存在喉气管受累的晚期甲状腺癌患者进行一期肿瘤全切及喉气管整复，其中7例喉受累患者全喉切除3例，喉部分切除4例；18例颈段气管受累患者中，8例直接切除肿瘤，10例切除受累气管壁后，修复方法包括：拉扰缝合1例，端端吻合3例、带蒂胸锁乳突肌骨膜瓣2例、岛状胸大肌肌皮瓣3例和颈部皮瓣1例。结果：住院期间肿瘤复发死亡1例。除3例全喉切除患者外，14例成功保留喉功能，其中拔除气管套管8例，堵管2例，继续带管4例。结论：对于累及喉气管的晚期甲状腺癌采用一期手术切除并整复不仅切实可行，而且可以提高此类患者的治愈机会，改善生活质量。     

Congenital anomalies of the larynx and trachea

A variety of congenital anomalies arise within the laryngeal or tracheal airway. Symptoms primarily include airway obstruction, hoarseness, and difficulty feeding. The diagnosis is typically made by a combination of clinical presentation, physical examination, and endoscopic evaluation. Definitive intervention may be necessary requiring endoscopic or open laryngeal surgery. Some of the more common congenital laryngeal and tracheal anomalies are discussed with respect to their diagnostic evaluation, clinical presentation, and management.     

Fatal malformations of the larynx and upper trachea

Five infants with a spectrum of rare malformations of the larynx and trachea are presented. All infants died because of problems with intubation and ventilation. The scries reflects the wide variety and complexity of malformations that may co-exist, and successful management may require open tracheotomy.     

Management of injuries to the larynx and trachea

The past decade has witnessed an accelerated number of laryngeal and tracheal injuries. The present decade may see a rapid decline due to more safety devices on automobiles and a cessation of the military conflict. A format has been recognized and accepted for the management of these injuries by many who have been interested and contributed to this subject. Open repair, internal splinting with a soft stent fixed to the thyroid cartilage, and often a split-thickness skin graft to cover the raw areas is the choice of most. In automobile accidents the type of injury usually falls into one of five categories: a. supraglottic tears and fractures; b. transglottic injuries; c. cricoid fractures; d. evulsion of the trachea from the cricoid; and e. lacerations or tears of the trachea. Laceration by knives and small caliber gun shot wounds usually requires a laryngofissure for exposure and repair of the defect. Schrapnel wounds and blunt missile injuries with loss of skin and cartilage should be repaired immediately with a transfer of bone or cartilage in a pedicle skin flap.