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Nederlands Tijdschrift Voor Geneeskunde Mar 2024This clinical lesson describes three patients with problems after a total laryngectomy. Patient A suffered from acute tracheitis and narrowing of the tracheostoma....
This clinical lesson describes three patients with problems after a total laryngectomy. Patient A suffered from acute tracheitis and narrowing of the tracheostoma. Patient B experienced acute dyspnea due to thick mucus plugs. Patient C had progressive symptoms of deteriorating speech and dysphagia, which resolved after dilatation of a pharyngeal stenosis. A total laryngectomy leads to definitive changes in anatomy and physiology. In case of respiratory symptoms, it is important to recognize the tracheostoma is the only entrance to the airway. Speech is generally well rehabilitated with a speech valve in a tracheoesophageal fistula.
Topics: Humans; Laryngectomy; Deglutition Disorders; Dyspnea
PubMed: 38512235
DOI: No ID Found -
The Laryngoscope Jan 2018To characterize the safety profile and effectiveness of esophageal dilation in head and neck cancer patients. (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
To characterize the safety profile and effectiveness of esophageal dilation in head and neck cancer patients.
METHODS
A systematic review was undertaken for articles reporting outcomes of esophageal dilation in head and neck cancer patients. The Medline, Scopus, Web of Science, and Cochrane databases were searched in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Complications related to esophageal dilation in head and neck cancer patients was the primary outcome of interest. Success rates, demographic data, cancer staging, and treatment data were assessed secondarily. Statistical analyses included both qualitative and quantitative assessments. A limited meta-analysis and pooling of the data was performed using a random effects model.
RESULTS
Of the collective 8,243 initial candidate articles, 15 retrospective studies containing data for a collective 449 patients were ultimately included in the analysis. There was significant heterogeneity in the outcomes data. With an overall complication rate of 10.6% (95% confidence interval [CI]: 4.1%,17%) and a pooled success rate of 72.9% (95% CI: 65.7%,80.1%) per patient, the articles generally supported the use of dilation.
CONCLUSION
Head and neck cancer patients experience a higher rate of complications following dilation compared to patients with other causes of benign stricture. Esophageal dilation is effective in improving dysphagia, but these benefits are often transient and thus necessitate repeat interventions. Laryngoscope, 128:111-117, 2018.
Topics: Dilatation; Esophageal Stenosis; Head and Neck Neoplasms; Humans; Risk Assessment; Treatment Outcome
PubMed: 28498643
DOI: 10.1002/lary.26618 -
Journal of Plastic, Reconstructive &... Oct 2023A leftover narrow strip of the posterior pharyngeal wall may form after laryngopharyngectomy, and whether to retain it during reconstruction remains debated owing to the... (Review)
Review
A leftover narrow strip of the posterior pharyngeal wall may form after laryngopharyngectomy, and whether to retain it during reconstruction remains debated owing to the differing views on the incidence of leakage and strictures. This study aimed to ascertain whether this remnant posterior pharyngeal wall is advantageous or disadvantageous to surgeons performing pharyngoesophageal reconstruction. We reviewed the data of patients with circumferential or near-circumferential pharyngoesophageal defects following oncological laryngopharyngectomy who underwent reconstructive surgery utilizing the anterolateral thigh flap. They were then categorized into two groups: circumferential and near-circumferential. Thereafter, their demographics, operative findings, and postoperative outcomes were compared. Forty patients (20 in each group) with an average age of 57.2 ± 6.7 years (range: 40-72) were enrolled in the study. All flaps except one survived. During a mean follow-up of 41.1 ± 24.6 (range: 6-95) months, the stricture rate was significantly lower in the near-circumferential group (one vs. nine [from 17 patients who had resumed oral intake postoperatively] patients in the near-circumferential and circumferential groups, respectively, p = 0.002). Oral intake was viable in all patients with near-circumferential defects but only in 11 patients with circumferential defects (p = 0.003). The near-circumferential group had fewer strictures and better tolerance of oral nutrition, supporting the incorporation of the residual posterior pharyngeal wall via near-circumferential reconstruction instead of discarding it to facilitate circumferential reconstruction.
Topics: Humans; Middle Aged; Plastic Surgery Procedures; Thigh; Constriction, Pathologic; Treatment Outcome; Retrospective Studies
PubMed: 37541048
DOI: 10.1016/j.bjps.2023.07.010 -
Journal of Dentistry Sep 2023Orthodontic treatment profoundly impact the pharyngeal airway (PA) of patients. Airway examination is an integral part of daily orthodontic diagnosis, and lateral...
OBJECTIVES
Orthodontic treatment profoundly impact the pharyngeal airway (PA) of patients. Airway examination is an integral part of daily orthodontic diagnosis, and lateral cephalograms (LC) are reliable to reveal PA structures. This study attempted to develop a simple method to help clinicians make a preliminary judgement of patients' PA conditions and assess the impact of orthodontic treatment on their airways.
METHODS
LCs of 764 patients were used to train a multistage unit segmentation model. Another 130 images were used to validate the model and more 130 images were used to test the model.
RESULTS
Unet was used as the backbone, with a mean dice value of 0.8180, precision of 0.8393, and recall of 0.8188. Furthermore, we identified seven key points and measured related indices. The length of the line separating the nasopharynx and oropharynx and the line separating the oropharynx and hypopharynx were manually measured thrice and the average values was compared. The intraclass correlation coefficient (ICC) for the two lines was 0.599 and 0.855. Then, we performed a single linear regression analysis, which indicated a strong correlation between the predictions and measurements for the two lines.
CONCLUSIONS
This method is reliable for segmenting three regions (nasopharynx, oropharynx, and hypopharynx) of the PA and calculating related indices. However, the predictions obtained from this model still have errors, and it is necessary for clinical practitioners to assess and adjust the predictions.
CLINICAL SIGNIFICANCE
Our model can help orthodontists formulate personalised treatment plans and evaluate the risk of airway stenosis during orthodontic treatment. This method may mark the beginning of a new and simpler approach for PA obstruction detection, specifically tailored to orthodontic patients.
Topics: Humans; Pharynx; Oropharynx; Nasopharynx; Hypopharynx; Radiography; Image Processing, Computer-Assisted
PubMed: 37506811
DOI: 10.1016/j.jdent.2023.104637 -
Auris, Nasus, Larynx Aug 2022Uvulopalatopharyngoplasty (UPPP) is performed as a surgical treatment at the oropharyngeal level for obstructive sleep apnea, but there are problems with variations in...
OBJECTIVE
Uvulopalatopharyngoplasty (UPPP) is performed as a surgical treatment at the oropharyngeal level for obstructive sleep apnea, but there are problems with variations in treatment effects and postoperative complications. Therefore, to improve those, we have devised and put into practice the so-called CWICKs, which is a modified version of barbed reposition pharyngoplasty as a surgical method. We outline the procedure of CWICKs and report the treatment results in comparison with the conventional UPPP.
METHODS
CWICKs are surgeries that use resorbable wound closure devices to pull the posterior palatal arch outward and elevate it anteriorly and superiorly to maintain an open upper airway during sleep at the soft palate level. We compared the therapeutic effects of 46 patients evaluated by polysomnography before and after surgery among CWICKs performed in our department between January 2015 and December 2019 and 91 patients who underwent UPPP in our department between January 2000 and December 2008.
RESULTS
In 46 patients who underwent CWICKs, significant improvement was observed before and after surgery using the apnea hypopnea index (AHI), obstructive apnea index (OAI), ration of each sleep stage, and SpO2 level > 90%. The improvement rate of AHI was 68.4%, and the surgical success rate was 58.7%. Postoperative patient satisfaction was also good, and significant improvement in subjective sleepiness (Epworth Sleepiness Scale) and subjective sleep quality (Pittsburgh Sleep Quality Index) was observed before and after surgery. No postoperative complications such as dysphagia or scar stenosis were observed in any of the patients in the CWICKs group. Compared with the 91 cases of UPPP, which is the conventional method, there was no significant difference in the improvement rate of AHI (p = 0.199), but the improvement rate of OAI had significantly improved (p = 0.013). Regarding the postoperative sleep stage, In the CWICKs group, a significant decrease in stage 1 and a significant increase in stage 2, stage 3, and stage rapid eye movement were observed, whereas in the UPPP group, no significant improvement in stage 3 was observed. Multivariate analysis of surgical success did not show an association with surgical methods (CWICKs or UPPP). On the other hand, an association was shown with age (<45), palatine tonsil size (≥3 / 5), high MPH (≥14 mm), and OAI rate (> 1/3).
CONCLUSION
The treatment outcome of CWICKs was equal to or better than that of the conventional UPPP. Future follow-up is required for long-term prognosis, but no serious postoperative complications, such as dysphagia or scar stenosis, have been observed. CWICKs are considered to be minimally invasive, simple, and effective surgical procedures with few complications.
Topics: Cicatrix; Constriction, Pathologic; Deglutition Disorders; Humans; Palate, Soft; Pharynx; Postoperative Complications; Sleep Apnea, Obstructive; Sleepiness; Treatment Outcome
PubMed: 34991916
DOI: 10.1016/j.anl.2021.11.015 -
Journal of Healthcare Engineering 2021Respiratory disorder is a disease with a very high incidence, in which obstructive apnea-hypopnea syndrome is the most harmful. It has become a common and frequently...
BACKGROUND
Respiratory disorder is a disease with a very high incidence, in which obstructive apnea-hypopnea syndrome is the most harmful. It has become a common and frequently occurring disease, which seriously influences the health of the affected population. The pathogenesis of obstructive sleep apnea/hypopnea syndrome (OSAHS) is numerous. With the continuous research on OSAHS disease, it has been found that one of its main pathogeneses is caused by the anatomical characteristics of upper airway obstruction induced during sleep. The narrowing and collapse of any plane can affect the ventilation of the upper respiratory tract. In recent years, with the deepening of research, the importance of the upper respiratory tract obstruction as a source of the disease has attracted increasing attention. Nasal stenosis can cause increased nasal resistance, increased pharyngeal inhalation negative pressure, soft palate collapse, and narrow pharyngeal cavity, resulting in open mouth breathing, which can be the initiating factor of the upper airway obstruction. With the development and popularization of nasal endoscopy technology, domestic and foreign scholars have reported more on the treatment of rhinogenic OSAHS with nasal cavity expansion, but they are different. There is still more controversy; the main controversy centered on the effective rate of surgical treatment and the improvement of objective indicators. Therefore, this study performed individualized nasal cavity expansion for patients with OSAHS who are mainly rhinogenic, from subjective symptoms, objective indicators, and effective rate of surgery. . Conduct research and analysis to provide references for the clinical treatment of such patients. For patients with the obstructive apnea-hypopnea syndrome with nasal congestion, individualized nasal cavity expansion was performed to study the clinical effect of nasal cavity expansion in the treatment of OSAHS. This article mainly screens cases through big data and selects a large hospital in China to perform individualized nasal cavity expansion surgery to treat 43 adult OSAHS patients with nasal congestion.
RESULTS
There are uploaded sleep monitoring, nasal reflex, nasal resistance, and nasal symptoms before and after surgery.
CONCLUSION
Spirometer examination records, along with apnea-hypopnea index and minimum arterial blood oxygen saturation, the minimum cross-sectional area of the nasal cavity, nasal cavity volume, nasal airway resistance, total nasal respiratory volume, and other information. Also we fill in the nasal obstruction symptom assessment scale, sleepiness scale, and study and analyze the surgical effect of nasal cavity expansion.
Topics: Adult; Humans; Nasal Cavity; Nasal Obstruction; Nose; Sleep; Sleep Apnea, Obstructive
PubMed: 34804458
DOI: 10.1155/2021/6926509 -
Annals of Surgery May 2015The aim of the study was to compare the short- and long-term outcomes of colopharyngoplasty and esophagocoloplasty for caustic injuries of the upper digestive tract.
OBJECTIVE
The aim of the study was to compare the short- and long-term outcomes of colopharyngoplasty and esophagocoloplasty for caustic injuries of the upper digestive tract.
BACKGROUND
Simultaneous esophageal and pharyngeal reconstruction by colopharyngoplasty allows regaining nutritional autonomy in patients with severe pharyngoesophageal caustic injuries.
METHODS
Patients who underwent upper digestive tract reconstruction for caustic injuries by colopharyngoplasty (n = 116) and esophagocoloplasty (n = 122) between 1993 and 2012 were included. Survival and functional outcomes were analyzed. Success was defined as nutritional autonomy after removal of the jejunostomy and tracheotomy tubes. Quality of life was assessed using the QLQ-OG25 and SF12v2 questionnaires.
RESULTS
Overall Kaplan-Meyer survival at 1, 5, and 10 years after colopharyngoplasty and esophagocoloplasty were 92%, 74%, 67% and 92%, 83%, 73%, respectively (P = 0.56). Quality of life and functional results (success: 57% vs 95%, P < 0.0001) were impaired after colopharyngoplasty. On multivariate analysis, older age (odds ratio [OR]: 0.94; confidence interval [CI]: 0.91-0.97 P < 0.0001) and pharyngeal reconstruction (OR: 0.05; CI: 0.02-0.13, P < 0.0001) were associated with failure. The decline in success with age was more pronounced after colopharyngoplasty with only 1 (7%) of 15 patients operated after the age of 55 being self-sufficient for eating and breathing. Laryngeal resection during colopharyngoplasty had no influence on success (54% vs 58%, P = 0.67) CONCLUSIONS:: The need to associate pharyngeal reconstruction during esophageal reconstruction for caustic injuries has a long-term negative impact on functional outcome.
Topics: Adult; Age Factors; Anastomosis, Surgical; Burns, Chemical; Caustics; Colon; Esophageal Stenosis; Esophagus; Female; Humans; Larynx; Male; Middle Aged; Pharynx; Quality of Life; Recovery of Function; Retrospective Studies; Treatment Outcome; Young Adult
PubMed: 24850062
DOI: 10.1097/SLA.0000000000000718 -
European Archives of... Oct 2023Total laryngeal and hypopharyngeal resection remained to be the mainly treatment option for advanced hypopharyngeal cancer, which resulted in complicated reconstructive...
BACKGROUND
Total laryngeal and hypopharyngeal resection remained to be the mainly treatment option for advanced hypopharyngeal cancer, which resulted in complicated reconstructive challenge for circumferential hypopharyngeal defect. The pedicled thoracoacromial artery compound flaps included Thoracoacromial artery perforator (TAAP) flap and pectoralis major myocutaneous (PMMC) flap. This study is to evaluate the clinical application of the pedicled thoracoacromial artery compound flaps for circumferential hypopharyngeal reconstruction.
METHODS
From May 2021 to April 2022, four hypopharyngeal cancer patients with circumferential hypopharyngeal defects were reconstructed by the pedicled thoracoacromial artery compound flaps. All patients were males. Patient age ranged from 35 to 62 years (average, 50 years). The Shoulder function were evaluated by SPADI. The average follow-up was 10.25 months (range from 4 to 18 months).
RESULTS
All of the pedicled thoracoacromial artery compound flaps in our study survived. The defect length between tongue base and cervical esophagus ranged from 8 to 10 cm after total laryngeal and hypopharyngeal resection. The TAAP flap size ranged from 6 × 7 cm to 7 × 10 cm, and the PMMC flap size ranged from 6 × 7 cm to 9 × 12 cm. The pedicle length of TAAP and PMMC flaps varied, respectively, from 5 to 8 cm (mean 6.5 cm) and 7 cm to 11 cm (mean 8.75 cm). The mean time of TAAP and PMMC flaps harvest was, respectively, 82 min and 39 min. All patients were able to resume soft diet in the fourth week of postoperation, but one patient was operated by gastrostomy in the second month of postoperation because of pharyngeal cavity stenosis, and the patient successfully resumed oral soft diet by endoscopic balloon dilation after postoperation radiotherapy. All patients have resumed oral feeding at last. There were mild dysfunction for our patients according to SPADI during the mid-long follow-up.
CONCLUSIONS
The pedicled thoracoacromial artery compound flaps have stable blood supply and provide adequate muscle coverage for greater protection during radiotherapy, and the microsurgical skills have no requirement. Therefore, the compound flaps provide a good choice for the reconstruction of circumferential hypopharyngeal defect, especially in the aged or patients with comorbidities who are not able to tolerate prolonged surgery.
Topics: Male; Humans; Aged; Adult; Middle Aged; Female; Hypopharyngeal Neoplasms; Plastic Surgery Procedures; Pectoralis Muscles; Perforator Flap; Pharyngeal Diseases; Arteries
PubMed: 37395759
DOI: 10.1007/s00405-023-08069-8 -
American Journal of Otolaryngology 2021Upper airway stenosis is one of the most formidable situations in medicine and is frequently encountered in the ENT clinic. We introduce here our method of emergency...
PURPOSE
Upper airway stenosis is one of the most formidable situations in medicine and is frequently encountered in the ENT clinic. We introduce here our method of emergency endonasal endotracheal intubation under videoendoscopic observation.
METHODS
Transnasal endoscopic observation was done, and the region of airway stenosis was detected. Then, the endotracheal tube was prepared and the endoscope was inserted into the tube. The endoscope with tube was inserted up to the larynx. Immediately after the administration of lidocaine to the larynx, the endoscope with tube was inserted to the endolarynx and then to the trachea. The endotracheal tube was tightly held in the nostril, and the endoscope was removed.
RESULTS
We have encountered four cases this year. The primary disease developing airway stenosis was acute epiglottitis due to pharyngeal and deep neck abscesses in three cases and laryngeal edema due to Ludwig's angina. All patients underwent uneventful intubation, and dyspnea was immediately ceased.
CONCLUSION
In cases showing severe suffocation, the clinician should perform airway maintenance even in an outpatient setting apart from a more monitored setting like the operation room. This technique resembles the usual nasal endoscopic laryngeal observation and is done even in the usual ENT office and/or emergency room. The supine position tends to worsen airway stenosis in patients with upper airway stenosis; however, this technique can be performed in a sitting or semi-sitting position. This method is less invasive for patients and also reduces the risk to the medical staff, especially in this COVID-19 era.
Topics: Aged; Aged, 80 and over; Dyspnea; Endoscopy; Epiglottitis; Female; Humans; Intubation, Intratracheal; Laryngeal Edema; Laryngostenosis; Male; Tracheal Stenosis; Video Recording
PubMed: 33109414
DOI: 10.1016/j.amjoto.2020.102779 -
Clinical Case Reports Nov 2020Aspiration of barium sulfate is possible during radiographic contrast procedures and is potentially life-threatening in severe cases. In patients with dysphagia or...
Aspiration of barium sulfate is possible during radiographic contrast procedures and is potentially life-threatening in severe cases. In patients with dysphagia or suspected tracheoesophageal fistula, barium compounds may be used, considering lateral projection fluoroscopy of the pharyngeal phase of swallowing, but iso-osmotic agents should also be considered.
PubMed: 33235777
DOI: 10.1002/ccr3.3066