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Neuroimaging Clinics of North America Nov 2022The larynx serves as the gateway between the upper and lower respiratory tracts and is involved in the tasks of phonation, deglutition, and airway protection.... (Review)
Review
The larynx serves as the gateway between the upper and lower respiratory tracts and is involved in the tasks of phonation, deglutition, and airway protection. Familiarity with the complex anatomy of the larynx is critical for detecting and characterizing disease in the region, especially in cancer staging. In this article, we review the anatomy of the larynx and cervical trachea, including an overview of their cartilages, supporting tissues, muscles, mucosal spaces, neurovascular supply, and lymphatics, followed by correlation to the clinically relevant anatomic sites of the larynx. Imaging techniques for evaluating the larynx and trachea will also be discussed briefly.
Topics: Humans; Larynx; Neck; Trachea
PubMed: 36244725
DOI: 10.1016/j.nic.2022.07.011 -
Seminars in Fetal & Neonatal Medicine Oct 2023Safe and effective management of the neonatal airway requires knowledge, teamwork, preparation and experience. At baseline, the neonatal airway can present significant... (Review)
Review
Safe and effective management of the neonatal airway requires knowledge, teamwork, preparation and experience. At baseline, the neonatal airway can present significant challenges to experienced neonatologists and paediatric anaesthesiologists, and increased difficulty can be due to anatomical abnormalities, physiological instability or increased situational stress. Neonatal airway obstruction is under recognised, and should be considered an emergency until the diagnosis and physiological implications are understood. When multiple types of difficulties are present or there are multiple levels of anatomical obstruction, the challenge increases exponentially. In these situations, preparation, multi-disciplinary teamwork and a consistent hospital-wide approach will help to reduce errors and morbidity.
Topics: Humans; Infant, Newborn; Airway Obstruction; Neonatology
PubMed: 38030433
DOI: 10.1016/j.siny.2023.101483 -
Seminars in Pediatric Surgery Jun 2016Glottic stenosis is a fixed, focal narrowing at the level of the laryngeal inlet, the true vocal cords. It may be either congenital or acquired and be related to a wide... (Review)
Review
Glottic stenosis is a fixed, focal narrowing at the level of the laryngeal inlet, the true vocal cords. It may be either congenital or acquired and be related to a wide range of etiologies. The stenosis may be either anterior, posterior, or in rare cases, complete. Isolated glottic stenosis is rare; lesions often involve adjacent regions, namely the subglottis. A diagnosis is made from careful history and examination, including evaluation by microlaryngoscopy and bronchoscopy. The management of glottic stenosis is challenging and should be tailored to each individual case. A secure and adequate airway is the treatment priority alongside optimization of voice and laryngeal competence. Endoscopic and open techniques in either single or multiple stages have been described.
Topics: Airway Management; Bronchoscopy; Combined Modality Therapy; Humans; Laryngoscopy; Laryngostenosis; Stents
PubMed: 27301598
DOI: 10.1053/j.sempedsurg.2016.02.003 -
Clinics in Perinatology Dec 2018The subglottis is a narrow region of the pediatric airway that is exquisitely susceptible to the development of airway stenosis. The incidence of acquired subglottic... (Review)
Review
The subglottis is a narrow region of the pediatric airway that is exquisitely susceptible to the development of airway stenosis. The incidence of acquired subglottic stenosis in the setting of prolonged intubation has significantly decreased because of improved endotracheal tube management protocols. Advances in otolaryngology interventions, such as balloon dilation and endoscopic cricoid split techniques, may allow the avoidance of tracheostomy in patients with mild to moderate subglottic stenosis. However, patients with severe subglottic stenosis are often tracheostomy dependent. Open surgical techniques to treat severe disease, such as laryngotracheal reconstruction and cricotracheal resection, offer high rates of tracheostomy decannulation.
Topics: Bronchoscopy; Cricoid Cartilage; Dilatation; Female; Humans; Infant, Newborn; Intubation, Intratracheal; Laryngoscopy; Laryngostenosis; Male; Plastic Surgery Procedures; Recovery of Function; Risk Assessment; Treatment Outcome
PubMed: 30396418
DOI: 10.1016/j.clp.2018.07.013 -
Seminars in Pediatric Surgery Jun 2016Subglottic stenosis (SGS) is a congenital or acquired condition characterized by a narrowing of the upper airway extending from just below the vocal folds to the lower... (Review)
Review
Subglottic stenosis (SGS) is a congenital or acquired condition characterized by a narrowing of the upper airway extending from just below the vocal folds to the lower border of the cricoid cartilage. With the introduction of prolonged intubation in neonates (mid 1960s), acquired SGS became the most frequent cause of laryngeal stenosis; unlike congenital SGS, it does not improve with time. Laryngeal reconstruction surgery evolved as a consequence of the need to manage these otherwise healthy but tracheotomized children. Ongoing innovations in neonatal care have gradually led to the salvage of premature and medically fragile infants in whom laryngeal pathology is often more severe, and in whom stenosis often involves not only the subglottis, but also the supraglottis or glottis-causing significant morbidity and mortality. The primary objective of intervention in these children is decannulation or preventing the need for tracheotomy. The aim of this article is to present a more detailed description of both congenital and acquired SGS, highlighting the essentials of diagnostic assessment and familiarizing the reader with contemporary management approaches.
Topics: Child; Dilatation; Humans; Infant, Newborn; Laryngoscopy; Laryngostenosis; Larynx; Postoperative Complications; Plastic Surgery Procedures; Trachea; Tracheotomy
PubMed: 27301599
DOI: 10.1053/j.sempedsurg.2016.02.006 -
The Annals of Otology, Rhinology, and... Mar 2021Multiple congenital abnormalities of the epiglottis have been reported and iatrogenic injuries to the larynx and subglottis are well known. We present a new pattern of... (Review)
Review
INTRODUCTION
Multiple congenital abnormalities of the epiglottis have been reported and iatrogenic injuries to the larynx and subglottis are well known. We present a new pattern of defect not previously reported in the literature.
METHODS
Epiglottic abnormalities at two institutions are reviewed. Cases of defects involving the lateral aspect of the epiglottis and aryepiglottic fold are identified. A literature review of known epiglottic defects is performed.
RESULTS
Two children possessing lateral notch injuries at the aryepiglottic attachment to the epiglottis are described. Both children have a history of multiple laryngeal instrumentation attempts and prolonged intubation. Both have swallowing difficulties and are gastrostomy dependent. Congenital epiglottic defects include aplasia and midline bifidity, however, no lateral congenital epiglottic defects have been reported.
CONCLUSION
Epiglottic defects, while rare, should be part of the differential for children with aspiration and feeding difficulties. A new pattern of defect is described and iatrogenic etiology proposed.
Topics: Epiglottis; Female; Humans; Infant, Extremely Premature; Infant, Newborn; Intubation, Intratracheal; Laryngeal Muscles; Laryngoscopy; Respiratory Aspiration
PubMed: 32772542
DOI: 10.1177/0003489420948546 -
Otolaryngologic Clinics of North America Aug 2023Laryngotracheal stenosis is the common endpoint for any process that results in the narrowing of the airway at the level of the glottis, subglottis, or trachea. Although... (Review)
Review
Laryngotracheal stenosis is the common endpoint for any process that results in the narrowing of the airway at the level of the glottis, subglottis, or trachea. Although endoscopic procedures are effective in opening the airway lumen, open resection and reconstruction can be necessary to reconstitute a functional airway. When resection and anastomosis are insufficient due to extensive length or location of the stenosis, autologous grafts can be used to expand the airway. Future directions in airway reconstruction include tissue engineering and allotransplantation.
Topics: Humans; Tracheal Stenosis; Constriction, Pathologic; Treatment Outcome; Larynx; Trachea; Laryngostenosis
PubMed: 37268515
DOI: 10.1016/j.otc.2023.04.018