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International Journal of Pediatric... Feb 2015Acquired subglottic stenosis (SGS) most commonly results from prolonged endotracheal intubation and is a diagnostic challenge in the intubated child. At present, no... (Clinical Trial)
Clinical Trial
BACKGROUND
Acquired subglottic stenosis (SGS) most commonly results from prolonged endotracheal intubation and is a diagnostic challenge in the intubated child. At present, no imaging modality allows for in vivo characterization of subglottic microanatomy to identify early signs of acquired SGS while the child remains intubated. Fourier domain optical coherence tomography (FD-OCT) is a minimally invasive, light-based imaging modality which provides high resolution, three dimensional (3D) cross-sectional images of biological tissue. We used long-range FD-OCT to image the subglottis in intubated pediatric patients undergoing minor head and neck surgical procedures in the operating room.
METHODS
A long-range FD-OCT system and rotary optical probes (1.2mm and 0.7mm outer diameters) were constructed. Forty-six pediatric patients (ages 2-16 years) undergoing minor upper airway surgery (e.g., tonsillectomy and adenoidectomy) were selected for intraoperative, trans-endotracheal tube FD-OCT of the subglottis. Images were analyzed for anatomical landmarks and subepithelial histology. Volumetric image sets were rendered into virtual 3D airway models in Mimics software.
RESULTS
FD-OCT was performed on 46 patients (ages 2-16 years) with no complications. Gross airway contour was visible on all 46 data sets. Twenty (43%) high-quality data sets clearly demonstrated airway anatomy (e.g., tracheal rings, cricoid and vocal folds) and layered microanatomy of the mucosa (e.g., epithelium, basement membrane and lamina propria). The remaining 26 data sets were discarded due to artifact, high signal-to-noise ratio or missing data. 3D airway models were allowed for user-controlled manipulation and multiplanar airway slicing (e.g., sagittal, coronal) for visualization of OCT data at multiple anatomic levels simultaneously.
CONCLUSIONS
Long-range FD-OCT produces high-resolution, 3D volumetric images of the pediatric subglottis. This technology offers a safe and practical means for in vivo evaluation of lower airway microanatomy in intubated pediatric patients. Ultimately, FD-OCT may be applied to serial monitoring of the neonatal subglottis in long-term intubated infants at risk for acquired SGS.
Topics: Adolescent; Child; Child, Preschool; Feasibility Studies; Female; Glottis; Humans; Imaging, Three-Dimensional; Intubation, Intratracheal; Laryngostenosis; Male; Signal-To-Noise Ratio; Tomography, Optical Coherence
PubMed: 25532671
DOI: 10.1016/j.ijporl.2014.11.019 -
Case Reports in Otolaryngology 2017Subglottic Eosinophilic Angiocentric Fibrosis (EAF) is an extremely rare disease of an elusive aetiology. It is chronically progressive benign condition that causes...
Subglottic Eosinophilic Angiocentric Fibrosis (EAF) is an extremely rare disease of an elusive aetiology. It is chronically progressive benign condition that causes narrowing of the subglottic region leading to dysphonia and airway compromise. The diagnosis is historical and imaging is nonspecific. We report a case xc of 56-year-old lady referred to our institution with globus sensation, hoarseness, and mild stridor. Incidental subglottic mass was found at time of diagnostic microlaryngoscopy and biopsy confirmed subglottic EAF. All laboratory investigations were unremarkable. Lesion was removed with laryngeal microdebrider and three courses of intravenous dexamethasone were administered. Patient's postoperative period was uneventful and had remained disease free for 1 year. To date, no consensus has been reached on the optimal treatment of subglottic EAF. We recommend regular follow-up to detect early recurrence.
PubMed: 28251006
DOI: 10.1155/2017/2381786 -
The Journal of Laryngology and Otology Jun 1948
Topics: Humans; Larynx; Neoplasms; Plasmacytoma
PubMed: 18866862
DOI: No ID Found -
The Journal of Laryngology and Otology Jul 1975
Topics: Accidents, Traffic; Adult; Child; Chondrosarcoma; Hoarseness; Humans; Infant; Laryngeal Cartilages; Laryngeal Diseases; Laryngeal Neoplasms; Laryngostenosis; Larynx; Lymphatic Metastasis; Prognosis; Radiography; Trachea; Tracheotomy; Vocal Cords
PubMed: 1176819
DOI: 10.1017/s0022215100080890 -
Chest Surgery Clinics of North America May 2003ILTS is a rare inflammatory disease that results in a cicatricial stenosis of the cricoid and upper trachea. It occurs almost exclusively in women and is without known... (Review)
Review
ILTS is a rare inflammatory disease that results in a cicatricial stenosis of the cricoid and upper trachea. It occurs almost exclusively in women and is without known cause. Patients present with dyspnea on exertion that progresses to dyspnea at rest, often with stridor. The diagnosis is usually made on the basis of patient history, physical examination, and radiography. Rigid bronchoscopy is usually reserved for the day of proposed surgery to confirm diagnosis and to plan the operative strategy. On occasion, the presence of active inflammation extending into the immediate subglottis or the patient's use of corticosteroids requires that surgery be postponed. In these cases, a patent airway is temporarily restored with careful bronchoscopic dilation. Single-staged laryngotracheal resection is successful in more than 90% of patients and is the most effective treatment when performed by experienced hands. Long-term follow-up shows stable airway and improvement in voice quality. Palliative procedures such as repeated airway dilations should be reserved for poor surgical candidates. Protective tracheostomy is rarely required.
Topics: Adult; Cicatrix; Female; Humans; Inflammation; Laryngostenosis; Male; Middle Aged; Otorhinolaryngologic Surgical Procedures; Suture Techniques; Tracheal Stenosis; Treatment Outcome
PubMed: 12755312
DOI: 10.1016/s1052-3359(03)00027-9 -
The Annals of Otology, Rhinology, and... Mar 2018To share the diagnostic and management challenges created by an extremely rare airway lesion-the subglottic ectopic thymic cyst.
OBJECTIVES
To share the diagnostic and management challenges created by an extremely rare airway lesion-the subglottic ectopic thymic cyst.
STUDY DESIGN
Case report and literature review.
METHODS
We review the presentation, management, and clinical course of an infant who presented with a subglottic mass that was histologically confirmed as a thymic cyst. A brief literature review supplements the case presentation Results: We present the third described case of an ectopic thymic cyst presenting as a subglottic mass. The differential diagnosis of subglottic masses in neonates consists primarily of subglottic hemangioma and mucous retention cysts. Otolaryngologists must be prepared for unexpected findings when dealing with critical airways. We compare the presentation and management of our patient with the 2 previously described cases. We propose an embryologic theory for the origin of these rare lesions.
CONCLUSIONS
An ectopic thymic cyst is a rare and unexpected cause of neonatal stridor. Management of pediatric airway lesions must allow for unexpected findings at the time of diagnostic and therapeutic endoscopy. The appropriate management of subglottic thymic cysts is poorly defined, but close surveillance for recurrence is mandatory.
Topics: Choristoma; Congenital Abnormalities; Diagnosis, Differential; Humans; Infant; Laryngeal Diseases; Laryngoscopy; Larynx; Male; Mediastinal Cyst; Respiratory Sounds; Treatment Outcome
PubMed: 29291277
DOI: 10.1177/0003489417749609 -
International Journal of Pediatric... Sep 2016
Topics: Cricoid Cartilage; Humans; Intubation, Intratracheal; Larynx
PubMed: 27426922
DOI: 10.1016/j.ijporl.2016.06.058 -
The Journal of Otolaryngology Jun 1991The posterior glottis is an area of the larynx previously referred to by the terms 'posterior commissure' and 'interarytenoid'; these are poorly defined and a new... (Review)
Review
The posterior glottis is an area of the larynx previously referred to by the terms 'posterior commissure' and 'interarytenoid'; these are poorly defined and a new definition of this unique area of the larynx is provided. Within the text is a series of experiments performed on nearly 300 larynges. The posterior glottis was examined in relation to the following: the embryology, the epithelium, mathematical dimensions, gross anatomy, microanatomical structures, submucosal spaces and the spread of carcinoma related to this area. Various significant findings were made. There exists a pharyngoglottic duct which divides the embryonic larynx into anterior (membranous) and posterior (cartilaginous) parts. The epithelium of the posterior glottis in neonates and non-smokers is respiratory in nature and the notion of a laryngeal respiratory function is reinforced by a mathematical analysis of the cross sectional areas of the larynx during inspiration. The presence of a posterior cricoarytenoid ligament which stabilizes the arytenoid is confirmed. The spread of carcinoma to the posterior glottis from the different primary laryngeal and pyriform fossa sites shows differing modes of invasion but in particular a direct extension and connection with the subglottis. The most significant conclusion from these studies is that the posterior glottis is so intimately related to the subglottis that it must be considered as part of the subglottis. The acceptance of this fact, however, requires a new definition of the larynx from that given by the American Joint Committee on Cancer Staging and that of U.I.C.C. The posterior glottis considered as part of the subglottis requires a review of our present understanding of the structure and function of the larynx and in particular the spread of cancer posteriorly.
Topics: Adult; Aged; Aged, 80 and over; Anthropometry; Carcinoma, Squamous Cell; Female; Glottis; Humans; Laryngeal Neoplasms; Male; Middle Aged; Neoplasm Metastasis; Neoplasm Staging; Sex Characteristics
PubMed: 1875468
DOI: No ID Found -
Ear, Nose, & Throat Journal May 2006Mucoepidermoid carcinoma of the subglottis is infrequently reported in the literature. This tumor subtype is more commonly associated with the major and minor salivary... (Review)
Review
Mucoepidermoid carcinoma of the subglottis is infrequently reported in the literature. This tumor subtype is more commonly associated with the major and minor salivary glands. Mucoepidertoid carcinoma of the larynx can be difficult to diagnose, and there is no consensus as to appropriate management. We report a case of a low-grade mucoepidermoid carcinoma that was confined to the subglottis and treated with organ-preservation surgery. A conservative surgical approach was taken because of the tumor's low-grade histology and its location and in order to preserve the patient's laryngeal function. At follow-up 15 months postoperatively, the patient remained disease-free, and laryngeal function was intact.
Topics: Carcinoma, Mucoepidermoid; Female; Follow-Up Studies; Glottis; Humans; Laryngeal Neoplasms; Middle Aged; Otorhinolaryngologic Surgical Procedures; Treatment Outcome
PubMed: 16771028
DOI: No ID Found -
Laryngoscope Investigative... Apr 2022(1) To highlight the important causes of chronic and recurrent cough in children. (2) To discuss multidisciplinary approach to management of chronic/recurrent pediatric... (Review)
Review
OBJECTIVES
(1) To highlight the important causes of chronic and recurrent cough in children. (2) To discuss multidisciplinary approach to management of chronic/recurrent pediatric cough.
METHODS
Review of scholarly articles, guidelines, expert panels via PubMed and Google Scholar.
CONCLUSION
Chronic cough (CC) in children is mainly attributed to persistent bacterial bronchitis, asthma, nonspecific cough, and gastroesophageal reflux disease (GERD) symptoms. A multi-disciplinary approach is cost-effective and aids with earlier diagnosis and appropriate treatment. Congenital or acquired narrowing of the subglottis is the leading ENT cause for recurrent croup (RC) in children. Laryngeal cleft-type 1 is commonly seen in children with recurrent aspiration and CC. Children are usually referred to pulmonologists for wet cough not responding to treatment. Eosinophilic esophagitis (EoE) and GERD should be considered in the differential diagnosis of CC in children with both respiratory symptoms and failure to thrive.Level of Evidence: 2a.
PubMed: 35434349
DOI: 10.1002/lio2.778