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The Journal of Laryngology and Otology Jun 2024This paper reports the innovative use of a modified nasopharyngeal airway device as a temporary stent in patients with laryngotracheal stenosis. It also discusses the...
BACKGROUND
This paper reports the innovative use of a modified nasopharyngeal airway device as a temporary stent in patients with laryngotracheal stenosis. It also discusses the technique of endoscopic stent placement, and our experience in terms of the indications and suitability.
METHOD
The nasopharyngeal airway device was modified to use as an airway stent by trimming it to the desired length. Next, the stent was inserted endoscopically and anchored using a novel approach.
RESULTS
The surgery was performed successfully without complications. The patients had full use of their voice while the stent was in situ. No significant granulation tissue was observed.
CONCLUSION
This paper demonstrates the feasibility of using a nasopharyngeal airway device as a temporary stent to prevent restenosis in cases where the patients have a strong demand for phonation. The modified nasopharyngeal airway device is potentially very promising, but cases must be selected carefully to avoid compromising efficacy and safety.
Topics: Humans; Stents; Tracheal Stenosis; Laryngostenosis; Male; Adult; Female; Nasopharynx; Treatment Outcome; Middle Aged; Feasibility Studies; Endoscopy
PubMed: 37926907
DOI: 10.1017/S0022215123001858 -
European Review For Medical and... Oct 2023Narrow maxilla occurring due to various congenital or acquired causes creates major orthodontic problems and complicates prosthetic dental rehabilitation. The etiologic...
OBJECTIVE
Narrow maxilla occurring due to various congenital or acquired causes creates major orthodontic problems and complicates prosthetic dental rehabilitation. The etiologic factors are mostly related to upper airway pathologies that restrict breathing and cause negative pressure at the base of the nose and nasopharynx. The upper and lower airway is a whole unit. Regional anomalies or acquired problems affect the entire system. This can lead to developmental issues and permanent disorders in childhood, which will last their real life. This study was planned to investigate the incidence of nasopharyngeal obstruction originating from allergic rhinitis, turbinate hypertrophy, septum deviation, and adenoid vegetation in children scheduled for orthodontic treatment due to maxillary stenosis.
PATIENTS AND METHODS
Our study group consists of one hundred children aged 12-16 years who applied to the orthodontist due to dental malalignment and were found to have a narrowing of the maxilla. After the orthodontic evaluation, the patients were referred for an ENT examination to evaluate the etiological factors originating from the upper respiratory tract. In the study group, nasal congestion and allergic rhinitis were first investigated. All symptoms were evaluated and scored. Then, an ENT physical examination was performed in all cases, and nasal cavities, nasopharynx, and oropharynx were assessed with a fiberoptic endoscope. Regarding etiological factors, allergic rhinitis, turbinate hypertrophy, nasal septum deviation, and adenoid vegetation that would prevent breathing were carefully investigated.
RESULTS
Firstly, deep palate, narrowed maxillary arch, V-shaped arch, adenoid face type, bilateral posterior crossbite, insufficient lip presence, maxillary incisor protrusion (upper forward thrust), skeletal class 2 division 1 malocclusion, and increased lower face height detected in patients primarily diagnoses were grouped according to their pathologies. Allergic rhinitis was found in 43 cases, turbinate hypertrophy in 30 instances, nasal septum deviation in 18 cases, and adenoid vegetation that prevented respiration in 61 patients.
CONCLUSIONS
It is known that increased nasal airway resistance due to allergic rhinitis, septal deviation, turbinate hypertrophy, or adenoid vegetation in the upper respiratory tract may lead to permanent orthodontic disorders in children and adolescents. A multidisciplinary approach, early diagnosis, and treatment should be the first step to prevent this situation. Secondly, it should be planned to correct the anatomical disorders that have occurred with appliances and, if necessary, surgical approaches. Taking precautions before permanent problems arise in childhood is also crucial in prosthetic dentistry.
Topics: Child; Adolescent; Humans; Maxilla; Nose; Nasopharynx; Rhinitis, Allergic; Hypertrophy
PubMed: 37869951
DOI: 10.26355/eurrev_202310_34073 -
Zhonghua Jie He He Hu Xi Za Zhi =... Oct 2023Tracheostomy is a common procedure in critically ill patients who require mechanical ventilation. Tracheostomies have several advantages over endotracheal tubes,...
Tracheostomy is a common procedure in critically ill patients who require mechanical ventilation. Tracheostomies have several advantages over endotracheal tubes, including less sinusitis or pharyngeal injuries, fewer sedative drugs, improved oropharyngeal hygiene, easier communication, more comfort, preservation of vocal cord function, and so on. However, patients with a tracheostomy require high quality care and often suffer from dysphagia, dysphonia, tracheal stenosis, or excessive airway secretions, . In China, there are currently no comprehensive evidence-based clinical guidelines or consensus documents on the management and rehabilitation of patients with a tracheostomy. Approaches to tracheostomy care are inconsistent among different institutions and clinicians. Therefore, a group of top experts specialized in this field in China were gathered to draft this document to reduce variations in practice in the management of patients with a tracheostomy and to minimize complications. Panel members were asked to complete surveys on various aspects of adult tracheostomy care, followed by a conference at which the results were presented and a number of themes outlined for a formal literature review and a preliminary draft. Several conferences were then held to discuss the differences of opinion among the panel members. In general, the panel reached a consensus and a total of 9 issues were covered in the document. At first, the importance of a standardized management protocol, pathophysiological characteristics, indications, complications, contradictions, and techniques used for tracheostomies were discussed. Then, more emphasis was placed on post-operative care such as airway clearance therapy, tube changes, and decannulation criteria, . In addition, the most important topic was elaborated, namely the methods used to promote the rehabilitation and decannulation of patients with a tracheostomy, including respiratory and other skeletal muscle training, dysphagia and verbal communication intervention, ventilation support, chest physiotherapy, and specifically the traditional Chinese medical therapies that were excellent in this area, such as acupuncture, moxibustion, and herbal medicine, . Finally, a flow chart was created to summarize the suggestions for managing and promoting rehabilitation or decannulation of patients with a tracheostomy. Proposed by Respiratory Equipment Committee of China Association of Medical Equipment, Young and Middle-Aged Pulmonary Rehabilitation Group of Pulmonary Rehabilitation Committee of China Association of Rehabilitation of Disabled Person, and Critical Illness Rehabilitation Group of China Association of Rehabilitation Medicine, and sponsored by several national or provincial natural science research projects, this work is expected to provide clear guidance for the general treatment of adult patients with a tracheostomy in China in the future.
Topics: Adult; Humans; Middle Aged; Critical Illness; Deglutition Disorders; Intubation, Intratracheal; Respiration, Artificial; Tracheostomy
PubMed: 37554082
DOI: 10.3760/cma.j.cn112147-20230331-00153 -
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 -
Acta Oto-laryngologica Aug 2023The treatment of refractory hypopharyngeal corrosive strictures remains challenging nowadays.
BACKGROUND
The treatment of refractory hypopharyngeal corrosive strictures remains challenging nowadays.
OBJECTIVES
To introduce a designed ladder-shaped stent for the treatment of refractory hypopharyngeal corrosive strictures.
MATERIAL AND METHODS
Patients with refractory hypopharyngeal corrosive strictures treated in our hospital between 2018 to 2022 were recruited in this study. All the patients had a dysphasia score of 4 and four patients had a tracheostomy preoperatively. A designed ladder-shaped stent was placed in the hypopharyngeal area after laser treatment to maintain the opening. This stent was kept for 3-6 months. All the patients were followed-up for at least 6 months after stent removal.
RESULTS
Six patients were recruited including two males, three females and one girl. All the patients were tolerable with the stent. There were no immediate or long-term complications. Patients were able to swallow a soft diet after the procedure. No tracheostomy was needed.
CONCLUSION
This use of a ladder-shaped stent is helpful in the treatment of hypopharyngeal strictures after laser treatment.
Topics: Male; Female; Humans; Constriction, Pathologic; Caustics; Hypopharynx; Stents; Device Removal; Treatment Outcome; Esophageal Stenosis
PubMed: 37534459
DOI: 10.1080/00016489.2023.2236147 -
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 -
The Laryngoscope Feb 2024In this report, we present a 55-year-old female with cervical stenosis that underwent C5-C7 anterior cervical discectomy and fusion surgery complicated by hardware...
In this report, we present a 55-year-old female with cervical stenosis that underwent C5-C7 anterior cervical discectomy and fusion surgery complicated by hardware failure requiring removal. One screw remained after transcervical hardware removal due to operative difficulty with the risk of exposing the hypopharyngeal submucosal space. The retained screw caused the patient significant discomfort and dysphagia prompting a transoral attempt at removal. Using a hypopharynx blade on an oral retractor for access, the single-port surgical robot successfully removed the foreign body from the distal hypopharynx. In this case, a single-port surgical robot expanded access to the inferior hypopharynx. Laryngoscope, 134:588-591, 2024.
Topics: Female; Humans; Middle Aged; Robotics; Hypopharynx; Robotic Surgical Procedures; Laryngoscopes
PubMed: 37439371
DOI: 10.1002/lary.30882 -
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 -
Archivos Argentinos de Pediatria Feb 2024The bilateral presentation of peritonsillar abscess is uncommon. Its management is controversial and it has been argued whether a quinsy tonsillectomy or an interval...
The bilateral presentation of peritonsillar abscess is uncommon. Its management is controversial and it has been argued whether a quinsy tonsillectomy or an interval tonsillectomy should be performed. Here we describe the case of a 14-year-old boy with sore throat, trismus, and fever. He had bilateral tonsillar hypertrophy, convex arches, and soft palate edema. Computed tomography: bilateral tonsillar hypertrophy, with post-contrast enhancement, both with collection, edema with moderate pharyngeal stenosis. The patient was hospitalized for intravenous therapy and tonsillectomy with bilateral drainage resulting in a complete resolution of his condition and discharge at 48 hours. In the presence of a peritonsillar abscess, an unsuspected contralateral abscess should be considered. It should be diagnosed and managed adequately to prevent complications. Quinsy tonsillectomy could be safe and should be considered in patients who will undergo anesthesia for abscess drainage. The final decision should be made for each patient on an individual basis.
Topics: Male; Humans; Adolescent; Peritonsillar Abscess; Tonsillectomy; Pharyngitis; Hypertrophy; Edema
PubMed: 37382552
DOI: 10.5546/aap.2023-03034.eng -
Management of Enlarging Tracheoesophageal Fistula with Voice Prosthesis in Laryngectomized Patients.The Laryngoscope Jan 2024Management of Enlarging tracheoesophageal fistula (TEF) with Voice Prosthesis in Laryngectomized Head and Neck Cancer Patients.
UNLABELLED
Management of Enlarging tracheoesophageal fistula (TEF) with Voice Prosthesis in Laryngectomized Head and Neck Cancer Patients.
OBJECTIVES
An enlarging TEF following voice prosthesis placement impacts patient quality of life, risks airway compromise, and can lead to aspiration pneumonia. Pharyngoesophageal strictures have previously been reported to be associated with TEF enlargement and leakage. We describe a series of patients with enlarging TEFs after Tracheoesophageal puncture (TEP) for voice prosthesis who required pharyngoesophageal reconstruction.
METHODS
Retrospective case series of laryngectomized H&N cancer patients with primary or secondary TEP who underwent surgical management for enlarging TEF site between 6/2016-11/2022.
RESULTS
Eight patients were included. The mean age was 62.8 years old. Seven patients had a history of hypothyroidism. Of seven with prior H&N radiation history, two had both historical and adjuvant radiation. Two of the eight TEPs were placed secondarily. Mean time from TEP to enlarging TEF diagnosis was 891.3 days. Radial forearm-free flaps were used in five patients. Six had stenosis proximal to the TEF whereas one had distal stenosis and one had no evidence of stenosis. Mean length of stay was 12.3 days. Mean follow-up was 400.4 days. Two required a second free flap for persistent fistula.
CONCLUSION
Surgical reconstruction of enlarging TEFs due to TEP/VP placement is effective in combination with addressing underlying pharyngeal/esophageal stenosis contributing to TEF enlargement and leakage. Radial forearm-free flaps have the additional benefit of a long vascular pedicle to access more distant and less-irradiated recipient vessels. Many fistulae are resolved after the first flap reconstruction, but some may require subsequent reconstruction in case of failure.
LEVEL OF EVIDENCE
4 Laryngoscope, 134:198-206, 2024.
Topics: Humans; Middle Aged; Larynx, Artificial; Tracheoesophageal Fistula; Laryngectomy; Retrospective Studies; Constriction, Pathologic; Quality of Life; Free Tissue Flaps; Pharyngeal Diseases; Trachea; Treatment Outcome
PubMed: 37366287
DOI: 10.1002/lary.30857