-
Zhonghua Er Bi Yan Hou Tou Jing Wai Ke... Aug 2023To analyze the clinical features, diagnosis, treatment and prognosis of nodular fasciitis (NF) in the head and neck. Seven cases of primary NF in the head and neck...
To analyze the clinical features, diagnosis, treatment and prognosis of nodular fasciitis (NF) in the head and neck. Seven cases of primary NF in the head and neck admitted to Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology from 1990 to 2022 were retrospectively analyzed, including 3 males and 4 females, aged from 2 to 67 years, and the location, course of disease, clinical manifestations, imaging findings, and treatment results of the disease were summarized. Of the 7 patients, the primary sites were respectively nasal vestibule, paranasal sinus, nasal dorsum, sella turcica and clivus, neck, subglottis, and tonsil. Three cases presented with rapidly growing subcutaneous painless masses within 2 months, 1 case presented with hemoptysis, hoarseness and asthma for 28 days, 1 case presented with blood in the nasal discharge for 2 months, 1 case presented with headache for 1 month, and 1 case was found to have tonsillar neoplasms on physical examination for 3 days. CT was performed in 5 patients and the lesions showed soft tissue density shadows, and MRI was also performed in 2 of them, which showed T1 isointensity or T2 slightly long abnormal signal shadows. All patients underwent simple surgical resection of the mass. The patients were followed up for 13 months to 10 years, and none had recurrence. Primary NF in the head and neck is rare, with atypical clinical symptoms and imaging findings. Surgery is the mainstay of treatment for NF with good results.
Topics: Female; Male; Humans; Retrospective Studies; Head; Neck; Asthma; Fasciitis
PubMed: 37599239
DOI: 10.3760/cma.j.cn115330-20221228-00775 -
Otolaryngology--head and Neck Surgery :... Dec 2023Determine the ideal head position to optimize visualization of the subglottis using flexible laryngoscopy.
OBJECTIVE
Determine the ideal head position to optimize visualization of the subglottis using flexible laryngoscopy.
STUDY DESIGN
Prospective cohort study.
SETTING
Outpatient multidisciplinary airway clinic at a tertiary care center.
METHODS
Patients presenting to a multidisciplinary airway clinic undergoing nasoendoscopic airway examination were enrolled. Three head positions were utilized to examine the subglottis during laryngoscopy: "sniffing," chin tuck, and stooping positions. In-office reviewers and blinded clinician participants evaluated views of the airway based on Cormack-Lehane (CL) scale, airway grade (AG), and visual analog scale (VAS). Demographic data were obtained. Statistical analysis compared head positions and demographic data using Student's t test, analysis of variance, and Tukey's post hoc analysis.
RESULTS
One hundred patients participated. No statistical differences existed among in-clinic or blinded reviewers for the CL score in any head position (p = .35, .5, respectively). For both AG and VAS, flexed and stooping positions were rated higher than the sniffing positions by both in-clinic and blinded reviewers (p < .01 for all analyses), but there was no statistical difference between these two positions (p = .28, .18, respectively). There was an inverse correlation between age and scores for AG and VAS in the flexed position for both sets of reviewers (p = .02, <.01 respectively), and a higher body mass index was significantly associated with the need to perform tracheoscopy for full airway evaluation (p < .01).
CONCLUSION
Both flexion and stoop postures can be implemented by an experienced endoscopist in awake, transnasal flexible laryngoscopy to enhance visualization of the subglottic airway.
Topics: Humans; Laryngoscopy; Prospective Studies; Intubation, Intratracheal; Larynx; Patient Positioning
PubMed: 37522249
DOI: 10.1002/ohn.419 -
Experimental and Computational... 2023Laryngotracheal stenosis (LTS) is a type of airway narrowing that is frequently caused by intubation-related trauma. LTS can occur at one or multiple locations in the...
Laryngotracheal stenosis (LTS) is a type of airway narrowing that is frequently caused by intubation-related trauma. LTS can occur at one or multiple locations in the larynx and/or trachea. This study characterizes airflow dynamics and drug delivery in patients with multilevel stenosis. Two subjects with multilevel stenosis (S1 = glottis + trachea, S2 = glottis + subglottis) and one normal subject were retrospectively selected. Computed tomography scans were used to create subject-specific upper airway models. Computational fluid dynamics modeling was used to simulate airflow at inhalation pressures of 10, 25, and 40 Pa, and orally inhaled drug transport with particle velocities of 1, 5, and 10 m/s, and particle size range of 100 nm-40 µm. Subjects had increased airflow velocity and resistance at stenosis with decreased cross-sectional area (CSA): S1 had the smallest CSA at trachea (0.23 cm) and resistance = 0.3 Pa·s/mL; S2 had the smallest CSA at glottis (0.44 cm), and resistance = 0.16 Pa·s/mL. S1 maximal stenotic deposition was 4.15% at trachea; S2 maximal deposition was 2.28% at glottis. Particles of 11-20 µm had the greatest deposition, 13.25% (S1-trachea) and 7.81% (S2-subglottis). Results showed differences in airway resistance and drug delivery between subjects with LTS. Less than 4.2% of orally inhaled particles deposited at stenosis. Particle sizes with most stenotic deposition were 11-20 µm and may not represent typical particle sizes emitted by current-use inhalers.
PubMed: 37305073
DOI: 10.1007/s42757-022-0151-9 -
Indian Journal of Otolaryngology and... Jun 2023The main purpose of this study is to evaluate and understand the clinical profile of patients presenting to an Indian tertiary care referral centre with Laryngotracheal...
The main purpose of this study is to evaluate and understand the clinical profile of patients presenting to an Indian tertiary care referral centre with Laryngotracheal Stenosis (LTS) and also to emphasise on the outcomes after treatment in these patients. This is a prospective observational study conducted at a tertiary care referral centre which included 18 patients diagnosed with LTS. All patients were evaluated clinically and radiologically to evaluate the degree of stenosis, site and length of the stenotic segment involved, intervened surgical procedure, intraoperative and postoperative complications following the procedure were all documented and taken into consideration. The data collected was analysed. The most common etiological cause of LTS was post intubation (77.8%). 61.5% among the 13 intubated patients had a history of intubation for more than 10 days. 83.3% of the cases had stenosis at the level of the subglottis and cervical trachea level. Post intubational airway stenosis is the most common cause of LTS. A precise assessment of the laryngotracheal complex is the cornerstone of LTS management. The choice of treatment depends on the location, severity, and length of stenosis, as well as on the patient's comorbidities, history of previous interventions, and on the expertise of the surgical team. Application of topical Mitomycin c during surgery reduces the incidence of granulations. Close postoperative follow up for a long time and the necessity of more than one intervention improves results and can spare patients the morbidity and mortality associated with acute airway obstruction.
PubMed: 37275098
DOI: 10.1007/s12070-023-03528-4 -
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 -
Cureus Apr 2023Subglottic hemangiomas are rare in adulthood. The presence of the lesion in the subglottic region makes it even more unusual. Moreover, these lesions do not have a...
Subglottic hemangiomas are rare in adulthood. The presence of the lesion in the subglottic region makes it even more unusual. Moreover, these lesions do not have a typical course and involution changes as seen in the infantile forms. An elderly female initially came with a brief history of dyspnea and symptoms of upper respiratory tract infection. The patient also complained of a change of voice and noisy breathing, with a recent history of intubation following COVID-19 pneumonia and late-onset bronchial asthma. Flexible nasopharyngolaryngoscopy showed a mass below the vocal folds, which was seen to arise from the posterior subglottic region. The patient eventually underwent endoscopic excision of the lesion under general anesthesia and recovered well. Symptoms of hoarseness and stridor, along with a history of intubation, should raise a high index of suspicion for laryngeal diseases. A delay in the diagnosis of an obstructing lesion in the subglottis occurs in the presence of a confounding lung infection and overlap of clinical features with those of bronchial asthma. Surgical excision is required not only to alleviate obstructive symptoms but also to rule out malignancy.
PubMed: 37255907
DOI: 10.7759/cureus.38293 -
The Laryngoscope Nov 2023A novel technique to treat subglottic stenosis, the "Maddern Procedure", has been gaining acceptance in academic centers. This study describes the technique in detail,...
INTRODUCTION
A novel technique to treat subglottic stenosis, the "Maddern Procedure", has been gaining acceptance in academic centers. This study describes the technique in detail, as well as its evolution over the first 28 patients performed at an academic center.
METHODS
A prospective case-series, with descriptive technique modifications cataloged throughout the 6 years needed to accumulate the patient cohort with a minimum of 2 years of follow-up (11/2015-11/2021). Main outcomes examined included changes to surgical indications, complications, and post-operative outcomes as measured by validated measures of voice and breathing.
RESULTS
Complete resection of subglottic scaring was performed, at first transcervically (2 pts), then transorally (26 pts). Successful performance of the procedure occurred in all patients without complications, with either successful decannulation of previously existing tracheotomies, or removal of perioperative tracheotomies. Buccal grafts (8/26) replaced skin graft as the graft of choice. Although high subglottic disease was first thought to be a contraindication, superior results became evident in cases of high stenosis rather than disease that included the upper trachea, with 4/26 patients requiring subsequent tracheal resection or tracheal dilation. Of the 22 remaining patients, 19/22 had successful arresting of restenosis, with 2/22 undergoing subsequent cricotracheal resection, and 1/22 pts requiring subglottic dilation. Overall, 19/26 Maddern pts (73%) had objectively favorable outcomes, with 24/26 (92%) reporting that they would have undergone the procedure again.
CONCLUSION
Full-thickness mucosal resection and relining of the subglottis is a developing technique that is a safe, yet technically challenging procedure which addresses the recurrent nature of the disease.
LEVEL OF EVIDENCE
Level 4 (Case-series) Laryngoscope, 133:3100-3108, 2023.
Topics: Humans; Constriction, Pathologic; Cricoid Cartilage; Retrospective Studies; Laryngostenosis; Larynx; Trachea; Treatment Outcome
PubMed: 37194674
DOI: 10.1002/lary.30752 -
BMC Pulmonary Medicine May 2023Fiberoptic bronchoscopy (FOB) and bronchoscopic biopsy are the established methods for diagnosing and treating sputum crust. However, sputum crust in concealed locations...
BACKGROUND
Fiberoptic bronchoscopy (FOB) and bronchoscopic biopsy are the established methods for diagnosing and treating sputum crust. However, sputum crust in concealed locations can sometimes be missed or undiagnosed, even with bronchoscopy.
CASE PRESENTATION
We present the case of a 44-year-old female patient who experienced initial extubation failure and postoperative pulmonary complications (PPCs) due to the missed diagnosis of sputum crust by FOB and low-resolution bedside chest X-ray. The FOB examination showed no apparent abnormalities prior to the first extubation, and the patient underwent tracheal extubation 2 h after aortic valve replacement (AVR). However, she was reintubated 13 h after the first extubation due to a persistent irritating cough and severe hypoxemia, and a bedside chest radiograph revealed pneumonia and atelectasis. Upon performing a repeat FOB examination prior to the second extubation, we serendipitously discovered the presence of sputum crust at the end of the endotracheal tube. Subsequently, we found that the sputum crust was mainly located on the tracheal wall between the subglottis and the end of the endotracheal tube during the "Tracheobronchial Sputum Crust Removal" procedure, and most of the crust was obscured by the retained endotracheal tube. The patient was discharged on the 20th day following therapeutic FOB.
CONCLUSION
FOB examination may miss specific areas in endotracheal intubation (ETI) patients, particularly the tracheal wall between the subglottis and distal end of the tracheal catheter, where sputum crust can be concealed. When diagnostic examinations with FOB are inconclusive, high-resolution chest CT can be helpful in identifying hidden sputum crust.
Topics: Female; Humans; Adult; Bronchoscopes; Sputum; Airway Extubation; Missed Diagnosis; Bronchoscopy; Intubation, Intratracheal; Fiber Optic Technology
PubMed: 37131123
DOI: 10.1186/s12890-023-02457-w -
BMJ Case Reports Apr 2023Tracheobronchopathia osteochondroplastica (TO) is a rare condition affecting the lumen of the tracheobronchial tree. It is characterised by the presence of multiple...
Tracheobronchopathia osteochondroplastica (TO) is a rare condition affecting the lumen of the tracheobronchial tree. It is characterised by the presence of multiple osseous and cartilaginous nodules with posterior wall sparing. While it is a benign condition, it can cause narrowing of the tracheal lumen and subglottis to varying degrees. Approximately 400 cases have been reported worldwide, with an incidence of 0.3% in autopsies and between 1 in 125 and 1 in 5000 on bronchoscopy. As most patients are asymptomatic, this may contribute to underdiagnoses and relative low incidence. Severity of the condition is often unrelated to patient symptomatology. We present a patient with one of the most severe cases of TO seen at our institution. Despite being asymptomatic, significant tracheal and bronchial narrowing was found incidentally on laryngobronchoscopy.
Topics: Humans; Tracheal Diseases; Bronchoscopy; Trachea; Osteochondrodysplasias
PubMed: 37055074
DOI: 10.1136/bcr-2022-249976