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Head & Neck Aug 2022The purpose of this review article is to summarize the existing literature surrounding wound healing mechanisms in laryngotracheal stenosis. (Review)
Review
BACKGROUND
The purpose of this review article is to summarize the existing literature surrounding wound healing mechanisms in laryngotracheal stenosis.
METHODS
A review of general wound healing pathophysiology, followed by a focused review of iatrogenic laryngotracheal stenosis (iLTS) and idiopathic subglottic stenosis (iSGS) as conditions of aberrant wound healing.
RESULTS
iLTS is the scarring of the laryngotracheal complex, coming secondary to injury from prolonged intubation. iSGS is a chronic fibroinflammatory scarring and narrowing of the subglottic airway in the absence of any obvious preceding injury or trauma. They are both thought to result from a prolonged and dysregulated wound healing response that promotes the deposition of pathologic scar in the airway.
CONCLUSIONS
Understanding the mechanisms that underlie wound healing will help identify and intervene on the process early in its development and discover future therapies that target individual wound healing mechanisms limiting the incidence of this recalcitrant disease process.
Topics: Cicatrix; Constriction, Pathologic; Humans; Laryngostenosis; Tracheal Stenosis
PubMed: 35488503
DOI: 10.1002/hed.27079 -
Journal of Thoracic Disease Mar 2020Idiopathic subglottic stenosis (iSGS) is a fibrotic disease of unclear etiology that produces obstruction of the central airway in the anatomic region under the glottis.... (Review)
Review
Idiopathic subglottic stenosis (iSGS) is a fibrotic disease of unclear etiology that produces obstruction of the central airway in the anatomic region under the glottis. The diagnosis of this entity is difficult, usually delayed and confounded with other common respiratory diseases. No apparent etiology is identified even after a comprehensive workup that includes a complete history, physical examination, pulmonary function testing, auto-antibodies, imaging studies, and endoscopic procedures. This approach, however, helps to exclude other conditions such as granulomatosis with polyangiitis (GPA). It is also helpful to characterize the lesion and outline management strategies. Therapeutic endoscopic procedures and surgery are the most common management modalities, but medical therapy can also play a significant role in preventing or delaying recurrence. In this review, we describe the morphology, pathophysiology, clinical presentation, evaluation, management, and prognosis of iSGS.
PubMed: 32274178
DOI: 10.21037/jtd.2019.11.43 -
Cleveland Clinic Journal of Medicine Jun 2020
Topics: Antirheumatic Agents; Biopsy; Calcinosis; Cyclophosphamide; Diagnosis, Differential; Dyspnea; Female; Humans; Laryngeal Cartilages; Laryngoscopy; Laryngostenosis; Methotrexate; Polychondritis, Relapsing; Prednisolone; Respiratory Sounds; Tomography, X-Ray Computed; Treatment Outcome; Young Adult
PubMed: 32487551
DOI: 10.3949/ccjm.87a.19129 -
Journal of Oral Pathology & Medicine :... Nov 2022Vascular anomalies are rare lesions of diverse nature that may affect the head and neck region. Any mass in or around the upper airway has the potential to obstruct or... (Review)
Review
Vascular anomalies are rare lesions of diverse nature that may affect the head and neck region. Any mass in or around the upper airway has the potential to obstruct or compromise it. The absolute priority, before etiologic treatment, is the evaluation of the risk for the airway and its management. Prenatal diagnosis of an upper airway obstruction requires a planned delivery in a center having a specialized team experienced in managing a compromised feto-neonatal airway, and who could perform an ex-utero intrapartum treatment to secure the airway. Even after birth, the airway remains central in the patient's overall management. Signs and symptoms of airway compromise must be evaluated keeping in mind the specific requirements of infants and small children and being aware that rapid worsening may occur. The treatment is then tailored to the patient and his lesion with the goal of improving symptoms while avoiding treatment-related complications. Maintaining reasonable expectations by the patient and families are part of a successful management. Cure is achievable for small and localized lesions, but symptom relief and mitigation of functional, esthetic and psychological impairments is the goal for large and complex lesions. If a tracheotomy was required, decannulation is one of the primary management goals.
Topics: Child; Female; Humans; Infant; Infant, Newborn; Pregnancy; Airway Obstruction; Esthetics, Dental; Laryngostenosis; Prenatal Diagnosis; Tracheotomy; Vascular Malformations
PubMed: 35347777
DOI: 10.1111/jop.13297 -
Multimedia Manual of Cardiothoracic... Dec 2022The treatment of benign subglottic stenoses can be challenging. It requires an experienced multidisciplinary team. It is important to define the aetiology, severity and...
The treatment of benign subglottic stenoses can be challenging. It requires an experienced multidisciplinary team. It is important to define the aetiology, severity and number/types of any pretreatments of the stenosis. Short-term symptom relief can be achieved with endoscopic techniques; however, this relief comes at the price of a high likelihood of restenosis, which often is more severe than the original stenosis. Successful long-term treatment of subglottic stenosis can be achieved by surgical resection in most cases. Cricotracheal resection is the established standard technique to treat subglottic stenosis. In patients with advanced disease, it can be extended by a dorsal mucosectomy, a lateral cricoplasty or a partial anterior laryngeal split in order to remove the entire diseased area. In this video tutorial, we describe a modification of cricotracheal resection. In this technique for an extended resection, the cricoid arch is partially preserved. In addition to restoring sufficient airway width, this modification has the advantage that the cricothyroid joint remains intact. Therefore, the reduction in the pitch and volume of the voice associated with the standard resection techniques is avoided.
Topics: Humans; Constriction, Pathologic; Trachea; Tracheal Stenosis; Laryngostenosis; Cricoid Cartilage; Treatment Outcome
PubMed: 36534064
DOI: 10.1510/mmcts.2022.104 -
Asian Journal of Surgery Mar 2023
Topics: Humans; Constriction, Pathologic; Laryngostenosis; Airway Obstruction
PubMed: 36117070
DOI: 10.1016/j.asjsur.2022.08.127 -
The American Journal of Pathology Aug 2021
Topics: Animals; Bronchiolitis Obliterans; Humans; Kidney Glomerulus; Laryngostenosis; Macular Degeneration; Muscular Dystrophy, Duchenne
PubMed: 34129845
DOI: 10.1016/j.ajpath.2021.06.003 -
The Laryngoscope Nov 2022Characterize and quantify epithelium in multiple etiologies of laryngotracheal stenosis (LTS) to better understand its role in pathogenesis.
OBJECTIVE
Characterize and quantify epithelium in multiple etiologies of laryngotracheal stenosis (LTS) to better understand its role in pathogenesis.
STUDY DESIGN
Controlled in vitro cohort study.
METHODS
Endoscopic brush biopsy samples of both normal (non-scar) and scar were obtained in four patients with idiopathic subglottic stenosis (iSGS) and four patients with iatrogenic LTS (iLTS). mRNA expression of basal, ciliary, and secretory cell markers were evaluated using quantitative PCR. Cricotracheal resection tissue samples (n = 5 per group) were also collected, analyzed using quantitative immunohistochemistry, and compared with rapid autopsy tracheal samples.
RESULTS
Both iSGS and iLTS-scar epithelium had reduced epithelial thickness compared with non-scar control epithelium (P = .0009 and P = .0011, respectively). Basal cell gene and protein expression for cytokeratin 14 was increased in iSGS-scar epithelium compared with iLTS or controls. Immunohistochemical expression of ciliary tubulin alpha 1, but not gene expression, was reduced in both iSGS and iLTS-scar epithelium compared with controls (P = .0184 and P = .0125, respectively). Both iSGS and iLTS-scar had reductions in Mucin 5AC gene expression (P = .0007 and P = .0035, respectively), an epithelial goblet cell marker, with reductions in secretory cells histologically (P < .0001).
CONCLUSIONS
Compared with non-scar epithelium, the epithelium within iSGS and iLTS is morphologically abnormal. Although both iSGS and iLTS have reduced epithelial thickness, ciliary cells, and secretory cells, only iSGS had significant increases in pathological basal cell expression. These data suggest that the epithelium in iSGS and iLTS play a common role in the pathogenesis of fibrosis in these two etiologies of laryngotracheal stenosis.
SETTING
Tertiary referral center (2017-2020).
LEVEL OF EVIDENCE
NA Laryngoscope, 132:2194-2201, 2022.
Topics: Cicatrix; Cohort Studies; Constriction, Pathologic; Humans; Keratin-14; Laryngostenosis; Mucin 5AC; RNA, Messenger; Tracheal Stenosis; Tubulin
PubMed: 35141889
DOI: 10.1002/lary.30040 -
Brazilian Journal of Otorhinolaryngology 2014It is essential for clinicians to understand issues relevant to the airway management of infants and to be cognizant of the fact that infants with congenital laryngeal... (Review)
Review
INTRODUCTION
It is essential for clinicians to understand issues relevant to the airway management of infants and to be cognizant of the fact that infants with congenital laryngeal anomalies are at particular risk for an unstable airway.
OBJECTIVES
To familiarize clinicians with issues relevant to the airway management of infants and to present a succinct description of the diagnosis and management of an array of congenital laryngeal anomalies.
METHODS
Revision article, in which the main aspects concerning airway management of infants will be analyzed.
CONCLUSIONS
It is critical for clinicians to understand issues relevant to the airway management of infants.
Topics: Cysts; Hemangioma; Humans; Laryngeal Diseases; Laryngeal Neoplasms; Laryngomalacia; Laryngostenosis; Larynx; Vocal Cord Paralysis
PubMed: 25457074
DOI: 10.1016/j.bjorl.2014.08.001 -
Auris, Nasus, Larynx Aug 2023The COVID-19 omicron variant has a low affinity for the lower respiratory tract. However, upper respiratory tract symptoms, such as nasal discharge and sore throat,...
OBJECTIVES
The COVID-19 omicron variant has a low affinity for the lower respiratory tract. However, upper respiratory tract symptoms, such as nasal discharge and sore throat, characterize the infection with this variant. Therefore, in laryngeal stenosis, disease severity assessment through blood oxygen saturation has not been useful.
METHODS
We report the case of "omicron laryngitis" in a 59-year-old male who visited the ear, nose, and throat (ENT) clinic with complaints of a sore throat and difficulty in swallowing saliva that persisted for a day.
RESULTS
Laryngoscopy revealed severe swelling of the transglottic region and exudates on the larynx. He was then diagnosed with COVID-19 and subjected to emergency tracheostomy for airway management. Until the emergence of the omicron variant, COVID-19 showed mainly lower airway and mild upper airway inflammatory features. However, upper airway stenosis should be suspected in cases presenting with "muffled speech," "dysphagia," "severe pain on swallowing," and "inspiratory dyspnea or stridor."
CONCLUSION
Therefore, laryngeal and pharyngeal evaluation using a flexible laryngoscope under appropriate infection control measures is necessary, considering the possibility of progression to fatal laryngeal stenosis, as noted in this case.
Topics: Male; Humans; Middle Aged; Laryngitis; Laryngostenosis; COVID-19; SARS-CoV-2; Pharyngitis
PubMed: 36114072
DOI: 10.1016/j.anl.2022.08.007