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Lin Chuang Er Bi Yan Hou Tou Jing Wai... Dec 2020To study the anatomical distribution and tumor extent of juvenile laryngeal papilloma(JLP), and to sum up the similarity and difference in distribution between...
To study the anatomical distribution and tumor extent of juvenile laryngeal papilloma(JLP), and to sum up the similarity and difference in distribution between initiatial and recurrent tumor. Data of 65 patients with JLP who were admitted to the Ear Institute, School of Medicine, Shanghai Jiao Tong University from January 2011 to December 2018 were retrospectively analyzed. The RRP tumor assessment method proposed by Derkay et al. was referred to, in which larynx was divided in to 11 anatomical sites. 2.9±1.3 Laryngeal anatomical sites were involved in patients with initial tumor, while that was 3.1±1.5 in patients with recurrent tumor. The most common sites were true vocal fords, anterior commissure and false vocal fords in both group; and the least ones were subglottis, posterior glottis and ary-epiglottic fold. However, subglottis(=0.038) and trachea(=0.007) were more likely to be involved in recurrent tumor, with statistical differences. There were differences in distribution of JLP between initial and recurrent tumor, which might be the result of suitable areas for HPV survival or micro-lesion of residual tumor.
Topics: China; Humans; Laryngeal Neoplasms; Larynx; Papillomavirus Infections; Respiratory Tract Infections; Retrospective Studies
PubMed: 33254341
DOI: 10.13201/j.issn.2096-7993.2020.12.008 -
BMJ Case Reports Feb 2021Chondrosarcoma of the larynx is rare accounting for approximately 1% of laryngeal cancers; clear cell subtype is a rare variant. Given the low risk of occult nodal...
Chondrosarcoma of the larynx is rare accounting for approximately 1% of laryngeal cancers; clear cell subtype is a rare variant. Given the low risk of occult nodal disease, they present a unique opportunity to maximise tissue preservation in order to optimise both recovery and long-term functional outcomes. We present a case of laryngeal clear cell chondrosarcoma causing critical airway obstruction. An emergency tracheostomy was performed and mapping biopsies were taken. The tumour originated from the cricoid and extended into both arytenoid superstructures precluding cricotracheal resection. A modified narrow-field laryngectomy was performed, preserving all pharyngeal mucosa and neurovascularly intact infrahyoids. Organ preservation surgery is preferred in the management of laryngeal chondrosarcoma. If laryngectomy is required, the surgeon must ensure that all uninvolved, functional tissue is preserved carefully to improve swallow and voice outcomes postoperatively. We describe a novel technique used to achieve this outcome.
Topics: Airway Obstruction; Arytenoid Cartilage; Biopsy; Chondrosarcoma; Cricoid Cartilage; Humans; Laryngeal Neoplasms; Laryngectomy; Magnetic Resonance Imaging; Male; Middle Aged; Tomography, X-Ray Computed; Tracheostomy
PubMed: 33563684
DOI: 10.1136/bcr-2020-236044 -
Journal of Visualized Experiments : JoVE Jan 2020Laryngotracheal stenosis (LTS) is a pathologic narrowing of the subglottis and trachea leading to extrathoracic obstruction and significant shortness of breath. LTS...
Laryngotracheal stenosis (LTS) is a pathologic narrowing of the subglottis and trachea leading to extrathoracic obstruction and significant shortness of breath. LTS results from mucosal injury from a foreign body in the trachea, leading to tissue damage and a local inflammatory response that goes awry, leading to the deposition of pathologic scar tissue. Treatment for LTS is surgical due to the lack of effective medical therapies. The purpose of this method is to construct a biocompatible stent that can be miniaturized to place into mice with LTS. We demonstrated that a PLLA-PCL (70% poly-L-lactide and 30% polycaprolactone) construct had optimal biomechanical strength, was biocompatible, practicable for an in vivo placement stent, and capable of eluting drug. This method provides a drug delivery system for testing various immunomodulatory agents to locally inhibit inflammation and reduce airway fibrosis. Manufacturing the stents takes 28-30 h and can be reproduced easily, allowing for experiments with large cohorts. Here we incorporated the drug rapamycin within the stent to test its effectiveness in reducing fibrosis and collagen deposition. Results revealed that PLLA-PCL tents showed reliable rapamycin release, were mechanically stable in physiological conditions, and were biocompatible, inducing little inflammatory response in the trachea. Further, the rapamycin-eluting PLLA-PCL stents reduced scar formation in the trachea in vivo.
Topics: Animals; Drug-Eluting Stents; Mice; Tracheal Stenosis
PubMed: 32065163
DOI: 10.3791/60483 -
Ear, Nose, & Throat Journal Sep 2021We aimed to comprehensively investigate different upper airway segments in adults, determine the predictors of the size of each segment, and identify an appropriate...
OBJECTIVES
We aimed to comprehensively investigate different upper airway segments in adults, determine the predictors of the size of each segment, and identify an appropriate endotracheal tube (ETT) size chart.
STUDY DESIGN
Retrospective chart review.
SETTING
Tertiary care center.
MATERIALS AND METHODS
The data for patients aged >18 years who underwent neck computed tomography were screened. Patients with existing tumors, trauma, or any pathology that can alter the normal airway anatomy and those with intubation, tracheostomy, or nasogastric tubes were excluded. Computed tomography software was used to measure the anteroposterior diameter (APD), transverse diameter (TD), and cross-sectional area (CSA) at the glottic, proximal subglottic, distal subglottic, and tracheal levels. Multiple regression analysis was used to identify the predictors of the airway size.
RESULTS
One hundred patients were reviewed. The TD was consistently smaller than or equal to the APD at each level in all but 3 patients. The mean CSA and TD (170 mm and 11.3 mm, respectively) of the glottis indicated that the glottis was most often the narrowest level, followed by the proximal subglottis where the mean CSA and TD were 192.1 mm and 12.7 mm, respectively. Moreover, the mean APD was the smallest at the level of the trachea (20.1 mm). Multiple regression analysis confirmed that height and sex were the predominant predictors of measurements for the 4 airway segments. In addition, age was associated with the TD and CSA of the distal subglottic and tracheal segments, respectively.
CONCLUSION
One-third of our participants exhibited a proximal subglottic diameter that was equal to or smaller than the glottic diameter. Our findings also suggested that the height and sex of the patients are important variables for the selection of an appropriate ETT size.
Topics: Adult; Body Height; Equipment Design; Female; Glottis; Humans; Intubation, Intratracheal; Male; Middle Aged; Multivariate Analysis; Retrospective Studies; Sex Factors; Tomography, X-Ray Computed; Trachea
PubMed: 31914813
DOI: 10.1177/0145561319900390 -
Oxford Medical Case Reports May 2022Foreign body aspiration in children, specifically sharp and metallic type, imposes a serious morbidity and mortality risk if intervention is delayed. The bronchoscopic...
Foreign body aspiration in children, specifically sharp and metallic type, imposes a serious morbidity and mortality risk if intervention is delayed. The bronchoscopic removal of sharp metallic foreign bodies is technically challenging for the operating surgeon. We present a case of an 8-year-old girl who presented with an alleged history of aspiration of metallic, sharp and open safety pin 8 hours prior to presentation following which she developed throat pain and painful swallowing. X-ray of soft tissue neck showed a radio-opaque foreign body being lodged in the supraglottic area. She underwent emergency direct laryngoscopy-guided foreign body removal under general anesthesia. There was an open metallic sharp safety pin hinged over the inter-arytenoid region with its one end reaching sub-glottis and other end toward the hypopharynx. No post-operative complications occurred and patient was discharged on the third post-operative day.
PubMed: 35619679
DOI: 10.1093/omcr/omac044 -
Rheumatology (Oxford, England) Dec 2019To describe tracheobronchial disease in patients with granulomatosis with polyangiitis (GPA) and evaluate the utility of dynamic expiratory CT to detect large-airway... (Observational Study)
Observational Study
OBJECTIVES
To describe tracheobronchial disease in patients with granulomatosis with polyangiitis (GPA) and evaluate the utility of dynamic expiratory CT to detect large-airway disease.
METHODS
Demographic and clinical features associated with the presence of subglottic stenosis (SGS) or endobronchial involvement were assessed in a multicentre, observational cohort of patients with GPA. A subset of patients with GPA from a single-centre cohort underwent dynamic chest CT to evaluate the airways.
RESULTS
Among 962 patients with GPA, SGS and endobronchial disease were identified in 95 (10%) and 59 (6%) patients, respectively. Patients with SGS were more likely to be female (72% vs 53%, P < 0.01), younger at time of diagnosis (36 vs 49 years, P < 0.01), and have saddle-nose deformities (28% vs 10%, P < 0.01), but were less likely to have renal involvement (39% vs 62%, P < 0.01). Patients with endobronchial disease were more likely to be PR3-ANCA positive (85% vs 66%, P < 0.01), with more ENT involvement (97% vs 77%, P < 0.01) and less renal involvement (42% vs 62%, P < 0.01). Disease activity in patients with large-airway disease was commonly isolated to the subglottis/upper airway (57%) or bronchi (32%). Seven of 23 patients screened by dynamic chest CT had large-airway pathology, including four patients with chronic, unexplained cough, discovered to have tracheobronchomalacia.
CONCLUSION
SGS and endobronchial disease occur in 10% and 6% of patients with GPA, respectively, and may occur without disease activity in other organs. Dynamic expiratory chest CT is a potential non-invasive screening test for large-airway involvement in GPA.
Topics: Adult; Aged; Bronchial Diseases; Female; Granulomatosis with Polyangiitis; Humans; Laryngostenosis; Male; Middle Aged; Myeloblastin; Peroxidase; Tomography, X-Ray Computed; Tracheal Stenosis; Tracheobronchomalacia
PubMed: 31199488
DOI: 10.1093/rheumatology/kez217 -
Indian Pediatrics Jun 2022
Topics: Glottis; Humans; Xanthogranuloma, Juvenile
PubMed: 35695144
DOI: No ID Found -
Indian Journal of Otolaryngology and... Sep 2017Iatrogenic laryngotracheal injury is the most serious complication of endotracheal intubation since this method of establishing airway was first described by Eugene...
Iatrogenic laryngotracheal injury is the most serious complication of endotracheal intubation since this method of establishing airway was first described by Eugene Bouchut in 1858. Even today, subglottic stenosis is the most dreaded complication of intubation. This animal study is focused on the host tissue response to intubation induced injury resulting in subglottic stenosis and methods to prevent this complication. To assess the role of topically applied Mitomycin-C and Triamcinolone Acetonide in wound healing process following post-extubation subglottic injury. Prospective Randomized block, single-blinded, experimental study. Forty New-Zealand white rabbits where block randomized and allocated into 4 groups based on the type of topical medication that was applied post-extubation. Further these groups where subdivided into 3 subgroups based on the time of sacrifice (4, 6 and 12 weeks) to study the histopathological changes that occurred in a temporal sequence at the subglottis. It was observed that the rabbits in the control group and those that received Mitomycin-C only had more respiratory distress compared to those treated with Triamcinolone Acetonide. Statistically significant histopathological changes were observed in all the 4 groups. Mitomycin-C applied topically did not alter the wound healing process following post-extubation injury in the subglottis. Triamcinolone Acetonide significantly altered wound healing in the subglottis and prevented occurrence of respiratory distress.
PubMed: 28929076
DOI: 10.1007/s12070-017-1056-y -
Iranian Journal of Otorhinolaryngology Mar 2022Benign lymphoid hyperplasia uncommonly involves the larynx. Involvement of glottis and subglottis is even rare, considering sparse lymphatic supply compared to...
INTRODUCTION
Benign lymphoid hyperplasia uncommonly involves the larynx. Involvement of glottis and subglottis is even rare, considering sparse lymphatic supply compared to supraglottis.
CASE REPORT
A young female presented to emergency with worsening breathing difficulty. After securing the airway, she had found to have circumferential glottis and subglottic mucosa covered firm swelling. Histopathological evaluation of the swelling showed it to be benign lymphoid hyperplasia. Coblation assisted excision of the lesion was done, and the patient became asymptomatic without any recurrence.
CONCLUSION
Idiopathic lymphoid hyperplasia is a very rare entity to present as glottis and subglottic lesions. Probably, it's the first case to be reported in the literature as laryngeal involvement sparing the supraglottis.
PubMed: 35655766
DOI: 10.22038/IJORL.2021.58575.3024 -
The Laryngoscope Jan 2017Idiopathic subglottic stenosis (iSGS) is an unexplained obstruction involving the lower laryngeal and upper tracheal airway. Persistent mucosal inflammation is a...
OBJECTIVES/HYPOTHESIS
Idiopathic subglottic stenosis (iSGS) is an unexplained obstruction involving the lower laryngeal and upper tracheal airway. Persistent mucosal inflammation is a hallmark of the disease. Epithelial microbiota dysbiosis is found in other chronic inflammatory mucosal diseases; however, the relationship between tracheal microbiota composition and iSGS is unknown. Given the critical role for host defense at mucosal barriers, we analyzed tissue specimens from iSGS patients for the presence of microbial pathogens.
METHODS
Utilizing 30 human iSGS, 20 intubation-related tracheal stenosis (iLTS), and 20 healthy control specimens, we applied molecular, immunohistochemical, electron microscopic, immunologic, and Sanger-sequencing techniques.
RESULTS
With unbiased culture-independent nucleic acid, protein, and immunologic approaches, we demonstrate that Mycobacterium species are uniquely associated with iSGS. Phylogenetic analysis of the mycobacterial virulence factor rpoB suggests that, rather than Mycobacterium tuberculosis, a variant member of the Mycobacterium tuberculosis complex or a closely related novel mycobacterium is present in iSGS specimens.
CONCLUSION
These studies identify a novel pathogenic role for established large airway bacteria and provide new targets for future therapeutic intervention.
LEVEL OF EVIDENCE
NA Laryngoscope, 127:179-185, 2017.
Topics: Case-Control Studies; Humans; Immunohistochemistry; In Situ Hybridization; Intubation, Intratracheal; Laryngostenosis; Microbiota; Microscopy, Electron; Mycobacterium; Phylogeny; Polymerase Chain Reaction; Tracheal Stenosis
PubMed: 27295947
DOI: 10.1002/lary.26097