Tracheal Resection (tracheal + resection)

Distribution by Scientific Domains

Selected Abstracts

Cricotracheal reconstruction following external beam radiotherapy for recurrent thyroid cancer

Bruce G. Ashford
Abstract Tracheal resection for invasive thyroid cancer is well described. Segmental tracheal or cricotracheal resection and reconstruction is an uncommon but established method in the treatment of invasive thyroid cancer. This has seldom been reported in a recurrence following external beam radiotherapy. Radiotherapy compromises healing and predisposes tracheal reconstruction to dehiscence. A fascia-only radial forearm free-flap reconstruction of a segmental cricotracheal resection is described. [source]

The management of thyroid carcinoma invading the larynx or trachea,

Jimmie Honings MD
Abstract Objectives/Hypothesis: To describe the controversies in the management of thyroid carcinoma invading the airway. Study Design: Contemporary review of literature; level of evidence: 5. Results: Invasion of the larynx or trachea by thyroid carcinoma is uncommon and often identified at the time of operation, when the surgeon must decide the extent of resection. Invasion of the airway is associated with loss of tumor differentiation and a reduction in long-term survival compared to tumors limited to the thyroid gland. Whether or not the invaded airway should be resected remains controversial. Tangential shave excision of tumor is commonly performed, despite a marked risk of local recurrence. Circumferential sleeve resection of the larynx and trachea is safe and lowers the risk of local recurrence. In recurrent disease, laryngotracheal resection provides effective palliation of airway obstruction and hemoptysis. Conclusions: Long-term (>10,20 years) prospective studies are required to compare the outcome after shave excision with segmental airway resection for thyroid carcinoma. Based on the current literature and on our experience, we advocate circumferential tracheal resection in the setting of airway involvement. Laryngoscope, 2010 [source]

Dilatation for Assisted Ventilation-Induced Laryngotracheal Stenosis

Philippe Clément MD
Abstract Objective: To assess the long-term results of dilatation and our experience with dilatation for assisted ventilation-induced laryngotracheal stenosis. Design: A retrospective study of 32 patients primarily treated with dilatation for assisted ventilation-induced laryngotracheal stenosis between 1977 and 2002. Setting: A tertiary care center and university teaching hospital. Patients: There were 19 men and 13 women aged 15 to 76 years. The stenosis was cicatricial with some inflammatory process in 27 patients and completely mature in 5 patients. The stenosis involved the cricoid and the trachea in four patients. In 28 patients, the stenosis involved only the trachea. Methods: Dilatation was performed with serially sized rigid bronchoscopes. Endoscopic laser vaporization was never performed in this series. Six patients were treated with only one dilatation. The 26 remaining patients were treated with successively 2 to 10 dilatations (mean, 3.3 dilatations). The dilatation success rate was analyzed using the Kaplan-Meier method. Results: Median duration of follow-up was 1.8 years. Mortality rate was 9.4%. The overall failure rate was 71.8%. Twenty patients presented with recurrent stenosis. The treatment of recurrent stenosis consisted of tracheal resection with end-to-end anastomosis (11 patients, 55%), cricotracheal anastomosis (5 patients, 25%), tracheal endoprosthesis (2 patients, 10%), and tracheotomy (1 patient, 5%). All patients who underwent tracheal or cricotracheal anastomosis were successfully treated. None of the variables under analysis (sex, age, medical history, cause for intubation, intubation type and duration, delay from initial injury, degree of stenosis, length of trachea involved, number of dilatations) were statistically related to the incidence of complications and the success rate of dilatations. Conclusions: We do not recommend dilatation technique as the sole treatment for assisted ventilation-induced laryngotracheal stenosis. This technique is helpful in case of emergency to restore an airway and useful for the assessment of stenosis. [source]

Results of endoscopic tracheoplasty for treating tracheostomy-related airway stenosis

S.A.R. Nouraei
Keypoints ,,Post-tracheostomy ,lambdoid' deformity of the trachea is a specific and uncommon variant of adult post-intubation laryngotracheal stenosis, in which airway obstruction is caused by inward collapse of over-resected tracheal cartilage as a result of post-decannulation stomal contracture. ,,We evaluated the results of endoscopic tracheoplasty as an alternative to open tracheal resection in 11 patients treated for this condition between 2004 and 2006. ,,Patients were treated with endoscopic CO2 laser resection, dilatation and endotracheal mitomycin C application. Suspension micro-laryngo-tracheoscopy and high-frequency supraglottic jet ventilation were used. Eleven patients with an average age of 56 years and lesion height and distance from glottis respectively of 11 ± 5 mm and 35 ± 12 mm were treated. ,,The median number of treatments fell from four at the start of the series to two at the end (P = 0.08). The average follow-up was 17 ± 8 months and all patients were cured with no cases of dysphagia or dysphonia. Almost all patients achieved and maintained a Medical Research Council Dyspnoea Scale of I or II. ,,Endoscopic tracheoplasty is an effective treatment for this condition. It achieves a successful outcome while avoiding the operative risks, prolonged hospitalisation, and morbidity that is associated with tracheal resection. We recommend it as the standard of care for treating patients with this injury. [source]