Hostname: page-component-586b7cd67f-t8hqh Total loading time: 0 Render date: 2024-11-26T05:06:02.907Z Has data issue: false hasContentIssue false
  • English
  • Français

End-to-end anastomosis in the management of laryngotracheal defects

Published online by Cambridge University Press:  13 March 2017

E D Gozen ,
M Yener ,
Z B Erdur  and
E Karaman
E D Gozen
Affiliation:
Otorhinolaryngology Department, Cerrahpasa Medical Faculty, Istanbul University, Turkey
M Yener
Affiliation:
Otorhinolaryngology Department, Cerrahpasa Medical Faculty, Istanbul University, Turkey
Z B Erdur
Affiliation:
Otorhinolaryngology Department, Cerrahpasa Medical Faculty, Istanbul University, Turkey
E Karaman*
Affiliation:
Otorhinolaryngology Department, Cerrahpasa Medical Faculty, Istanbul University, Turkey
*
Address for correspondence: Dr Emin Karaman, İstanbul Üniversitesi Cerrahpaşa Tıp Fakültesi, KBB ABD, Cerrahpasa, Fatih, 34098, İstanbul, Turkey E-mail: [email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective:

To present clinical experience and surgical outcomes of end-to-end anastomosis in the management of laryngotracheal stenosis and tracheal defects following invasive thyroid malignancy resection.

Methods:

A retrospective analysis was performed of 14 patients with laryngotracheal stenosis and tracheal invasive thyroid malignancy. All patients underwent tracheal or cricotracheal resection and primary end-to-end anastomosis.

Results:

Length of stenosis was 1.7–4 cm. Stenosis was classified as Myer and Cotton grade II in 4 patients, grade III in 6 and grade IV in 2. Surgical procedures included tracheotracheal end-to-end anastomosis (n = 4), cricotracheal anastomosis (n = 2) and thyrotracheal anastomosis (n = 6). Patients with invasive thyroid malignancy underwent segmental resection of the involved segment with tumour-free margins, and tracheal or cricotracheal end-to-end anastomosis. Successful decannulation was achieved in 13 patients (93 per cent). Post-operative complications were: wound infection (n = 1), subcutaneous emphysema (n = 1), temporary unilateral vocal fold palsy (n = 1), granulation tissue development (n = 1), and restenosis (n = 2).

Conclusion:

End-to-end anastomosis can be used safely and successfully in the management of advanced laryngotracheal stenosis and wide laryngotracheal defects. Greater success can be achieved using previously described surgical rules and laryngotracheal release manoeuvres.

Keywords

Airway ObstructionTracheal StenosisAcquired Subglottic Stenosis
Type
Main Articles
Information
The Journal of Laryngology & Otology , Volume 131 , Issue 5 , May 2017 , pp. 447 - 454
Copyright
Copyright © JLO (1984) Limited 2017 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1 Ramdev, S, Ghosh, P, Mukhopadhyaya, S. Radiological evaluation of chronic laryngotracheal stenosis. Indian J Otolaryngol Head Neck Surg 2005;57:108–9Google Scholar
2 Stauffer, JL, Olson, DE, Petty, TL. Complications and consequences of endotracheal intubation and tracheostomy: a prospective study in 150 critically ill adult patients. Am J Med 1981;70:65–76 Google Scholar
3 Pearson, FG, Andrews, MJ. Detection and management of tracheal stenosis following cuffed tube tracheostomy. Ann Thorac Surg 1971;12:359–74CrossRefGoogle ScholarPubMed
4 Grillo, HC, Donahue, DM, Mathisen, DJ, Wain, JC, Wright, CD. Postintubation tracheal stenosis: treatment and results. J Thorac Cardiovasc Surg 1995;109:486–92Google Scholar
5 Myer, CM, O'Connor, DM, Cotton, RT. Proposed grading system for subglottic stenosis based on endotracheal tube sizes. Ann Otol Rhinol Laryngol 1994;103:319–23CrossRefGoogle ScholarPubMed
6 Pearson, FG, Cooper, JD, Nelems, JM, Van Nostrand, AW. Primary tracheal anastomosis after resection of the cricoid cartilage with preservation of recurrent laryngeal nerves. J Thorac Cardiovasc Surg 1975;70:806–16Google Scholar
7 Grillo, HC. Primary reconstruction of airway after resection of subglottic laryngeal and upper tracheal stenosis. Ann Thorac Surg 1982;33:3–18 CrossRefGoogle ScholarPubMed
8 Wynn, R, Har-El, G, Lim, JW. Tracheal resection with end-to-end anastomosis for benign tracheal stenosis. Ann Otol Rhinol Laryngol 2004;113:613–17Google Scholar
9 Grillo, HC. Management of nonneoplastic diseases of the trachea. In: Shields, TW, LoCicero, J 3rd, Ponn, RB, eds. General Thoracic Surgery, 5th edn. Philadelphia: Lippincott Williams and Wilkins, 2000;885–97Google Scholar
10 Liu, L, Wu, W, Ma, Y, Liu, Y, Wang, Y, Oghagbon, EK et al. Laryngotracheal resection and reconstruction for subglottic tracheal stenosis--our experience of 32 cases. Clin Otolaryngol 2015;40:143–7Google Scholar
11 Pookamala, S, Kumar, R, Thakar, A, Venkata Karthikeyan, C, Bhalla, AS, Deka, RC. Laryngotracheal stenosis: clinical profile, surgical management and outcome. Indian J Otolaryngol Head Neck Surg 2014;66:198–202 Google Scholar
12 Sarper, A, Ayten, A, Eser, I, Ozbudak, O, Demircan, A. Tracheal stenosis after tracheostomy or intubation: review with special regard to cause and management. Tex Heart Inst J 2005;32:154–8Google Scholar
13 Zias, N, Chroneou, A, Tabba, MK, Gonzalez, AV, Gray, AW, Lamb, CR et al. Post tracheostomy and post intubation tracheal stenosis: report of 31 cases and review of the literature. BMC Pulm Med 2008;8:18Google Scholar
14 Sharpe, DA, Dixon, K, Moghissi, K. Endoscopic laser treatment for tracheal obstruction. Eur J Cardiothorac Surg 1996;10:722–6Google Scholar
15 Marques, P, Leal, L, Spratley, J, Cardoso, E, Santos, M. Tracheal resection with primary anastomosis: 10 years experience. Am J Otolaryngol 2009;30:415–18Google Scholar
16 Rubikas, R, Matukaitytė, I, Jelisiejevas, JJ, Račkauskas, M. Surgical treatment of non-malignant laryngotracheal stenosis. Eur Arch Otorhinolaryngol 2014;271:2481–7CrossRefGoogle ScholarPubMed
17 Krajc, T, Janik, M, Benej, R, Lucenic, M, Majer, I, Demian, J et al. Urgent segmental resection as the primary strategy in management of benign tracheal stenosis. A single center experience in 164 consecutive cases. Interact Cardiovasc Thorac Surg 2009;9:983–9Google Scholar
18 Rosen, FS, Pou, AM, Buford, WL. Tracheal resection with primary anastomosis in cadavers: the effects of releasing maneuvers and length of tracheal resection on tension. Ann Otol Rhinol Laryngol 2003;112:869–76Google Scholar
19 Grillo, HC, Dignan, EF, Miura, T. Extensive resection and reconstruction of mediastinal trachea without prosthesis or graft: an anatomical study in man. J Thorac Cardiovasc Surg 1964;48:741–9Google Scholar
20 Montgomery, WW. Suprahyoid release for tracheal anastomosis. Arch Otolaryngol 1974;99:255–60Google Scholar
21 Dedo, HH, Fishman, NH. Laryngeal release and sleeve resection for tracheal stenosis. Ann Otol Rhinol Laryngol 1969;78:285–96Google Scholar
22 Maddaus, MA, Toth, JL, Gullane, PJ, Pearson, FG. Subglottic tracheal resection and synchronous laryngeal reconstruction. J Thorac Cardiovasc Surg 1992;104:1443–50CrossRefGoogle ScholarPubMed
23 George, M, Lang, F, Pashe, P, Monier, P. Surgical management of laryngotracheal stenosis in adults. Eur Arch Otorhinolaryngol 2005;262:609–15Google Scholar
24 Negm, H, Mosleh, M, Fathy, H. Circumferential tracheal resection with primary anastomosis for post-intubation tracheal stenosis: study of 24 cases. Eur Arch Otorhinolaryngol 2013;270:2709–17Google Scholar
25 Couraud, L, Jougon, JB, Velly, JF. Surgical treatment of nontumoral stenoses of the upper airway. Ann Thorac Surg 1995;60:250–6Google Scholar