Non-intubation traumatic laryngotracheal stenosis: management policies and results (original) (raw)
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Management of Laryngotracheal trauma: A review of current trends and future Directions
JPMA. The Journal of the Pakistan Medical Association, 2020
Laryngotracheal trauma is rare but can pose serious threats to one's life. Presenting symptoms vary according to the severity of injury. Immediate Airway control is first step in the management, intubation should be considered by a senior member of the trauma team if the injury is minor while tracheostomy should be reserved for more severe injuries. Evaluation by a fibre-optic laryngoscopy and CT scan should be done whenever possible. Reconstruction is done according to the site involved using suture, titanium miniplates and stents. Tissue engineering has added a new horizon in this management but up till now complete laryngotracheal regeneration is very far-fetched, but tissue regeneration at individual sites have shown some positive results. More work needs to be done in this less explored field including laryngeal transplantation.
Damage Control of Laryngotracheal Trauma: The Golden Day
Colombia médica, 2020
Laryngotracheal trauma is rare but potentially life-threatening as it implies a high risk of compromising airway patency. A consensus on damage control management for laryngotracheal trauma is presented in this article. Tracheal injuries require a primary repair. In the setting of massive destruction, the airway patency must be assured, local hemostasis and control measures should be performed, and definitive management must be deferred. On the other hand, management of laryngeal trauma should be conservative, primary repair should be chosen only if minimal disruption, otherwise, management should be delayed. Definitive management must be carried out, if possible, in the first 24 hours by a multidisciplinary team conformed by trauma and emergency surgery, head and neck surgery, otorhinolaryngology, and chest surgery. Conservative management is proposed as the damage control strategy in laryngotracheal trauma.
Laryngeal injury from prolonged intubation: A prospective analysis of contributing factors
The Laryngoscope, 2011
Objectives/Hypothesis-The factors leading to laryngeal injury due to intubation are not fully understood. This study sought to determine if duration of intubation, size of endotracheal tube, and/or type of endotracheal tube impact the degree of vocal fold immobility and other laryngeal injury upon extubation. Study Design-Prospective study. Methods-Sixty-one adult patients intubated for more than 48 hours were examined by recorded flexible nasolaryngoscopy shortly after extubation. Results-Forty-one percent of patients had some degree of vocal fold immobility. However, neither the duration of intubation (range, 2-28 days; mean, 9.1 days), the size of endotracheal tube (range, 6 to 8), nor the type of endotracheal tube significantly affected the degree of laryngeal injury including vocal fold immobility. Additionally, none of the collected demographic information (age, gender, height, weight) significantly affected the degree of laryngeal injury. Conclusions-In this cohort, duration of intubation, type of endotracheal tube, and size of endotracheal tube do not significantly correlate to the incidence of vocal fold mobility and degree of laryngeal injury noted after prolonged intubation.
Early Intervention for the Treatment of Acute Laryngeal Injury After Intubation
JAMA Otolaryngology–Head & Neck Surgery, 2021
IMPORTANCE Patients with laryngeal injury after endotracheal intubation often present long after initial injury with mature fibrosis compromising cricoarytenoid joint mobility and glottic function. OBJECTIVE To compare functional outcomes between early and late intervention for intubation-related laryngeal injury. DESIGN, SETTING, AND PARTICIPANTS This retrospective cohort study involved 29 patients with laryngeal injury resulting from endotracheal intubation who were evaluated at a tertiary care center between May 1, 2014, and June 1, 2018. Ten patients with intubation injury to the posterior glottis who received early treatment were compared with 19 patients presenting with posterior glottic stenosis who received late treatment. Statistical analysis was performed from May 1 to July 1, 2019. EXPOSURES Early intervention, defined as a procedure performed 45 days or less after intubation, and late treatment, defined as an intervention performed greater than 45 days after intubation. MAIN OUTCOMES AND MEASURES Patient-specific and intervention-specific covariates were compared between the 2 groups, absolute differences with 95% CIs were calculated, and time to tracheostomy decannulation was compared using log-rank testing. RESULTS The 2 groups had similar demographic characteristics and a similar burden of comorbid disease. Ten patients who received early intervention (7 women [70%]; median age, 59.7 years [range, 31-72 years]; median, 34.7 days to presentation [IQR, 1.5-44.8 days]) were compared with 19 patients who received late intervention (11 women [58%]; median age, 53.8 years [range, 34-73 years]; median, 341.9 days to presentation [IQR, 132.7-376.3 days]). Nine of 10 patients (90%) who received early intervention and 11 of 19 patients (58%) who received late interventions were decannulated at last follow-up (absolute difference, 32%; 95% CI, −3% to 68%). Patients who received early treatment required fewer total interventions than patients with mature lesions (mean, 2.2 vs 11.5; absolute difference, 9.3; 95% CI, 6.4-12.1). In addition, none of the patients who received early treatment required an open procedure, whereas 17 patients (90%) with mature lesions required open procedures to pursue decannulation. CONCLUSIONS AND RELEVANCE This study suggests that early intervention for patients with postintubation laryngeal injury was associated with a decreased duration of tracheostomy dependence, a higher rate of decannulation, and fewer surgical procedures compared with late intervention. Patients who underwent early intervention also avoided open reconstruction. These findings may bear relevance to the management of patients requiring extended durations of endotracheal intubation during recovery for critical illness related to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection.
Indian Journal of Otolaryngology and Head & Neck Surgery, 2020
Aetiology of acquired laryngotracheal stenosis (ALTS) is complex and heterogenous. The aim of this study is to discuss the role of primary aetiology of intubation in the development and outcomes of Post intubation Laryngo tracheal stenosis (PILTS). A retrospective review of patients diagnosed and managed as PILTS from May 2008 to January 2017 was conducted. Demography, primary aetiology of intubation, grade of stenosis, length of the stenotic segment, treatment and outcomes of these patients were recorded and analysed. Based on aetiology of intubation, patients were divided into Poisoning (I), Neurogenic (II) and Rest of aetiologies (III) group respectively. Group I had 28/52 patients (53.8%) followed by group II, 15/52(28.8%) and group III, 9/52(17.3%) respectively. Organophosphorus compound poisoning (OPP) (44.2%) was the commonest cause overall followed by Brain injury (23.1%) and Acute Respiratory Distress Syndrome (ARDS) (11.5%). Trachea (46.15%) was the commonest subsite involved in this study. 24/28(85.7%) of patients had advanced (either grade 3 or 4) subglottic stenosis. The average length of stenotic segment in the study was 18.5 ± 9.2 mm (7-34 mm). 39/52(74.9%) of patients underwent open surgical approaches like cricotracheal resection and anastomosis, Laryngotracheal reconstruction or Shian-Yan Lee technique. 48/52(92.3%) patients were decannulated successfully. There was no significant association between primary etiology of intubation and outcomes. We conclude that OPP and neurological disease patients are more susceptible to airway injury. The authors emphasize that clinicians should be aware of these facts and manage these susceptible patients accordingly.
Early Diagnosis and Treatment of Laryngeal Injuries from Prolonged Intubation in Adults
Otolaryngology–Head and Neck Surgery, 1999
Prolonged endotracheal intubation can cause injuries to 1 or more regions of the larynx, making safe extubation impossible and leading to tracheostomy in many patients. Unfortunately, a considerable number of these patients do not benefit from early laryngeal evaluation, which may reveal potentially treatable soft, obstructive tissue before it undergoes irreversible fibrosis. Between July 1992 and December 1995, we performed immediate direct telelaryngoscopy on 142 adults who required tracheostomy because of failed extubation. When present, obstructive tissue was removed with microsurgical techniques. One hundred twenty‐nine (90%) patients were decannulated within 3 weeks. The 2 main reasons for failure of early decannulation were intractable granulation (in patients with insulin‐dependent diabetes) and coexisting tracheal stenosis. Immediate telelaryngoscopy is recommended in all patients who require tracheostomy because of failed extubation. Flexible laryn‐goscopy is not adequate ...
Management of Laryngo Tracheal Injury Our Experience
MOJ Clinical & Medical Case Reports, 2016
Laryngotracheal trauma is life-threatening. It is considered to be a rare occurrence but now it is more common due to high speed vehicle accident. Failure to recognize such injuries and promptly secure an airway may have fatal consequences. 1 We are reporting 3 cases of blunt trauma following which they developed absolute dysphagia, difficulty in breathing and difficulty in phonation. These patients were promptly and appropriately managed. Two patients were surgically managed and one patient was conservatively managed. They are on regular follow up and are doing well. Here we highlight a successful management of such rare cases.
Extensive Laryngotracheal Trauma
The Internet Journal of Otorhinolaryngology, 2009
Isolated laryngotracheal trauma is rare in modern days. Evaluation and treatment (time and mode of treatment) of these types of injury varies from patient to patient and surgeon to surgeon. Air way maintenance is the first priority irrespective of type and cause of trauma. We are reporting this case to give importance to do early tracheostomy in air way breach cases in spite of no stridor at presentation. Inexperience Surgeon should wait till the proper radiological and clinical evaluations are not done.
A clinical study on laryngotracheal injuries following endotracheal intubation
International Journal of Otorhinolaryngology and Head and Neck Surgery
Background: Despite major advances in the design of endotracheal tubes and developments in the management of difficult airways, endotracheal intubation remains by far the most common cause of laryngotracheal injuries (LTI). These LTI are challenging to manage and are associated with significant morbidity and mortality. Hence, the present study was done to find out the incidence, types of LTI and to study the factors affecting the same.Methods: A prospective study was conducted on patients who were intubated for more than 48 hours and admitted in medical intensive care units in a tertiary referral hospital, for a period of 1 year. All patients following extubation were evaluated for LTI by x-ray neck (antero-posterior and lateral view), rigid endoscopy and flexible naso-pharyngo-laryngoscopy. Results: Thirty patients were included in the study. Majority of the patients (56.6%) were found normal while 43.2% patients were having LTI following extubation in the form of bilateral vocal ...
Laryngeal Trauma: External Approaches
Operative Techniques in Otolaryngology-Head and Neck Surgery, 2020
When endolaryngeal approaches are inadequate and when there is significant injury to the larynx, transcervical approaches are necessary. This is most often necessary for Schaefer-Fuhrman Class II-IV. Assessment and treatment always begin with evaluation and management of the airway followed by operative endoscopy to determine the extent of injury and guide surgical repair. Treatment includes open reduction and fixation of cartilaginous fractures but when there is significant endolaryngeal injury, a laryngofissure with or without stenting is often necessary. Postoperative care continues until decannulation. Secondary procedures may be required.