Complications and outcomes following open laryngotracheal reconstruction: A 15 year experience at an Australian paediatric tertiary referral centre

Cheung, P.; Koh, Huiting L.; Cheng, Alan

doi:10.1016/j.ijporl.2021.110687

Cited by 8 publications

(28 citation statements)

References 25 publications

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“…Biopsies and grafts from each of these cartilage types are routinely harvested in the clinic and represent a less invasive and more practical approach to obtain CPCs for cartilage repair. [24][25][26][27] Among these options, ear CPCs (eCPCs) are the easiest to harvested through a minimally invasive biopsy, a procedure that is commonly perform for tympanoplasty, is painless and leaves no visible scar. 24 Human eCPCs have been recently isolated for auricular tissue engineering by Otto et al 17 Furthermore, eCPCs have been isolated and characterized to a limited extent from lapine, 21 porcine, 18,19 cercopithecine, 20 and canine 22 models.…”

Section: Introductionmentioning

confidence: 99%

Human cartilage progenitor cells from ear, nose, rib, and joint have a robust, stable phenotype for cartilage repair

Ghavimi

Gehret

Giordano

et al. 2022

Preprint

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Background: Cartilage progenitor cells (CPCs) are a small but highly proliferative cell population that resides within cartilage. Joint cartilage CPCs have a high chondrogenic potential and superior cartilage formation characteristics; however, CPCs from other cartilage sources more accessible for translation such as ear, nose, and rib are broadly unexplored. Our study illuminates the differences between CPCs from these four cartilages, their corresponding tissue chondrocyte (CC), and bone marrow-derived mesenchymal stem cell (MSC). Methods: CPCs subtypes were isolated from pediatric cartilage via fibronectin selection, immunophenotyped by flow cytometry and compared to MSCs. Trilineage differentiation capacity was assessed via histology and qRT-PCR. Next, triiodothyronine was used to hypertrophically challenge each CPC subset and their corresponding chondrocyte population. After 28 days cartilage pellets were assessed via histology, immunohistochemistry, and qRT-PCR. Findings: Each CPC subset possessed a specific immunophenotypic signature with CD56 as a potential common marker. All CPC subsets proliferated 2-fold faster than MSCs and 4-fold faster than CCs. Additionally, CPCs had a substantially reduced propensity for osteogenic differentiation and very limited adipogenic capacity by histology and gene expression. Finally, all CPC subsets resisted the hypertrophic challenge more than the corresponding chondrocyte population marked by less collagen X secretion and downregulation of hypertrophy associated genes. Interpretation: CPCs represent a promising cell type for cartilage regeneration. The ease of accessibility of the ear and nose CPCs present opportunities for new translational approaches and reduced clinical timelines.

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Section: Introductionmentioning

confidence: 99%

Human cartilage progenitor cells from ear, nose, rib, and joint have a robust, stable phenotype for cartilage repair

Ghavimi

Gehret

Giordano

et al. 2022

Preprint

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“…In adults, LTR has a 90% success rate with low rates of revision. However, in children, success rates significantly drop and the incidence of restenosis requiring revision surgery increases to over 24% [12][13][14] . The most common factor contributing to this abysmal success rate is graft failure caused by the limited volume of available autologous cartilage in children 12 .…”

Section: Introductionmentioning

confidence: 99%

“…However, in children, success rates significantly drop and the incidence of restenosis requiring revision surgery increases to over 24% [12][13][14] . The most common factor contributing to this abysmal success rate is graft failure caused by the limited volume of available autologous cartilage in children 12 . Often, especially for the younger patients, surgeons have to delay the procedure keeping the patient with a tracheostomy tube until the child has grown enough to supply sufficiently sized cartilage for an effective LTR.…”

Section: Introductionmentioning

confidence: 99%

A Translational Tissue Engineering Approach to Airway Reconstruction Leveraging Decellularized Meniscus and Cartilage Progenitor Cells

Gehret

Ghavimi

Dumas

et al. 2022

Preprint

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Severe subglottic stenosis develops in over 20,000 infants per year and requires laryngotracheal reconstruction (LTR) to enlarge the airway by implanting autologous cartilage from a rib graft. However, young children often lack sufficiently sized costal cartilage resulting in increased donor site morbidity and operative time, as well as an elevated risk for airway restenosis necessitating revision surgery. To overcome these limitations, we have created a first-of-its-kind scaffold based on porcine meniscal cartilage decellularization (MEND) by selectively digesting the elastin and blood vessels uniquely present in the meniscus to create microchannels that support cellular re-invasion. Here we demonstrated that MEND can be fully recellularized in 3 days with ear-derived cartilage progenitor cells (eCPCs) and reaches structural and functional maturation suitable for implant within 3 weeks of chondrogenic differentiation, a time frame compatible with clinical translation, a first in airway tissue engineering. To further this therapy toward clinical translation, we validated the eCPCs-MEND grafts in a New Zealand white rabbit LTR model. Our results demonstrated airway expansion, graft re-epitheliazation, neocartilage formation, and integration with adjacent native laryngotracheal cartilage, notably at a higher degree than the standard of care of autologous costal cartilage. No instances of adverse events of extrusion, granulation, infection, or calcification were observed in any of the 38 rabbits of our 3 months study. These results demonstrate the feasibility of our translational tissue engineering approach to laryngotracheal reconstruction and could overcome the autograft-associated limitations in pediatric patients and a decrease the risk of invasive revision surgery.

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“…Pediatric laryngotracheal stenosis (LTS) is a challenging condition to be managed [ 1 ]. It can be either congenital or acquired narrowing of the airway, affecting the glottis, subglottis, and/or trachea [ 2 ].…”

Section: Introductionmentioning

confidence: 99%

“…In addition, most of them are expensive. Over the last decade, very little progress has been made in the invention of new stents in postoperative LTR patients [ 1 ]. Although an ideal supra-stomal stent does not exist, many stents are present, like the soft silicone Montgomery T-tube, the Teflon Aboulker stent, the Eliachar laryngotracheal (LT) stent, and the laryngotracheal mold of Monnier [ 13 , 14 ].…”

Section: Introductionmentioning

confidence: 99%

A refashioned foley catheter: novel cost-effective available stent in pediatric laryngotracheal reconstruction

El-Sobki

Elkahwagi

El-Deeb

et al. 2022

Eur Arch Otorhinolaryngol

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Purpose Pediatric laryngotracheal reconstruction (LTR) for laryngotracheal stenosis (LTS) mandates stenting in certain situations. This study presents a novel commercially available and cost-effective stent, a refashioned foley catheter. Methods This prospective clinical study was performed on pediatric cases with LTS up to 8 years. The study was performed in a tertiary referral center. The selection of the proper foley catheter size for age was explained. The atraumatic insertion maneuver of the stent was also shown in detail in different situations of LTS. The endoscopic removal of the stent was also described. The mean follow-up was 6.45 ± 1.3 months. Results The study included 31 cases using the refashioned foley catheter stents. The study included 17 males and 14 females with a mean age of 3.45 ± 1.09. Subglottic stenosis was the most common cause of LTR in the study (74.2%) cases. The mean duration of stenting was 40.5 ± 3.7 days. Decannulation was achieved in 96.8% of cases. No stent complications were encountered like stent migration, excess granulation tissue, intractable aspiration, or pressure necrosis. Conclusion The refashioned foley catheter is a novel, available, and inexpensive stent that can be utilized for LTR cases for pediatric LTS. The newly described stent is soft, pliable with atraumatic insertion and easy endoscopic removal with minimal complications.

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Complications and outcomes following open laryngotracheal reconstruction: A 15 year experience at an Australian paediatric tertiary referral centre

Cited by 8 publications

References 25 publications

Human cartilage progenitor cells from ear, nose, rib, and joint have a robust, stable phenotype for cartilage repair

Human cartilage progenitor cells from ear, nose, rib, and joint have a robust, stable phenotype for cartilage repair

A Translational Tissue Engineering Approach to Airway Reconstruction Leveraging Decellularized Meniscus and Cartilage Progenitor Cells

A refashioned foley catheter: novel cost-effective available stent in pediatric laryngotracheal reconstruction

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