Functional outcome after single-stage laryngotracheal reconstruction with rib cartilage grafting

Schweiger, Thomas; Roesner, Imme; Rodrigues, Isaac de Faria Soares; Evermann, Matthias; Frick, Anna Elisabeth; Denk-Linnert, Doris-Maria; Klepetko, Walter; Höetzenecker, Konrad

doi:10.1016/j.jtcvs.2020.11.155

Cited by 13 publications

(7 citation statements)

References 21 publications

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“…In this technique, which has been modified at our centre [ 13 ], the larynx was 1st split and a cartilage graft was inserted posteriorly to widen the lumen. Afterwards, the cartilage was covered with a dorsal mucosal flap, whereby no internal stenting was required postoperatively [ 14 ].…”

Section: Methodsmentioning

confidence: 99%

In-depth analysis of pre- and postoperative functional outcome parameters in patients receiving laryngotracheal surgery

Evermann,

Roesner,

Denk-Linnert

et al. 2024

European Journal of Cardio-Thoracic Surgery

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Background Surgical treatment for airway stenosis necessitates personalized techniques based on the stenosis location and length, leading to favorable surgical outcomes. However, there is limited literature on functional outcomes following laryngotracheal surgery with an adequate number of patients. Material and Methods We conducted a retrospective analysis of patients who underwent laryngotracheal surgery at the Department of Thoracic Surgery, Medical University of Vienna, from January 2017 to June 2021. The study included standardized functional assessments before and after surgery, encompassing spirometry, voice measurements, swallowing evaluation, and subjective patient perception. Results The study comprised 45 patients with an average age of 51.9 ±15.9 years, of whom 89% were female, with idiopathic being the most common etiology (67%). Procedures included standard cricotracheal resection (CTR) in 11%, CTR with dorsal mucosal flap in 49%, CTR with dorsal mucosal flap and lateral cricoplasty in 24%, and single-stage laryngotracheal reconstruction in 16%. There were no in-hospital mortalities or restenosis cases during the mean follow-up period of 20.8±13.2 months. Swallowing function remained intact in all patients. Voice evaluations showed a decrease in fundamental vocal pitch (203 (81-290) Hz vs. 150 (73-364) Hz, p < 0.001) and dynamic voice range (23.5 ±5.8 semitones vs. 17.8 ±6.7 semitones, p < 0.001). However, no differences in voice volume were observed (60.0 ±4.1 dB vs. 60.2 ±4.8 dB, p = 0.788). The overall predicted voice profile changed from R0B0H0 to R1B0H1. Conclusion Laryngotracheal surgery proves effective in fully restoring breathing capacity while preserving vocal function. Even in cases of high-grade and complex airway stenosis necessitating laryngotracheal reconstruction, favorable functional outcomes can be achieved.

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Section: Methodsmentioning

confidence: 99%

In-depth analysis of pre- and postoperative functional outcome parameters in patients receiving laryngotracheal surgery

Evermann,

Roesner,

Denk-Linnert

et al. 2024

European Journal of Cardio-Thoracic Surgery

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“…These augmentations, typically employing a costal graft, can be performed in an open fashion, often paired with other airway framework treatments, or endoscopically. 9,11,12 Endoscopic posterior cricoid split with cartilage graft placement was first described by Gray et al in 1994 for bilateral vocal fold paralysis. 13 In 2003, Inglis et al introduced a method for endoscopic division of the posterior plate of the cricoid and its mucosa with costal cartilage graft insertion in children (enPCCG), with the goal of creating a prosthesis-free airway.…”

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confidence: 99%

“…Distinct from the former, the framework of the larynx can be expanded through cricoid split and graft insertion, which is the most attractive option based on prior experience with open grafting. These augmentations, typically employing a costal graft, can be performed in an open fashion, often paired with other airway framework treatments, or endoscopically 9,11,12 . Endoscopic posterior cricoid split with cartilage graft placement was first described by Gray et al in 1994 for bilateral vocal fold paralysis 13 .…”

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A Single Center Description of Adult and Pediatric Endoscopic Posterior Costal Cartilage Grafting

Richard,

Gelbard,

Daniero

et al. 2024

Otolaryngol.--head neck surg.

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ObjectivePosterior glottis impairment alters breathing, voicing, and swallowing. Bilateral vocal fold movement impairment (BVFMI) occurs when the vocal cords are fixed/remain midline. Studies inadequately assessed endoscopic posterior costal cartilage grafting (enPCCG) for BVFMI across broad ages. We aim to assess decannulation and prosthesis free airway in children and adults who have undergone enPCCG.Study DesignRetrospective cohort.SettingReferral center.MethodsThis study included adults and children who received enPCCG for BVFMI (2010‐2018) and were followed for 35 months on average. The main outcome was successful decannulation of patients, or airway improvement in those without tracheostomy. Data on comorbidities, surgical complications, and interventions following surgery were collected.ResultsTen children and 11 adults underwent enPCCG for BVFMI. Eighty‐one percent of patients had a tracheostomy at surgery; adults were more likely to have a tracheostomy at surgery (P = 0.035), and to undergo double‐staged procedure (P = 0.035) and stent (P = 0.008). Average stent duration was 29.7 days. Overall decannulation rate was 76% (90% for children; 70% for adults). Children were more likely to receive postoperative intensive care unit care (P = 0.004). Adults had mean 4.4 post‐enPCCG interventions per patient compared to children's mean 3.91 interventions. The most common interventions were steroid injection (17.6%) and balloon dilation (16%). Preliminary analysis suggests postoperative dysphonia was reported in 66.7% of patients; postoperative dysphagia was rare.ConclusionEnPCCG was more successful at achieving decannulation in children. Adults required additional interventions. A double‐staged operation with prolonged stenting is recommended for adult patients. A majority of patients were decannulated at last follow‐up.

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“…In their article in this issue of the Journal, Schweiger and colleagues graciously refer to the pioneering work of Aurel Rethi, a Hungarian otolaryngologist active in the first half of the 20th century, in the introduction to an update on their group's experience with a single-stage operation for glottosubglottic stenosis (GSGS). 1 Their group has mixed and matched the "greatest hits" of tracheal surgery, incorporating techniques developed by otolaryngologists and thoracic surgeons alike, to effectively treat the challenging problem of an airway stricture involving the subglottic larynx and extending through the glottis. Their approach, which they term "single-stage laryngotracheal resection" (SSLTR), combines a posterior laryngeal split, laryngeal augmentation with a cartilage graft, circumferential resection of subglottic scar, and resurfacing of the posterior cricoid with a membranous tracheal flap to correct GSGS.…”

mentioning

confidence: 99%

Commentary: Tinker, tailor, surgeon, scholar—effective surgical management of glotto-subglottic stenosis

Muniappan

2022

The Journal of Thoracic and Cardiovascular Surgery

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Functional outcome after single-stage laryngotracheal reconstruction with rib cartilage grafting

Cited by 13 publications

References 21 publications

In-depth analysis of pre- and postoperative functional outcome parameters in patients receiving laryngotracheal surgery

In-depth analysis of pre- and postoperative functional outcome parameters in patients receiving laryngotracheal surgery

A Single Center Description of Adult and Pediatric Endoscopic Posterior Costal Cartilage Grafting

Commentary: Tinker, tailor, surgeon, scholar—effective surgical management of glotto-subglottic stenosis

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