Laryngeal Granuloma Caused by Short-term Endotracheal Intubation

Kaneda, Naoko; Goto, Ryokichi; Ishijima, Shu; Kawakami, Suwako; Park, Ki‐Eun; Shima, Yoriko

doi:10.1097/00000542-199905000-00036

Cited by 24 publications

(19 citation statements)

References 8 publications

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“…A higher incidence was reported among females, who are considered to be more susceptible because of the anatomical dimensions of the female larynx, very small stature or obesity accompanied by a short neck were suggested to be risk factors for granuloma formation [2, 3, 5]. Injury and/or friction between the subglottic area and the tube are thought to be the causes of these granulomas [6–8].…”

Section: Discussionmentioning

confidence: 99%

Subglottic granuloma after aortic replacement: resection via flexible bronchoscopy after an emergency tracheostomy

Nose

Sekimura

et al. 2014

Journal of Surgical Case Reports

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A subglottic granuloma is one of the late-phase complications that can occur after intubation. It can cause a life-threatening airway obstruction; therefore, a rapid diagnosis and appropriate treatment plan is necessary. A 62-year-old male had undergone an emergency total arch replacement for acute aortic dissection. Postoperative ventilation support had been performed until the 15th postoperative day (POD). He was discharged from the hospital on POD 30. On POD 50, he was brought to our hospital by an ambulance with severe dyspnea. A large subglottic granuloma occupying the trachea was identified by flexible bronchoscopy. After an emergency tracheostomy, resection of the granuloma with argon plasma coagulation via flexible bronchoscopy was performed safely. Physicians should suspect a post-intubation subglottic granuloma when patients who have undergone intubation report feeling throat discomfort. Resection via flexible bronchoscopy after tracheostomy is a safe and feasible procedure that may shorten the duration of therapy and hospital stay.

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Section: Discussionmentioning

confidence: 99%

Subglottic granuloma after aortic replacement: resection via flexible bronchoscopy after an emergency tracheostomy

Nose

Sekimura

et al. 2014

Journal of Surgical Case Reports

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“…The intubation time does not seem to be the only determining factor for injury; Table 1 shows data of some patients that developed granulomas after just a few hours of intubation time, a fact that other authors have highlighted. 9,10 Granulomas are implanted on the posterior portion of the glottis; as such one would not expect them to cause voice symptoms immediately after extubation, since they to not develop immediately. However, complaints of hoarseness are frequent, and often arise soon after extubation or in the next few days.…”

Section: Discussionmentioning

confidence: 99%

“…Kaneda et al 9 reported a vocal fold granuloma in a female patient that was intubated with a small diameter tracheal tube (6.5 mm) for only 4.5 hours. Shimokojin et al 10 described shorter intubation times resulting in laryngeal granulomas in three patients (2 hours and 20 minutes to 5 hours and 40 minutes.…”

Section: Introductionmentioning

confidence: 99%

Aspectos clínicos, histológicos e de microscopia eletrônica dos granulomas de intubação das pregas vocais

Martins¹,

Dias²,

Santos³

et al. 2009

Rev. Bras. Otorrinolaringol.

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Granul omas are bilateral and pediculated lesions of the vocal apophysis. Etiologies: intubation, reflux, trauma, vocal abuse, idiopathic origin. Aim: To analyze the clinical and morphological aspects of post intubation granulomas. Methods: retrospective study of patients submitted to microsurgery for post intubation laryngeal granulomas seen at our Medical School starting in 2002. We analyzed: age, gender, indication and time of intubation, symptoms, videolaryngoscopic diagnosis and biopsy findings. Light microscopy was performed on all specimens, and electron microscopy on three of them. Results: ten patients (7 females and 3 males), between the ages of 2 and 72 years, intubation time between 4h and 21 days. Hoarseness was a frequent symptom, starting in the first week following extubation. Histology shows mild epithelial hyperplasia, severe inflammation and vessel proliferation in the corion. Under SEM, the epithelium presented mild superficial desquamation. Under TEM, intracellular junctions showed widening with structural changes in the desmosomes. In the corion there were vessel proliferations, inflammation and fibroblasts with structural alterations. Conclusions: post intubation granulomas appear in any age and hoarseness is a frequent symptom. Morphological alterations occur in the corion as vessel proliferations, inflammation, and intracytoplasmatic alterations in fibroblasts suggesting cellular dysfunction and damage.

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“…In fact, in a 20-year review of arytenoid cartilage dislocations, Rubin 6 found that 77.8% of arytenoid cartilage dislocations were due to intubation trauma. Although very rare, injury from even shortterm endotracheal intubation may lead to granuloma formation 7 which, if symptomatic, can require further surgical intervention. 8 During the past 10 years many efforts have been made to reduce the traumatic effects of nasal intubation.…”

Section: ^6mentioning

confidence: 99%

Parker Flex-Tip and Standard-Tip Endotracheal Tubes: A Comparison During Nasotracheal Intubation

Prior

Heaton

Jatana

et al. 2010

Anesthesia Progress

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The placement of endotracheal tubes in the airway, particularly through the nose, can cause trauma. Their design might be an important etiologic factor, but they have changed little since their introduction. Recently Parker Medical ( Bridgewater, Conn ) introduced the Parker Flex-Tip ( PFT ) tube, suggesting that it causes less trauma. This study aimed to compare the PFT endotracheal tube to a sidebeveled, standard-tip endotracheal tube ( ETT ) for nasotracheal intubation ( Figures 1 and 2). Forty consecutive oral surgery patients requiring nasotracheal intubation were randomized to receive either a standard ETT or the PFT tube. Intubations were recorded using a fiber-optic camera positioned proximal to the Murphy eye of the tube. This allowed visualization of the path and action of the tube tip as it traversed the nasal, pharyngeal, laryngeal, and tracheal airway regions. Video recordings made during intubation and extubation were evaluated for bleeding, trauma, and intubation time. Both bleeding and trauma were recorded using a visual analogue scale ( VAS ) and by 3 different evaluators. The PFT received significantly better VAS values than the standard tubes from all 3 raters (P , 0.05) in both the extent of trauma and bleeding. Since the intubations were purposefully conducted slowly for photographic reasons, neither tube displayed a time advantage. This study suggests that the PFT tube design may be safer by causing less trauma and bleeding than standard tube designs for nasotracheal intubation.

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Laryngeal Granuloma Caused by Short-term Endotracheal Intubation

Cited by 24 publications

References 8 publications

Subglottic granuloma after aortic replacement: resection via flexible bronchoscopy after an emergency tracheostomy

Subglottic granuloma after aortic replacement: resection via flexible bronchoscopy after an emergency tracheostomy

Aspectos clínicos, histológicos e de microscopia eletrônica dos granulomas de intubação das pregas vocais

Parker Flex-Tip and Standard-Tip Endotracheal Tubes: A Comparison During Nasotracheal Intubation

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