Total cricoidectomy and laryngotracheal reconstruction for subglottic stenosis with glottic involvement

Yamamoto, Kazumichi; Tomiyama, Kenichi; Mitsuoka, Masahiro

doi:10.1510/icvts.2011.274357

Cited by 4 publications

(4 citation statements)

References 3 publications

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“…Management of anterior commissure synechiae involves surgical and/or laser dissection of the web and is challenging to address, [13][14][15][16] often presenting with consequences such as loss of normal tissue architecture and vibration. Treatment for subglottic and posterior glottic stenosis is more involved, and may include posterior cricoid split, posterior cordotomy, endoscopic dilation, and/or surgical resection of scar tissue, [17][18][19][20][21][22] all of which may disrupt normal airway function. Reduced vocal fold pliability, on the other hand, is a clinical entity without any medical or surgical treatment, and is largely managed via vocal therapy, 23,24 which may be frustrating for patients seeking more immediate outcomes.…”

Section: Discussionmentioning

confidence: 99%

Factors Associated with Iatrogenic Laryngeal Injury in Recurrent Respiratory Papillomatosis

So,

Hillel,

Motz

et al. 2023

Otolaryngol.--head neck surg.

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ObjectiveTo describe iatrogenic laryngeal injury and identify its risk factors in recurrent respiratory papillomatosis (RRP) patients receiving surgical care.Study DesignCase‐control.SettingTertiary care academic hospital in a metropolitan area.MethodsCharts of patients with RRP seen at our institution from January 2002 to December 2022 were reviewed. Patients were separated into 2 cohorts based upon whether they experienced any form of iatrogenic laryngeal injury—including anterior commissure synechiae, vocal cord scar, reduced vocal fold pliability, vocal fold motion impairment, and glottic and/or subglottic stenosis. Adjusted logistic regressions were performed to identify factors associated with iatrogenic laryngeal injury.ResultsOf 199 RRP patients, 133 (66.8%) had identifiable iatrogenic laryngeal injury. The most common injuries were anterior commissure synechiae (n = 67; 50.4%) and reduced vocal fold pliability (n = 54; 40.6%). On a multivariate logistic regression, patients with diabetes mellitus (adjusted odds ratio [aOR] [95% confidence interval [CI]]: 2.99 [1.02, 8.79]; P = .04) and who received at least 10 surgeries lifetime (aOR [95% CI]: 14.47 [1.70, 123.19]; P = .01) were at increased risk for iatrogenic laryngeal injury, whereas receiving less than 5 surgeries (aOR [95% CI]: 0.21 [0.09, 0.51]; P < .001) was found to be protective. When treating the lifetime number of surgeries as a continuous variable, a greater number of surgeries was a significant risk factor for iatrogenic laryngeal injury (aOR [95% CI]: 1.32 [1.14, 1.53]; P < .001).ConclusionThese results suggest the importance of strict glucose control for diabetic patients receiving RRP surgical care, and emphasize the clinical need to identify medical therapies to decrease RRP surgical frequency for patients.

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Section: Discussionmentioning

confidence: 99%

Factors Associated with Iatrogenic Laryngeal Injury in Recurrent Respiratory Papillomatosis

So,

Hillel,

Motz

et al. 2023

Otolaryngol.--head neck surg.

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“…20 This procedure has got an overall decannulation rate reported of more than 90%. [21][22][23] Since the cricoid is the only ring-shaped laryngeal cartilage warranting an adequate diameter for the airway, its removal can lead to postoperative stenosis of the airway. Actually, in our cohort the development of a stenosis of the neoglottis was the most frequent postoperative complication, occurring in 58% of cases.…”

Section: Discussionmentioning

confidence: 99%

“…An extended PCTR can be performed in patients with an additional glottic pathology (posterior glottic stenosis or vocal cord synechiae) 20 . This procedure has got an overall decannulation rate reported of more than 90% 21–23 …”

Section: Discussionmentioning

confidence: 99%

The glottic–subglottic laryngectomy: Surgical technique, oncological, and functional outcomes

Bertolin

Lionello

Baldovin

et al. 2021

Journal of Surgical Oncology

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Objectives: The aim of this article was to describe the surgical technique and report the oncological and functional outcomes of the partial glottic-subglottic laryngectomy (GSL).Methods: A retrospective review of the clinical charts of patients who underwent GSL for laryngeal cancer from 1989 to 2020 at the Otolaryngology Unit of the Vittorio Veneto Hospital, a referral center for laryngeal cancer treatment. Results:The present article considered 36 patients who were submitted to GSL for laryngeal cancer. The pathological exam found squamous cell carcinoma (SCC) in 16 cases, adenoid-cystic carcinoma (ACC) in 9 cases, laryngeal chondrosarcoma in 8 cases, 1 giant cell carcinoma, 1 carcinosarcoma, and 1 metastasis of colon adenocarcinoma. Considering the 16 SCC cases we observed a recurrence rate of 31%, the overall survival (OS) and disease-specific survival (DSS) were 75%. The 9 ACC cases had a recurrence rate of 23% and OS/DSS of 88%. In the 8 chondrosarcomas no relapses were reported and the OS/DSS were 100%. Among the patients without recurrence of the disease, a definitive decannulation was achieved in 21 cases (75%). Conclusions:The GSL represents a valid alternative to total laryngectomy in selected cases of laryngeal cancer involving the glottic and subglottic regions.

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“…The detailed surgical techniques have been described in a previous human case report 5 ; almost the same procedure was used in the present study ( Figure 1). The dogs were anesthetized with intramuscular ketamine hydrochloride (15 mg/kg) and xylazine hydrochloride (3 mg/kg), and anesthesia was maintained with halothane inhalation.…”

Section: Animal Experimentsmentioning

confidence: 99%

Healing process after total cricoidectomy and laryngotracheal reconstruction: Endoscopic and histologic evaluation in a canine model

Yamamoto

Honda

Yamamoto

et al. 2013

The Journal of Thoracic and Cardiovascular Surgery

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Objective: The surgical procedure for subglottic stenosis is technically challenging when the vocal cords are involved and concomitant management for glottic involvement is required. After total cricoidectomy and laryngotracheal anastomosis, T-tube placement for 3 to 6 months is recommended. Bone grafts might shorten this period. We report the histologic and endoscopic changes after total cricoidectomy with or without bone grafts in a canine model to suggest an appropriate period for T-tube placement and the necessity for bone grafts. Methods: Ten dogs underwent total cricoidectomy and laryngotracheal anastomosis with or without bone grafts harvested from the ribs. Endoscopic examination was performed monthly, and 1 dog from both groups was humanely killed at 1, 2, 3, 6, and 12 months. The T-tube was removed before death in the dogs killed at 1, 2, and 3 months and at 3 and 6 months in those killed at 6 and 12 months, respectively. Results: Endoscopically, the glottic opening was in good condition in all dogs, except for 1 that had glottic stenosis. Histologically, active lymphocyte infiltration was observed in dense collagen fibers at the anastomosis at 1 month. At 2 and 3 months, fibroblasts were evident, suggesting active collagen fiber production. At 6 and 12 months, the collagen fibers had become looser. The bone grafts were intact and did not influence the surrounding tissue. Conclusions: In the canine model, 6 months of T-tube placement is probably sufficient; however, 3 months of placement might not be. Additionally, no difference was found between the dogs with and without a bone graft.

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Total cricoidectomy and laryngotracheal reconstruction for subglottic stenosis with glottic involvement

Cited by 4 publications

References 3 publications

Factors Associated with Iatrogenic Laryngeal Injury in Recurrent Respiratory Papillomatosis

Factors Associated with Iatrogenic Laryngeal Injury in Recurrent Respiratory Papillomatosis

The glottic–subglottic laryngectomy: Surgical technique, oncological, and functional outcomes

Healing process after total cricoidectomy and laryngotracheal reconstruction: Endoscopic and histologic evaluation in a canine model

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