Trachea

Pediatric tracheotomy in special populations: Comparison of operative times and survival

May 31, 2010     Catherine A. Craig, MD, Ashley Brooke Robey, MD, and Debora W. Goebel, MD
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Abstract

We conducted a retrospective study to analyze various aspects of tracheotomy in children with abnormal laryngotracheal anatomy, a congenital cardiac anomaly, both, or neither. Our study population consisted of 53 children who had undergone tracheotomy performed by a single otolaryngologist; 12 patients had abnormal laryngotracheal anatomy and 9 had a cardiac anomaly. Mean operative times were significantly longer in both of these groups than they were in children with normal anatomy (69 vs. 50 min; p < 0.0001) and in children with no cardiac anomaly (65 vs. 53 min; p < 0.05). Post-tracheotomy survival at 1 and 2 years for children with a cardiac anomaly was significantly worse than survival for those without (44 vs. 91%; p < 0.001). Likewise, children who had been intubated for 10 days or more had significantly worse survival than did those who were intubated for less than 10 days (55 vs. 95%; p < 0.001). Finally, we found that the patients with prolonged intubation, respiratory failure, and a cardiac surgical history had higher mortality rates associated with tracheotomy.

Adenoid cystic carcinoma of the trachea metastatic to the nasal cavity: A case report

December 1, 2009     Azita S. Khorsandi, MD, James E. Silberzweig, MD, Bruce M. Wenig, MD, Mark L. Urken, MD, and Roy A. Holliday, MD
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Abstract

Cases of carcinoma metastatic to the nasal cavity are rare. We report the case of a 63-year-old woman with a metastasis to the nasal cavity from a primary tracheal adenoid cystic carcinoma (ACC). The nasal tumor was treated with surgical resection. No evidence of any local recurrence was observed at 4 years of follow-up. To the best of our knowledge, no case of a tracheal ACC metastatic to the nasal cavity has been previously reported in the literature. Although rare, metastatic disease to the nasal cavity should be considered in patients who have a known primary carcinoma elsewhere and who present with nasal symptoms.

Tracheal amyloidosis-an unusual cause of stridor

April 30, 2009     Emer E. Lang, FRCS(ORL), Eimear Phelan, AFRCSI, and Helena Rowley, FRCS(ORL)
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Abstract

Amyloidosis confined to the trachea is an exceedingly rare entity. We describe the case of a 63-year-old man who presented with a history of dysphonia and stridor. Rigid bronchoscopy revealed a segment of abnormal tissue at the midtracheal level, resembling granulation tissue. A stent was placed in an attempt to secure the patient's airway, which was >50% narrowed. Although the patient's stridor disappeared completely, 5 days postoperatively it recurred, worsening within hours. Emergency bronchoscopy revealed that the tracheal stent was almost completely obstructed with amyloid and granulation tissue, despite high-dose steroid therapy, and had to be removed. Tracheostomy was performed to bypass the diseased trachea. We also highlight some of the problems encountered with tracheal stenting in benign tracheal disease.

Idiopathic tracheal stenosis

March 31, 2009     Swapna K. Chandran, MD and Robert T. Sataloff, MD, DMA, FACS

Tracheal diverticulum: A report of 4 cases

January 1, 2009     B.G. Sharma, MD
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Abstract

Tracheal diverticulum is a rare entity. When it does occur, it is usually discovered incidentally in an asymptomatic patient as an outpouching from the tracheal wall, usually on the right side. It can be either congenital or acquired. A tracheal diverticulum may act as a reservoir for secretions that may spill over into the tracheobronchial tree, predisposing affected patients to cough, dyspnea, stridor, and chronic chest infection. The author describes 4 cases of tracheal diverticulum—3 congenital and 1 acquired—that were discovered on chest x-ray. The congenital form was found incidentally in 3 asymptomatic middle-aged women, and the acquired case (a tracheobronchial diverticulum) was discovered during a workup for chronic cough and fever in a young man. All 4 patients were thoroughly evaluated with conventional chest and neck radiographs, barium-swallow imaging, linear tomography, computed tomography, and magnetic resonance imaging. Resection of these tracheal diverticula was not considered for any patient. The author also reviews the literature on tracheal diverticulum.

Intratracheal ectopic thyroid tissue presenting with protracted airway obstruction: A case report

July 31, 2008     Mo Khan, MD, Peter G. Michaelson, MD, Major, USAF, MC, FS, and Michael L. Hinni, MD
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Abstract

Intratracheal ectopic thyroid tissue is a rare finding, with few cases reported in the literature. Ectopic thyroid tissue results when the thyroid gland fails to descend to its final position during early development. These lesions present in various locations, and the clinician should be aware of their existence and presenting signs and symptoms.

Tracheal diverticulum: A rare finding in a patient with worsening chronic cough

July 31, 2008     Gregory P. Danielson, MD, Veronika Jedlovszky, MD, and Gary P. Landrigan, MD
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Abstract

Acquired tracheal diverticulum is a rare clinical entity with only limited reports in the literature. We report a case of a tracheal diverticulum that was identified as part of a work-up for a worsening cough. In this case the diverticulum was observed 2 years after surgical management of a retropharyngeal abscess. It was felt that pooling of secretions in the acquired pouch was a contributing factor in the exacerbation of the patient's chronic cough. Because of the patient's extensive comorbidities, observation and serial computed tomography scans were recommended.

Near-complete tracheal ring deformity: A case report

June 30, 2008     Melissa L. Somers, MD and Dana L. Suskind, MD
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Abstract

Long-segment near-complete tracheal ring deformity is a rare condition with few documented cases. We present the case of a 7-week-old male with total anomalous pulmonary venous return and long-segment near-complete tracheal rings. We discuss the presentation, evaluation, and management of near-complete and complete tracheal rings.

Adult-onset iatrogenic tracheomalacia

May 31, 2008     Christopher Y. Chang, MD and James P. Thomas, MD

Pleomorphic adenoma of the trachea

April 30, 2008     Michael J. Rodriguez, MD, Giovana R. Thomas, MD, and Uzma Farooq, MD
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Abstract

Primary pleomorphic adenoma of the trachea is rare, as only 33 cases have been previously reported worldwide since 1922. We describe a new case of primary tracheal pleomorphic adenoma that was discovered incidentally in a 78-year-old man. The tumor was excised, and the patient recovered without complication. Salivary gland tumors of the trachea should be considered in the differential diagnosis of tracheal lesions; the diagnosis is confirmed by pathologic evaluation. Patients are adequately treated with sleeve resection and primary anastomosis whenever possible.

Formation of an airway foreign body during removal of a metal tracheostomy tube: A case report

March 1, 2008     Mitchell R. Gore, PhD and Austin S. Rose, MD
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Abstract

Tracheostomy tube changes are often performed in the clinic or at the bedside without complication. We report a case in which the removal of a long-term metal tube in a clinic setting was complicated by the presence of fibrinous debris on the tube. The debris had accumulated over a period of at least 3 years. The patient was taken to the operating room, and the tube was removed. However, the fibrinous debris remained behind, leaving an airway foreign body. The foreign body was subsequently removed with an optical foreign-body extraction forceps under direct visualization. Based on our experience and on the limited amount of information available in the literature, we recommend that long-term metal tracheostomy tubes be changed not in the clinic but in the operating room, where potential complications can be more easily managed.

Views of a type I posterior glottic stenosis before and after lysis

August 31, 2007     Melinda Davis-Malesevich, BS; Albert Merati, MD
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Posterior glottic stenosis (PGS) can be devastating. It is estimated to occur in 4% of patients who have been intubated for 1 week and in 14% of those who have been intubated for up to 2 weeks.

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