Trachea

Surgical treatment of acquired tracheocele

May 31, 2006     Edward A. Porubsky, MD; Christine G. Gourin, MD
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Abstract
Acquired tracheoceles are rare clinical entities that can cause a variety of chronic and recurrent aerodigestive tract symptoms. The management of acquired tracheoceles is primarily conservative, but surgical intervention may be indicated for patients with refractory symptoms. We present a case of acquired tracheocele and describe a method of successful surgical management.

Outcomes of primary and secondary tracheoesophageal puncture: A 16-year retrospective analysis

April 1, 2006     Elaine Cheng, MD; Margie Ho, MA; Cindy Ganz, MS; Ashok Shaha, MD; Jay O. Boyle, MD; Bhuvanesh Singh, MD; Richrd J. Wong, MD; Snehal Patel, MD; Jatin Shah, MD; Ryan C. Branski, PhD; Dennis H. Kraus, MD
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Abstract
The current study retrospectively reviewed the cases of 68 patients who had undergone total laryngectomy and tracheoesophageal puncture (TEP) over a 16-year period. Fifty-one patients underwent primary TEP and 17 underwent secondary TEP. Nearly 80% of patients who received TEP at the time of laryngectomy achieved excellent voice quality perceptually. In contrast, only 50% of secondary TEP patients achieved excellent voice ratings. This difference was statistically robust (p = 0.03). Although both surgical and prosthesis-related complications occurred more frequently following primary TEP, statistically significant differences were not achieved. Neither pre- nor postoperative radiotherapy had any effect on voice restoration or complication rates. Based on these data, primary TEP may be preferable for several reasons, including a greater likelihood of successful voice restoration, a shorter duration of postoperative aphonia, and the elimination of the need for a second operation and interim tube feedings.

Management of a tracheal tear during laryngopharyngoesophagectomy with gastric pull-up

April 1, 2006     Sandra Koterski, MD; Norman Snow, MD; Mike Yao, MD
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Abstract
Laceration of the posterior tracheal wall is one of the risks of transhiatal esophagectomy. Various methods of repairing such lacerations have been described; many of these methods involve a thoracotomy, but some do not. We describe a case of a posterior tracheal wall tear that occurred during a laryngopharyngectomy with a gastric pull-up. The tear was repaired with the transposed stomach and did not require a thoracotomy. The transposed stomach was used to patch the tear and block communication between the environment and the mediastinum. Bedside endoscopic examination on postoperative day 5 revealed that the tear had healed. Key management considerations in such a circumstance include having the patient breathe without positive pressure ventilation postoperatively and keeping the tracheal lumen and stoma clear during the healing process in order to prevent the development of positive tracheal pressure. With these safeguards in place, the transposed stomach approach is a safe method of repairing posterior tracheal wall tears.

Acute external laryngotracheal trauma: Diagnosis and management

March 1, 2006    
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Abstract
Laryngotracheal trauma may result in lifelong complications or even death if diagnosis or treatment is delayed. Emergency room physicians, trauma surgeons, anesthesiologists, and especially otolaryngologists should maintain a high level of awareness of and suspicion for laryngotracheal trauma whenever a patient presents with multiple trauma in general or with cervical trauma in particular. Although there is some controversy regarding care, treatment in experienced hands will usually result in a favorable outcome. In this article, we review and update the diagnosis and management of acute external laryngotracheal trauma.

Unusual paratracheal masses presenting with vocal fold paralysis

February 1, 2006     Evan R. Reiter, MD; Michael O. Idowu, MD; Celeste N. Powers, MD, PhD
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Abstract
Most paratracheal masses are of thyroid origin. We describe two cases of vocal fold paralysis that were caused by unusual paratracheal masses. In one case, a 35-year-old man was found to have a malignant lymphoma that originated in the mediastinum and extended above the clavicle. The other patient was a 53-year-old man with an enlarged left thyroid lobe, tumor invasion of the adjacent larynx and trachea, and multiple pulmonary nodules all due to adenoid cystic carcinoma. Unusual paratracheal masses presenting with vocal fold paralysis may mimic thyroid malignancies, thereby posing both diagnostic and therapeutic challenges. Fine-needle aspiration cytology is often helpful in making a definitive diagnosis, but incisional biopsy is necessary in some cases.

Airway obstruction by granulation tissue within a fenestrated tracheotomy tube: Case report

January 1, 2006     Michael A. Carron, MD; Sihun Alex Kim, MD; Raja Sawhney, MFA; Patrick Reidy, MD
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Abstract
Complications of tracheotomy tube placement can be categorized as intraoperative, early postoperative, and late postoperative. Among the late complications is the development of granulation tissue. We describe one of the few reported cases of granulation tissue that formed within a fenestrated tracheotomy tube. In this case, the granulation tissue grew through the fenestrations, obliterated the tracheal lumen, and tethered the tube to the trachea itself. As a result, the patient required emergency treatment to restore airway patency.

How to lengthen a tracheostomy tube

May 31, 2005     Declan A.E. Costello, MA, MRCS
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Subglottic synechia

March 1, 2005     Ezechiel Nehus, MD; Michael M. Johns III, MD
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Office-based procedures for the voice

June 30, 2004     C. Blake Simpson, MD; Milan R. Amin, MD
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July 2004 Supplement

June 30, 2004    
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Office-based laser procedures for the upper aerodigestive tract: Emerging technology

June 30, 2004     Gregory N. Postma, MD; Michael R. Goins, MD; Jamie A. Koufman, MD, FACS
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