François Gorostidi1, Antoine Reinhard1, Philippe Monnier1, Kishore Sandu2. 1. Department of Otolaryngology, Head and Neck Surgery, University Hospital of Lausanne (CHUV), Lausanne, Switzerland. 2. Department of Otolaryngology, Head and Neck Surgery, University Hospital of Lausanne (CHUV), Lausanne, Switzerland. kishore.sandu@chuv.ch.
Abstract
OBJECTIVES/HYPOTHESIS: Our study evaluates the efficacy of extraluminal bioresorbable plates to treat refractory localized airway malacia in patients undergoing corrective surgery for complex multilevel laryngotracheal stenosis. STUDY DESIGN: Retrospective case series. METHODS: Secondary malacic airway segments were characterized (severity, site, type) by a dynamic transnasal flexible laryngotracheobronchoscopy before surgery. Extraluminal bioresorbable plates were used to stabilize the malacic segment through a transcervical approach under intraoperative flexible endoscopic guidance. Results were evaluated subjectively and by a postoperative dynamic endoscopy. We report our experience in seven patients (6 children, 1 adult). RESULTS: External tracheal stiffening allowed complete or partial resolution of refractory proximal airway malacia in six of seven complex cases described (result in one case is awaited). It allowed quick decannulation in four of seven patients who experienced multiple previous failures. Decannulation failures were due to recurrence of stenosis. With up to 2 years of follow-up, we report no direct complications related to the presence of extraluminal bioresorbable plates around the airway. CONCLUSION: Extraluminal biodegradable tracheal stiffening represents a valid therapeutic option in select cases of upper airway malacia. It can be highly useful in cases of complex multilevel airway obstructions. External stiffening needs to be planned on a case-to-case basis according to the type of malacia and must be performed under endoscopic guidance. LEVEL OF EVIDENCE: 4. Laryngoscope, 126:2605-2610, 2016.
OBJECTIVES/HYPOTHESIS: Our study evaluates the efficacy of extraluminal bioresorbable plates to treat refractory localized airway malacia in patients undergoing corrective surgery for complex multilevel laryngotracheal stenosis. STUDY DESIGN: Retrospective case series. METHODS: Secondary malacic airway segments were characterized (severity, site, type) by a dynamic transnasal flexible laryngotracheobronchoscopy before surgery. Extraluminal bioresorbable plates were used to stabilize the malacic segment through a transcervical approach under intraoperative flexible endoscopic guidance. Results were evaluated subjectively and by a postoperative dynamic endoscopy. We report our experience in seven patients (6 children, 1 adult). RESULTS: External tracheal stiffening allowed complete or partial resolution of refractory proximal airway malacia in six of seven complex cases described (result in one case is awaited). It allowed quick decannulation in four of seven patients who experienced multiple previous failures. Decannulation failures were due to recurrence of stenosis. With up to 2 years of follow-up, we report no direct complications related to the presence of extraluminal bioresorbable plates around the airway. CONCLUSION: Extraluminal biodegradable tracheal stiffening represents a valid therapeutic option in select cases of upper airway malacia. It can be highly useful in cases of complex multilevel airway obstructions. External stiffening needs to be planned on a case-to-case basis according to the type of malacia and must be performed under endoscopic guidance. LEVEL OF EVIDENCE: 4. Laryngoscope, 126:2605-2610, 2016.
Authors: Meghan McGill; Nikhila Raol; Kevin S Gipson; Sarah N Bowe; Jackson Fulk-Logan; Anahita Nourmahnad; Joon Yong Chung; Michael J Whalen; David L Kaplan; Christopher J Hartnick Journal: Laryngoscope Date: 2018-11-08 Impact factor: 3.325