Removal Of Granulation Tissue Research Articles

Miniseminar: Update in endoscopic management of the pediatric airway

Endoscopic techniques are important in the diagnosis and treatment of pediatric airway pathology. Recent medical literature has placed an increasing emphasis on the open surgical management of pediatric airway problems including laryngotracheal reconstruction. This miniseminar is designed to provide an update regarding endoscopic managment of a variety of pediatric airway problems, and discuss the role of endoscopic versus open managment. Specific techniques for management will be discussed by each of the panelists. This will include a review of endoscopic diagnosis of airway problems. The panelsits will discuss endoscopic management of subglottic stenosis, including the role of laser ablation, powered instrumentation, balloon dilation, and stent placement, as well as the role of adjuvant medical therapy. Decision making regarding endoscopic versus open reconstruction will be presented. The endoscopic treatment of laryngeal vascular malformations, including subglottic and supraglotic lesions will be discussed. This will include the use of laser ablation as well as medical treatment. The role of powered instrumentation for papillomas, subglottic stenosis and removal of granulation tissue will be addressed. Powered instrumentation will be compared to laser and non-powered dissection. The endoscopic approach to bilateral vocal cord paralysis in children will also be reviewed. The panelists will then discuss a variety of cases of pediatric airway problems. The format will be a brief presentation by each of the panelists followed by an interactive discussion. Time for questions and comments will be allowed.

Spinal cord compression and epidural abscess extension of pleural empyema

We report a case of epidural extension of pleural empyema with cord compression and neurologic deficit. Surgical decompression was required and emergency bilateral laminectomy was performed with removal of abscess and granulation tissue. Methicillin-resistant Staphylococcus aureus grew in cultures of pleural and epidural specimens and appropriate intravenous antibiotics were started. In spite of early diagnosis and rapid management the patient suffered severe sequelae.

Tuberculous otitis media in a renal transplant recipient

Tuberculous otitis media is a rare cause of chronic suppurative infection of the middle ear and a very uncommon form of extrapulmonary tuberculosis. Although there have been several case reports in the nonimmunosuppressive population of tuberculous otitis media, it has never been reported in an immunosuppressed allograft recipient. We present a case of diagnosed tuberculous otitis media after recurrent chronic otitis media treated several times with empiric antibiotic treatment. After the patient developed postauricular fistula and underwent surgical removal of granulation tissue, the diagnosis was made on the basis of histopathology and growth in culture of Ziehl-Neelsen. Clinical response promptly followed institution of antituberculous treatment including isoniazid, rifampicin, ethambutol, and pyrazinamide.

Root resorption--diagnosis, classification and treatment choices based on stimulation factors.

Etiology of different types of root resorption requires two phases: mechanical or chemical injury to the protective tissues and stimulation by infection or pressure. Injury can be similar in various types of root resorption. The selection of proper treatment is related to the stimulation factors. Intrapulpal infection is the stimulation factor in internal root resorption and external periradicular inflammatory root resorption. Adequate root canal treatment controls intrapulpal bacteria and arrests the resorption process. In cervical root resorption, infection originates from the periodontal sulcus and stimulates the pathological process. As adequate infection control in the sulcus is unlikely, removal of granulation tissue from the resorption lacuna and sealing are necessary for repair. Removal of the stimulation factor, i.e. pressure, is the treatment of choice in root resorption related to pressure during orthodontic treatment, or an impacted tooth or tumor. In ankylotic root resorption, there is no known stimulation factor; thus, no predictable treatment can be suggested. Therefore, various types of root resorptions can be classified according to the stimulation factors: pulpal infection resorption, periodontal infection resorption, orthodontic pressure resorption, impacted tooth or tumor pressure resorption, and ankylotic resorption.

Indication for redo hepatic portoenterostomy for insufficient bile drainage in biliary atresia: re-evaluation in the era of liver transplantation.

To determine the role of redo hepatic portoenterostomy (HPE) in biliary atresia (BA) patients with insufficient bile excretion after the initial HPE, 25 patients (type I, correctable: 2; type III, uncorrectable: 23) undergoing the initial HPE at 25 to 119 days of age were studied. Four patients achieved disappearance of jaundice (total bilirubin [T.Bil] < 2 mg/dl) postoperatively. A redo HPE was performed at 2 to 8 months of age with sufficient and extensive removal of granulation and scar tissue at the hepatic hilum. Five patients became free of jaundice in 3 to 6 months (group 1), while the remaining 20 did not (group 2). Disappearance of jaundice after the initial HPE had been achieved in 2 of 5 patients (40%) in group 1 and 2 of 20 (10%) in group 2 ( P < 0.05). Age, serum T.Bil, aspartate aminotransferase albumin, prothrombin time, cholinesterase, total cholesterol, and Fischer's ratio at redo HPE showed no significant differences between the two groups. On liver histology obtained at redo HPE, cirrhosis and hepatocyte degeneration were seen in 1 of 5 cases (20%) in group 1 and 12 of 20 (60%) in group 2 ( P < 0.05). Redo HPE may thus be effective in BA patients with insufficient bile drainage who achieved disappearance of jaundice after the initial HPE and have not developed cirrhosis.

Identification of periodontopathic bacteria DNA from periodontitis-involved gingival tissue using a PCR method

The purpose of this study was to determine the presence of periodontopathic bacteria DNA in the granulation tissue of periodontally involved gingival tissue. Forty periodontitis patients were examined. Subgingival plaque and saliva samples were collected from the patients before surgery. Then, granulation tissue was also collected during surgery. Another 20 patients, who had more than 4 mm in probing pocket depth, were also examined as a control. They received only initial treatment without periodontal surgery. Plaque and saliva samples were also collected from them. Seven periodontopathic bacteria, Porphyromonas gingivalis, Bacteroides forsythus, Toreponema denticola, Campylobacter rectus, Actinobacillus actinomycetemcomitans, Prevotella intermedia, and Prevotella nigrescens, were detected by a PCR method from these samples of all patients. As clinical parameters, probing pocket depth, clinical attachment level, and bleeding on probing were recorded. One year after surgery, sampling of subgingival plaque and saliva, and measurement of clinical parameters were performed on the patients. The DNA of periodontopathic bacteria was detected in the granulation tissue of 29 out of 40 patients. P. gingivalis, B. forsythus, T. denticola, C. rectus, A. actinomycetemcomitans, P. intermedia and P. nigrescens were detected in 23, 11, 12, 9, 3, 2 and 1 subject(s) respectively. The sites with undetectable level of any periodontal pathogens at one year after surgery showed a clinical attachment gain of 2.44 mm, while those that showed detectable pathogen levels had only a 0.77 mm gain. Our results indicated that the removal of granulation tissue contributed to eliminating periodontal pathogens and to avoiding re-infection by those bacteria. Complete eradication of periodontopathic bacteria would be necessary for successful periodontal treatment.

Re-osseointegration after treatment of peri-implantitis at different implant surfaces. An experimental study in the dog.

Peri-implantitis is a condition that includes soft tissue inflammation and rapid loss of bone. Treatment of peri-implantitis includes both antimicrobial and bone augmenting methods. The question of whether true re-osseointegration may occur following treatment of peri-implantitis is controversial. The aim of this study was to investigate whether the character of the implant surface was of importance for the occurrence of re-osseointegration following treatment of peri-implantitis. Four beagle dogs were used. The mandibular premolars were extracted. After 12 months, 3 ITI(R) solid screw dental implants were placed in each side of the mandible. In the left side, implants with a turned surface (Turned sites) were used, while in the right side implants with a SLA surface (SLA sites) were placed. After 3 months of healing, peri-implantitis was induced by ligature placement and plaque accumulation. When about 50% of the initial bone support was lost, the ligatures were removed. Five weeks later, treatment was initiated. Each animal received tablets of Amoxicillin and Metronidazole for a period of 17 days. Three days after the start of the antibiotic regimen, one implant site (experimental site) in each quadrant was exposed to local therapy. Following flap elevation, the exposed titanium surface was cleaned with the use of cotton pellets soaked in saline. The implants were submerged. Six months later, biopsies were obtained. Treatment resulted in a 72% bone fill of the bone defects at Turned sites and 76% at SLA sites. The amount of re-osseointegration was 22% at Turned sites and 84% at SLA sites. A treatment regimen that included (i) systemic administration of antibiotics combined with (ii) granulation tissue removal and implant surface cleaning resulted in resolution of peri-implantitis and bone fill in adjacent bone defects. Further, while substantial "re-osseointegration" occurred to an implant with a rough surface (SLA), bone growth on a previously exposed smooth surface (Turned) was minimal.

Is tracheotomy decannulation possible in oxygen-dependent children?

Objective: The goal was to determine whether decannulation can be safely achieved in children with persistent oxygen requirements. Design: The study was a prospective evaluation of 12 oxygen-dependent children at a tertiary care academic children's medical center. Methods: Twelve tracheotomy-dependent children with persistent oxygen requirements were evaluated for decannulation. Patients requiring more than 35% FiO were not considered. Direct laryngoscopy and bronchoscopy were performed in all patients. Two required single-stage laryngotracheoplasty to correct subglottic stenosis, 1 required tracheal resection, and 7 required removal of suprastomal granulation tissue. Oxygen was administered after decannulation through a nasal cannula. Results: Decannulation was successful in 92% (11 of 12) of patients. At final follow-up, oxygen requirements decreased in 58% of patients after decannulation. Conclusions: Decannulation can be successful in children who remain oxygen dependent; conversion to a more physiologic airway may be an adjunct to reducing or eliminating their oxygen demand. (Otolaryngol Head Neck Surg 2000;123: 263–8.)

Anesthetic Implications of Laryngeal Trauma

Anesthetic Implications of Laryngeal Trauma

Bronchoscopic Resection of Wallstent-Associated Granulation Tissue Using Argon Plasma Coagulation

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Subscribe to eTOC Secondary Logo Journal Logo All Articles Images Videos Podcasts Blogs Advanced Search Toggle navigation Subscribe Register Login Articles & Issues Current IssuePrevious IssuesPublished Ahead-of-Print For Authors Submit a ManuscriptInformation for AuthorsLanguage Editing ServicesAuthor Permissions Journal Info About the JournalEditorial BoardAdvertisingOpen AccessSubscription ServicesReprintsRights and Permissions All Articles Images Videos Podcasts Blogs Advanced Search July 1998 - Volume 5 - Issue 3 Previous Abstract Next Abstract Export All Images to PowerPoint File Add to My Favorites Email to Colleague Colleague's E-mail is Invalid Your Name: Colleague's Email: Separate multiple e-mails with a (;). Message: Thought you might appreciate this item(s) I saw in Journal of Bronchology & Interventional Pulmonology. Your message has been successfully sent to your colleague. Some error has occurred while processing your request. Please try after some time. Export to End Note Procite Reference Manager Save my selection Brief Report: PDF OnlyBronchoscopic Resection of Wallstent-Associated Granulation Tissue Using Argon Plasma CoagulationColt, Henri G. M.D. Author Information Pulmonary Special Procedures and Nd:YAG Laser Unit, Pulmonary Division. University of California at San Diego Medical Center. California, U.S.A. Journal of Bronchology: July 1998 - Volume 5 - Issue 3 - p 209-212 Free Abstract A 27-year-old woman with advanced relapsing polychondritis and severe tracheobronchial obstruction underwent successful removal of Wallstent-associated granulation tissue using the argon plasma coagulator. Patency of the left and right distal bronchi was restored without risk of damaging the structural integrity of the metal stents themselves. The argon plasma coagulator allows monopolar, noncontact application of a controllable high-frequency electrical current for coagulation and desiccation of inflamed, fibrous scar and granulation tissue. Using the proper technique, bronchoscopic applications are safe and effective. This instrument warrants further consideration for inclusion in the therapeutic armamentarium of the interventional pulmonologist. © Williams & Wilkins 1998. All Rights Reserved. Source Bronchoscopic Resection of Wallstent-Associated Granulation Tissue Using Argon Plasma Coagulation Journal of Bronchology & Interventional Pulmonology5(3):209-212, July 1998. Full-Size Email + Favorites Export View in Gallery Email to Colleague Colleague's E-mail is Invalid Your Name: Colleague's Email: Separate multiple e-mails with a (;). Message: Thought you might appreciate this item(s) I saw in Journal of Bronchology & Interventional Pulmonology. Your message has been successfully sent to your colleague. Some error has occurred while processing your request. Please try after some time. Related Articles Export All Images to PowerPoint File Add to My Favorites Email to Colleague Colleague's E-mail is Invalid Your Name: Colleague's Email: Separate multiple e-mails with a (;). Message: Thought you might appreciate this item(s) I saw in Journal of Bronchology & Interventional Pulmonology. Your message has been successfully sent to your colleague. Some error has occurred while processing your request. Please try after some time. Export to End Note Procite Reference Manager Save my selection Article Level Metrics Article Keywords Keyword Highlighting Highlight selected keywords in the article text. Argon plasma coagulation Metal stents Tracheobronchial stenosis Laser resection Search for Similar Articles You may search for similar articles that contain these same keywords or you may modify the keyword list to augment your search. Argon plasma coagulation\r, Metal stents\r, Tracheobronchial stenosis\r, Laser resection Related Links Articles in PubMed by Henri G. 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Tracheal Perforation Developed during Endotracheal Granulation Tissue Removal with CO2 Laser: A case report

Tracheal Perforation Developed during Endotracheal Granulation Tissue Removal with CO2 Laser: A case report

The Effect of Gastroesophageal Reflux on Laryngotracheal Reconstruction

To determine the need for preoperative evaluation for gastroesophageal reflux disease (GERD) in all children undergoing laryngotracheal reconstruction (LTR) and to assess the effect of GERD on the outcome of LTR. Prospective, single-blind observational study. Tertiary care children's hospital. Seventy-four pediatric patients with laryngotracheal stenosis who underwent LTR at the Children's National Medical Center, Washington, DC, from October 1, 1986, through August 31, 1994. Evaluation for and treatment of GERD, LTR, endoscopy, and removal of granulation tissue. Successful decannulation and number of endoscopies required to remove laryngeal and tracheal granulation tissue. Seventy-four patients underwent 82 LTRs. The senior surgeon was blinded to the status of GERD evaluation and treatment. Four groups were identified: 37 patients (40 LTRs) with no preoperative evaluation for GERD; 10 patients (11 LTRs) with normal findings on preoperative evaluation for GERD; seven patients (nine LTRs) with abnormal findings on preoperative evaluation for GERD but who failed to receive appropriate treatment; and 20 patients (22 LTRs) with abnormal findings on preoperative evaluation for GERD who received appropriate therapy. Severity and extent of stenosis as determined by multicentricity of stenosis, type of repair, and duration of stent were similar in the four groups. The effect of GERD and its treatment on the outcome of LTR was measured by the number of endoscopies necessary for removal of granulation tissue following reconstruction and successful decannulation. Statistical analyses indicate that (1) all children do not require preoperative evaluation for GERD; (2) neither the presence of GERD nor its treatment are major factors in determining the outcome of LTR. Preoperative evaluation for GERD and its treatment do not favorably affect the outcome of LTR.

Repair of long-segment tracheal stenosis in infancy

Long-segment stenosis of the trachea in infancy is a considerable surgical challenge because the infants are generally extremely ill and the airway is small. The optimal type of repair is not clearly defined. This report summarizes our experience with rib cartilage tracheoplasty done with cardiopulmonary bypass. Six patients underwent repair of long-segment tracheal stenosis between September 1987 and September 1994. The mean age was 14 weeks (range 1 to 58 weeks). Patients had stenosis of at least 70% of the tracheal length, typically with complete cartilaginous rings. In all patients stenosis was repaired by placement of a section of rib cartilage as an augmentation patch into the anterior surface of the trachea, which had been incised through the entire length of the stenosis. To avoid distal airway intubation, we used cardiopulmonary bypass for all procedures, with a mean bypass duration of 110 minutes (range 54 to 175 minutes). Mechanical ventilation was required for a median of 11 days after the operation (range 7 to 81 days), and the median postoperative hospital stay was 17 days (range 12 to 180 days). All patients are long-term survivors. Complications included the need for extracorporeal membrane oxygenation to treat ventricular dysfunction in one patient and graft dehiscence requiring revision of the distal graft in another. The latter patient has required several treatments with a bronchoscope for removal of granulation tissue. All other patients are free of symptoms and have normal growth with a mean follow-up of 4.7 years (range 5 months to 7.6 years). We conclude that rib cartilage tracheoplasty for long-segment tracheal stenosis provides excellent results in short and intermediate follow-up. In addition, the use of cardiopulmonary bypass allows an unobstructed view of the tiny infant airway and thus permits a precise repair. (J T HORAC C ARDIOVASC S URG 1995;110:1504-12)

Guided tissue regeneration in the treatment of degree II furcations in maxillary molars

he present clinical trial was designed to evaluate the clinical effect of GTR in the treatment of degree II furcation defects in maxillary molars. 28 patients, 21 to 59 years of age, referred for treatment of advanced periodontal disease were included. They presented with similar periodontal lesions in the right and the left maxillary molar regions, but had only one surface which exhibited furcation involvement. A total of 28 pairs of contralateral furcation defects of degree II including 18 interproximal pairs (10 mesial, 8 distal) and 10 buccal pairs, were available for the study. After the completion of basic therapy, the furcation involved molars in the right and left quadrants in each patient were randomly assigned to either a test or a control treatment procedure. Following flap elevation, scaling, root planing and granulation tissue removal, an e-PTFE membrane at the test site was adjusted to cover the entrance to the furcation defect and adjacent bone and was retained in this position with sling sutures. The mucoperiostal flaps were subsequently adjusted and positioned to cover the entire surface of the membrane and were secured in this position. An identical surgical procedure was performed in the control tooth regions with the exception of the placement of a teflon membrane. No periodontal dressing was used. Starting the day before surgery and continuing for 7 days, the patients received 1 + 1 g of Amoxicillin per day; morning and evening. The sutures were removed after 10 days. At the test sites, the membranes were removed after 6 weeks of healing. The treated sites were examined and re-entry procedures performed 6 months after reconstructive surgery. Open flap debridement at maxillary furcations of degree II resulted in some gingival recession and probing depth reduction, but no change occurred in parameters describing probing attachment or bone levels. The addition of GTR at buccal furcations enhanced the treatment result by promoting probing attachment and bone gain and reduced the amount of soft tissue recession above what was accomplished by flap debridement alone. No such benefit of membrane therapy was observed at mesial and distal furcations.

Treatment of Class II Furcation Involvements in Humans With Bioresorbable and Nonresorbable Guided Tissue Regeneration Barriers. A Randomized Multi‐Center Study

In this multi-center study 38 patients with contralateral molar Class II furcation defects were treated with GTR therapy using a bioresorbable matrix barrier (test) and a nonresorbable expanded polytetrafluoroethylene (ePTFE) barrier (control). Following flap elevation, scaling, root planing, and removal of granulation tissue, each device was adjusted to cover the furcation defect. The flaps were repositioned and sutured to complete coverage of the barriers. A second surgical procedure was performed at control sites after 4 to 6 weeks to remove the nonresorbable barrier. Before treatment and 12 months postsurgery all patients were examined and probing depths, clinical attachment levels, and position of the gingival margin were recorded. The primary response variable was the change in clinical attachment level in a horizontal direction (CAL-H change). Both treatment procedures reduced the probing depths (P < or = 0.001). Statistically significant gain of clinical attachment level in both horizontal and vertical direction was found at the test sites. At control sites gain of attachment in horizontal direction was statistically significant. The gain of CAL-H was 2.2 mm at test sites compared to 1.4 mm at control sites (P < or = 0.05). At test sites, the gingival margin was maintained close to the pre-surgical level (0.3 mm), whereas at control sites gingival recession was evident (0.9 mm), the difference being statistically significant (P < or = 0.01). Postsurgical complications, such as swelling and pain were more frequent following the control treatment (P < or = 0.05).

Healing of periodontal lesions in monkeys following the guided tissue regeneration procedure. A histological study.

The purpose of the present investigation was to study histologically the healing of periodontal lesions in monkeys during the first 9 weeks following periodontal reconstructive surgery according to the principle of guided tissue regeneration. Horizontal interproximal lesions and through-and-through bifurcation defects were surgically produced in 2 adult monkeys. Following removal of granulation tissue and root planing, notches indicating the level of the reduced bone level were prepared in the root surfaces. Sterile teflon membranes were then adjusted to cover the defects, and the gingival flaps were sutured in a coronally displaced position. Sacrifice of the animals was scheduled to allow for observation periods of 1, 3, 4 and 9 weeks. Evaluation of histological specimens revealed a continuous growth of new connective tissue during a period of 4 weeks. The coronal growth of new tissue did not increase significantly between 4 and 9 weeks. New cementum had formed in the most apical part of one notch after 1 week of healing, and following 3 and 4 weeks, new cementum with inserting periodontal ligament fibers were observed in all notches and to a varying degree, also more coronally on the root surfaces of both interproximal and bifurcation defects. Limited regrowth of alveolar bone was observed in the 9-week specimens. Judged from the course of the blood vessels within the newly formed connective tissue in the defects, the tissue in the central part of the defects had originated from the alveolar bone, whereas the tissue adjacent to the root surfaces seemed to have its origin in the residual periodontal ligament.

Factors that influence successful decannulation after surgery for laryngo-tracheal stenosis in children

The process to decannulation requires attention to details from the time of initial tracheostomy, through the pre- and peri-operative period up until the decannulation event. Important points to consider during this process are: a formal tracheostomy rather than a tracheotomy; other potential sites of obstruction than the laryngeal stenosis; gastrooesophageal reflux; prevention and control of infection and the use of prophylactic antibiotics; method and type of suture material; stenting; movement and method of feeding. Decannulation itself requires attention to removal of granulation tissue and control of tracheomalacia and tracheostenosis.

Ventilating Tracheal Resectoscope

The ventilating tracheal resectoscope (Karl Storz) combines the advantages of a ventilating bronchoscope and the resecting cytoscope for removal of soft tissue from the airway. The resectoscope offers several distinct advantages over other methods of granulation tissue removal. The procedure is done under direct vision with magnification and illumination of a rod-lens optical system. Suprastomal granulation tissue is resected cleanly, without tearing or stripping adjacent mucosa. Hemorrhage is readily controlled with the coagulating mode. The resectoscope can also be used for removing benign tumors (such as recurrent respiratory papillomatosis) from the trachea and bronchi. Its use in the efficient removal of malignant tumors and subglottic soft tissue has also been described.

O-194 - Removal of granulation tissue from the bottom of acetic acid-induced gastric ulcers in rats

O-194 - Removal of granulation tissue from the bottom of acetic acid-induced gastric ulcers in rats

Composite hyoid-sternohyoid interposition graft revisited: UCLA experience 1974-1984.

The surgical correction of severe laryngotracheal stenosis remains a challenging problem. We report on a series of 20 patients treated with the composite hyoid-sternohyoid interposition graft (HSIG). They range in age from 1 to 66 years and all had severe subglottic stenosis refractory to dilatation and stenting procedures. The major cause of stenosis was prolonged endotracheal intubation (16/20); the majority of patients (13/20) had severe medical illness complicating their airway management. Postoperative results were judged on the basis of decannulation, voice strength, and quality as well as activity tolerance. Follow-up periods were over 24 months in all cases. Twelve patients were decannulated and three keep their tracheotomy tubes permanently plugged. All have socially acceptable voices and good activity tolerance. Seven patients who were aphonic had voice improvement. There were three complete failures; one secondary to infection, one due to severe scleroderma, and one because of graft displacement. Each patient underwent an average of four postoperative endoscopies for airway evaluation and removal of granulation tissue. CAT scanning was useful in diagnosing postoperative problems, especially graft displacement, which was impossible to diagnose by endoscopic examination. We conclude that the composite hyoid-sternohyoid interposition graft is a useful and reliable tool in the treatment of subglottic stenosis.