Supraglottic Surgery Research Articles

Analysis of infants with moderate to severe laryngomalacia

Objective:To investigate the clinical features and the treatment of moderate-severe laryngeallacia, and the application of CO₂laser supraglotation in laryngeallacia.Method:Collecting the clinical data of 18 infants with moderate-to-severe laryngeallacia diagnosed in our hospital,10 cases were moderate. Eight cases were severe children; according to the classification of laryngeallacia, most of them were mixed type, including 2 cases of type Ⅱ, 3 cases of type Ⅲ, 5 cases of typeⅠ + type Ⅱ, 7 cases of typeⅡ+ type Ⅲ, and 1 case of typeⅠ+ typeⅡ + type Ⅲ. Among them, 8 patients underwent CO₂laser supraglotation,10 patients underwent conservative treatment.The children underwent surgery to evaluate the improvement of laryngeal wheezing, respiration, body weight, and Diet situation. All children were followed up for 12 months.Result:Eight cases with severe laryngeallacia receving CO₂laser supraglotation had rapid improvement after surgery, including laryngeal wheezing, dyspnea, and cough symptoms. They were completely cured 3 months after surgery; None of the 10 cases of moderate children were cured in 3 months, 2 cases of laryngeal wheezing and dyspnea basically disappeared in 6 months, 7 cases improved, 1 case was in the plateau stage; Despnea in 8 cases of children basically disappeared 12 months later and 2 cases with mild throat wheezing, continuing conservative treatment; The weight changes, diet and respiration were closely monitored in all 18 children. The weight of the 5 children after surgery in the 3, 6 and 12 months were significantly higher than that in the untreated children. The difference was statistically significant (P<0.05).Conclusion: Electronic laryngoscope should be taked when children are suspected of laryngeal asthma, which could help diagnose moderate-severe laryngeallacia. Follow-up should be done closely. CO₂laser supraglottic surgery for severe laryngeallacia, can relieve dyspnea, throat wheezing, eating difficulties and gain weight. The surgical is safety with very slight trauma and less complications, which is worth promoting; for moderate laryngeal softening, close follow-up is recommended, most of which can be treated conservatively. If there is a change in the condition, surgery should be considered.

The risk factors of intraoperative anesthesia adverse events in children with laryngeal diseases

BackgroundThis study aimed to investigate the risk factors of intraoperative anesthesia adverse events (IAAEs) in children with laryngeal diseases. MethodsWe retrospectively recruited 118 children with laryngeal diseases who underwent surgical therapy. Based on medical history and preoperative imaging diagnosis, the baseline data, including sex, age, weight, onset age, the number of operation, the degree of airway obstruction, the nature of disease, the location of disease, complications, tracheotomy, and trachea intubation, were defined and recorded. IAAEs, such as pulse oxygen saturation (SpO2) decline, heart rate (HR) decline, emergency orotracheal intubation, emergency tracheotomy, and remaining intubated postoperatively, were also recorded. The risk factors for IAAEs were identified using multivariate logistic regression model. ResultsIncreasing severity of airway obstruction and the presence of pneumonia were risk factors for SpO2 and HR decline in children with laryngeal diseases. Older age, supraglottic rather than subglottic disease, and trachea intubation rather than unprotected airway during surgery were protective factors for SpO2 decline. Furthermore, severe airway obstruction increased risks of emergency orotracheal intubation and remaining intubated postoperatively, whereas supraglottic rather than subglottic disease were protective factors for emergency orotracheal intubation and remaining intubated postoperatively. Only HR decline was found to be associated with the presence of congenital heart disease. ConclusionsThe severe airway obstruction increases the risk of SpO2 decline and HR decline as well as the possibility of perioperative emergency orotracheal intubation and remaining intubated postoperatively, whereas supraglottic surgery and surgery performed under endotracheal intubation reduce the incidence rates of these IAAEs in children with laryngeal diseases.

Pharyngeal and hypopharyngeal reconstruction after multilating surgery for malignant hypopharyngeal cancers.

The authors summarise their reconstructive surgical experience after the radical excision of hypopharyngeal tumours. In selective cases the preservation of the larynx is a reliable surgical option and supraglottic surgery is sufficient to remove the tumour. Myocutaneous paddle flaps were used in every case after the surgical resection for the reconstruction of the pharyngo-oesophageal entrance. After total circular pharyngo-laryngectomy, the continuity of the upper digestive tract was reconstructed by tubed myocutanous flaps.

The Adjustable Supraglottiscope

Transoral surgery in the supraglottic larynx is facilitated by the use of a new instrument, an adjustable supraglottiscope. Conventional adjustable laryngoscopes are not designed for supraglottic surgery and are therefore difficult to use in this area. The adjustable supraglottiscope: (1) provides wide exposure of the supraglottis and much of the lower pharynx, (2) allows instruments to be introduced from the side (between the blades), (3) allows for true suspension, and (4) retracts the endotracheal tube out of the way. These factors provide greater visualization and control of the surgical field and thus improve hemostasis and precision. The adjustable supraglottiscope has been used successfully in a variety of clinical situations. Transoral supraglottic surgery now takes considerably less time and is done with much greater ease. The adjustable supraglottiscope is a valuable instrument in our armamentarium and extends our versatility for endoscopic management of lesions of the supraglottic larynx and lower pharynx.

Supraglottic surgery in vestibular cancer.

This paper deals with the experience acquired in the E.N.T. Clinic of the University of Ferrara regarding horizontal supraglottic laryngectomy in vestibular cancer. The anatomical background of this functional surgery and the most important principles of the technique are specified. The results regard 121 cases (13 T1 cases, 93 T2 cases and 15 T4 cases) divided into three groups: 1. patients who had only surgery (68 cases); 2. patients who for various reasons also had complementary postoperative radiotherapy (39 cases); 3. patients with extralaryngeal expansion who had preoperative radiotherapy (14 cases). The high overall survival rate for the 121 cases is particularly significant, as is the shortening of the high-risk period to less than the usual 5 years. The 4-year cure rate is 78% and remains unchanged right through the 7-year follow-up. The authors feel that these data demonstrate further the validity of supraglottic laryngectomy when its precise indications are rigorously observed.

Supraglottic surgery of the larynx.

Supraglottic surgery of the larynx.