Temporary Tracheostomy Research Articles

Primary Squamous Cell Carcinoma of Thyroid: A case Report

Background: The thyroid gland lacks the squamous cell and the primary squamous cell carcinoma (SCC) of the thyroid gland is an uncommon malignancy with less than 1 % of all thyroid malignancy with a very poor prognosis. So far few cases are reported in the literature with very low survival rates.Case report: A 60 years female presented with a rapidly enlarging right lobe of the thyroid with pain, dysphagia and hoarseness of two months duration. She had hard fixed 4cm x 4cm right lobe of thyroid with right vocal cord paralysis. Ultrasound demonstrates 36mm x 36mm right lobe with mixed echogenicity with calcifications. Fine needle aspiration cytology suggested anaplastic carcinoma. Computed tomography showed heterogeneously enhancing soft tissue density in the right lobe of the thyroid gland measuring 51mm x 37mm x 53mm with shifting of the trachea towards the left side with no significant cervical lymph nodes. CT chest, ultrasonography abdomen and pelvis did not reveal any primary lesion or other metastatic disease and stage was made as T4N0M0. Patient underwent total thyroidectomy with center neck clearance with temporary tracheostomy. Histopathology came out to be squamous cell carcinoma and patient was send for chemo-radiotherapy.Conclusion: Primary squamous cell carcinoma of thyroid is a rare and aggressive entity with poor prognosis. Fine needle aspiration cytology is effective confirmatory tool but efforts shall be made to rule out metastatic SCC originating from other sites. Surgery, radiotherapy and chemotherapy alone are ineffective. Aggressive treatment with surgery followed by adjuvant radiotherapy with or without chemotherapy is recommended to achieve better outcome.Nepalese Journal of ENT Head and Neck Surgery, Vol. 6, No. 1, 2015

Radiotherapy after partial laryngectomy: an analysis of 36 cases and a proposal to optimize radiotherapy.

Laryngeal cancer treatment options include radical surgery, "organ preservation surgery", radiotherapy and chemotherapy. There is no proven evidence of a significant increase in late toxicity with adjuvant radiotherapy after conservative surgery. The aim of this retrospective study was to evaluate the toxicity, local-regional control and overall survival of adjuvant radiotherapy after conservative surgery. A total of 36 patients was treated with radiotherapy after partial laryngectomy at the Radiotherapy Department of the Institute for Cancer Treatment and Research (IRCC) of Candiolo and of the Mauriziano Hospital in Turin, between 1994 and 2007. The postoperative treatment doses ranged from 45 to 70.2 Gy with conventional fractionation. The Kaplan-Meier method was applied for statistical analysis. The RTOG-EORTC scale was used to evaluate late and acute toxicity. Overall 5- and 10-year survival was 93% and 47%, respectively. Local control was 93.5% at 5 and was unchanged at 10 years. Grade 2 acute cutaneous and mucous toxicity was 41% and 62%, and grade 3, 6.9% and 3.5%, respectively. Only one patient required percutaneous endoscopic gastrostomy due to severe dysphagia and one patient required temporary tracheostomy for severe acute laryngeal edema (grade 3). Two patients experienced late toxicity greater than grade 3. The median dose to the residual larynx was 59.5 Gy (range, 45-70.2), and the median dose to the neck was 50.4 Gy (range, 39.6 -55.8). The results of our study showed a dose-dependent increase in the late toxicity trend at doses over and above 60 Gy, which is higher than the cutoff dose reported in the literature. There was no indication from our data that adjuvant postoperative radiotherapy means additional toxicity. The use of highly conformal techniques can further reduce toxicity of the radiotherapy.

Indications and outcome of tracheostomy in Ilorin, North Central Nigeria: 10 years review.

Background:The study aims to highlight common indications as well as outcome of treatment among patients with tracheostomy in Ilorin, North-Central Nigeria.Methods:A review of clinical records of all patients with tracheostomy over a period of ten years (2002-2011), using the Theatre, Ward, ICU and the emergency register after approval from the ethical review committee. Data retrieved included; demographic profile, primary diagnosis, indication for tracheostomy, surgical technique, hospital admission and care outcome of management. All information retrieved input and analysed using an SPSS version 17.0 and data analyzed descriptively.Results:Seventy-six patients had complete data for analysis, age range from 1-89yrs, and mean age of 41.9yrs. There are 48males and 28 females with M:F ratio of 1.6:1. Majority of the patients were in the 3rd–5th decade. About 47.4% had temporary tracheostomy. The commonest indication for tracheostomy is upper airway obstruction secondary to aerodigestive tract tumors in 60.5%, then trauma in 26.3%. The complications are higher among the under tens’. Out of the 36 temporary tracheostomy only 18 were successfully decannulated. The mean hospital stay was 22±2days. Overall 15% mortality was recorded.Conclusion:Common reason for tracheostomy is essentially same earlier documentation in developing countries, common among males, emergency type still most common, neoplasm, prolonged intubation and trauma are the commonest indications, its complication is still high among the under tens’. The outcome is good with 15% mortality due to the primary disease and not from tracheostomy.

Creating an integrated tracheostomy care pathway for patients in an Irish regional hospital setting - the feasibility and effectiveness of a dedicated tracheostomy team

Introduction: Temporary tracheostomy is increasingly used earlier in the management of the general critical care population. With rising numbers of temporary tracheostomies, more patient are being transferred from the Intensive Care Unit (ICU) to general wards, so the care pathway for inpatients has to be considered in both ICU and ward environments (Paul, 2010). International guidelines emphasise that the timely involvement of the multidisciplinary team (MDT) is essential for the good aftercare of patients with a tracheostomy (Global Tracheostomy Collaborative). A number of studies have documented the benefits of a dedicated or outreach tracheostomy MDT to support patient care and weaning from tracheostomy. Reduction in length of stay, time to decannulation, and incidence of adverse events have been reported. Impacts on quality of patient care have not been well documented (Garruba, Turner & Grieveson, 2009). In the Irish context, dedicated tracheostomy teams are less common in regional hospital settings. Little is known about their potential to improve patient outcomes. Objectives: The aim of this project was to: 1. Explore the feasibility of creating a dedicated tracheostomy team in an Irish regional hospital setting 2. Examine the potential for this team to improve outcomes and experience for patients with temporary tracheostomy in a regional hospital setting Method: With the support of a local quality improvement forum, a process mapping exercise was completed examining the journey for the patient with a temporary tracheostomy in a regional hospital setting. An audit of patient charts was completed, and outcomes at various stages of the patient journey were documented. Potential points for co-ordination of MDT care along the patient journey were identified, based on a comparison with international guidelines. A dedicated tracheostomy team was convened, based on need identified from audit findings, and staff resources available. The team consisted of Consultant Intensivist, Physiotherapy, Speech & Language Therapy, Intensive Care Nursing, and Respiratory Nursing. A once weekly MDT tracheostomy ward round was established. Repeat audit of patient charts was completed to evaluate the impact of above. Results: It is feasible to create and maintain a dedicated tracheostomy team in this regional hospital setting. Challenges were encountered, particularly in relation to availability of staff, but these can be addressed through planning and flexibility. The implementation of the team and ward rounds led to improvements in: - clarity of plan for weaning and decannulation - cuff management - time to assessment for basic communication support - time to assessment for speaking valve - time to swallow assessment Conclusion: A dedicated tracheostomy team can contribute to improvements in quality of care for the patient with temporary tracheostomy in a regional hospital setting. Due to the heterogenity of this clinical population, a larger sample size is required to explore its effectiveness, with regards to reducing length of hospital and ICU stay. Process mapping is a useful form of clinical audit. In this instance, multiple potential points for co-ordination of MDT care along the patient journey were identified, which could be addressed with further quality measures going forward.

Tracheocutaneous Fistula Closure with Turnover Flap and Polydioxanone Plate.

An alternative surgical treatment is proposed for closure of tracheocutaneous fistulas. The authors present a new technique for reconstruction of persistent tracheocutaneous fistula resultant from temporary tracheostomy. The single-stage closure under local anesthesia involves a fistulous tract turnover flap with a perforated 0.15 mm polydioxanone plate between the flap and the subcutaneous closure. This article presents 3 cases of persistent tracheocutaneous fistula treated by this method. At follow-up examination after follow-up, no recurrent fistula formation had occurred, and no respiratory deformity was present.

Complicação Rara Pós-Laringectomia Subtotal Reconstrutiva com Cricohioidoepiglotopexia

INTRODUÇÃO: As laringectomias subtotais reconstrutivas supracricoideias com cricohioidoepiglotopexia e cricohioidopexia foram introduzidas para tratar radicalmente os tumores da laringe em doentes selecionados, respeitando as funções deste órgão (deglutição, fonação e respiração). A dispneia, é uma possível complicação a curtoprazo destes procedimentos, que é evitada com traqueotomia temporária. As estenoses laríngeas pós-laringectomia subtotais reconstrutivas são pouco comuns e atrasam o processo de descanulação. Apresenta-se o caso clínico de um doente submetido a cricohioidoepiglotopexia com uma complicação pós-operatória rara caracterizada por uma epiglote muito descida e com báscula posterior, causando estenose laríngea e atraso da descanulação. Esta complicação foi resolvida com sucesso por microcirurgia laríngea com laser CO2.
 Recebido: 11/09/2016 - Aceite: 17/10/2016

Temporary tracheostomy: a practical approach to the placement and management of a tracheostomy tube

A temporary tracheostomy can be a life-saving intervention when there is a structural or functional obstruction of airflow at, or rostral to, the level of the larynx. In most instances, the intervention is intended for short-term use, with appropriate diagnosis and treatment of the primary underlying condition instigated as soon as possible. Surgery can usually be performed on the stable, anaesthetised and intubated patient. Single-lumen uncuffed tubes are ideal for most instances, unless the patient is to be maintained on a ventilator. If commercial tubes are not available then a cut-down endotracheal tube may be used. The diameter of the tube should not be more than 50% the diameter of the trachea. While a relatively simple technique, temporary tracheostomy can be associated with a high complication rate, including tube dislodgement, obstruction and dyspnoea; coughing/gagging; pneumonia; dysphagia, vomiting/regurgitation; aspiration; tracheal stenosis; tracheocutaneous fistula; and laryngeal nerve injury.

Clinical outcomes of transoral videolaryngoscopic surgery for hypopharyngeal and supraglottic cancer

BackgroundTransoral videolaryngoscopic surgery (TOVS) was developed as a new distinct surgical procedure for hypopharyngeal cancer (HPC) and supraglottic cancer (SGC) staged at up to T3. However, long-term treatment outcomes of TOVS remain to be validated.MethodsUnder a straight broad intraluminal view provided by combined use of a distending laryngoscope and a videolaryngoscope, we performed en bloc tumor resection via direct bimanual handling of the ready-made straight-form surgical instruments and devices. We retrospectively analyzed functional and oncologic outcomes of 72 patients with HPC (n = 58) or SGC (n = 14) whose minimum follow-up was 24 months or until death.ResultsThe cohort comprised nine patients of Tis, 23 of T1, 33 of T2, and 7 of T3. Among 36 patients (50%) who underwent neck dissection simultaneously, all but one were pathologically node-positive. Twelve patients underwent postoperative concurrent chemoradiation (CCRT) as adjuvant treatment, and another four patients underwent radiation or CCRT for second or later primary cancer. The endotracheal tube was removed in an operation room in all but two patients who underwent temporary tracheostomy. Pharyngeal fistula was formed transiently in two patients. The median time until patients resumed oral intake and could take a soft meal was 2 and 5 days, respectively. Eventually, 69 patients (96%) took normal meals. The 5-year cause-specific survival (CSS), overall survival (OS), larynx-preserved CSS, and loco-regional controlled CSS were 87.3%, 77.9%, 86.0%, and 88.0%, respectively. Multivariate analysis revealed N2-3 as an independent prognostic factor in both CSS (hazard ratio [HR] = 25.51, P = 0.008) and OS (HR = 4.90, P = 0.022), which indirectly reflected higher risk of delayed distant metastasis.ConclusionsConsidering its sound functional and oncological outcomes with various practical advantages, TOVS can be a dependable, less invasive, and cost-effective surgical option of an organ-function preservation strategy for HPC and SGC.

Managing dysphagia in patients with neurological conditions

British Journal of Neuroscience NursingVol. 13, No. 3 CommentManaging dysphagia in patients with neurological conditionsRosie ThompsonRosie ThompsonSearch for more papers by this authorRosie ThompsonPublished Online:14 Jul 2017https://doi.org/10.12968/bjnn.2017.13.3.106AboutSectionsView articleView Full TextPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareShare onFacebookTwitterLinked InEmail View article References Fletcher J (2015) Dealing with dysphagia, a multi-disciplinary approach. Nursing and Residential Care 17(8): 430-432. https://doi.org/10.12968/nrec.2015.17.8.430 Google ScholarHeadway (2010) Dysphagia after brain injury. https://tinyurl.com/y8qwu3df (accessed 21 June 2017) Google ScholarLancaster J (2015) Dysphagia: its nature, assessment and management. Br J Community Nurs Suppl Nutrition: S28-32. https://doi.org/http://dx.doi.org/10.12968/bjcn.2015.20.Sup6a.S28 Link, Google ScholarMarsh S, Ross N, Pittard A (2011) Neuromuscular disorders and anaesthesia. Part 1: generic anaesthetic management. Contin Educ Anaesth Crit Care Pain 11(4): 115-8. doi: https://doi.org/https://doi.org/10.1093/bjaceaccp/mkr020 Crossref, Google ScholarMalhi H (2016) Dysphagia: warning signs and management. Br J Nurs 25(10): 546–9. https://doi.org/http://dx.doi.org/10.12968/bjon.2016.25.10.546 Link, Google ScholarMiles A, McFarlane M, Kainth P, Parmar P (2014) Interdisciplinary management of dysphagia. Nursing and Residential Care. 16(10): 561-7. https://doi.org/https://doi.org/10.12968/nrec.2014.16.10.561 Link, Google ScholarMyatt R (2015) Nursing care of patients with a temporary tracheostomy. Nurs Stand 29(26): 42–9. https://doi.org/https://doi.org/10.7748/ns.29.26.42.e9742 Crossref, Google ScholarNational Institute for Health and Care Excellence (2006) Nutrition Support for Adults: Oral nutrition support, enteral tube feeding, and parenteral nutrition [CG32] https://tinyurl.com/kz8nu6h (accessed 21 June 2017) Google ScholarNational Patient Safety Agency (2011) Dysphagia Diet Food Texture Descriptors. https://tinyurl.com/l4o2say (accessed 21 June 2017) Google ScholarNational Tracheostomy Safety Project (2013) NTSP Manual. https://tinyurl.com/y7qy8jzg (accessed 21 June 2017) Google ScholarNutrition and Diet Resources (2014) Easier Swallowing: Fluid Thickening Guide. Nutrition and Diet Resources, Glasgow Google ScholarRoyal College of Physicians and British Society of Rehabilitation Medicine (2003) Rehabilitation following acquired brain injury: national clinical guidelines. RCP BSRM, London Google ScholarRoyal College of Physicians, British Society of Gastroenterology (2010) Oral Feeding Difficulties and Dilemmas: A Guide to Practical Care, Particularly Towards the End of Life. Royal College of Physicians, London Google ScholarRoyal College of Speech and Language Therapists (2013) RCSLT Resource Manual for Commissioning and Planning Services for SLCN: Dysphagia. RCSLT, London. http://tinyurl.com/ybdlszy3 (accessed 21 June 2017) Google ScholarRoyal College of Speech and Language Therapists (2014) Position paper. Speech and language therapy in adult critical care. http://tinyurl.com/y7lu853l (accessed 21 June 2017) Google ScholarScottish Intercollegiate Guidelines Network (2010) Management of Patients with Stroke: Identification and Management of Dysphagia. A National Clinical Guideline. https://tinyurl.com/y86mfoso (accessed 21 June 2017) Google ScholarSmithard DG (2015) Dysphagia: prevalence, management and the community nurse. Community Pract 88(10): 32–5 Google ScholarTanton M (2010) Developing a screening tool and training package to identify dysphagia in all settings. Nurs Times 106(15): 18–20 Google Scholar FiguresReferencesRelatedDetails 2 June 2017Volume 13Issue 3ISSN (print): 1747-0307ISSN (online): 2052-2800 Metrics History Published online 14 July 2017 Published in print 2 June 2017 Information© MA Healthcare LimitedPDF download

Suspected retropharyngeal haemorrhage as a complication of guttural pouch mycosis

SummaryAn 11‐year‐old Thoroughbred mare presented for evaluation of severe, acute bilateral epistaxis of several hours’ duration. Endoscopic evaluation revealed active haemorrhage from the right guttural pouch and significant dorsal compression of the nasopharynx. Rapid and severe retropharyngeal swelling developed, prompting placement of a temporary tracheostomy. Guttural pouch mycosis was suspected and transarterial coil embolisation of the right internal carotid, external carotid and maxillary arteries was successfully performed. It was suspected that haemorrhage from the vasculature of the guttural pouch tracked caudally into the retropharyngeal region resulting in significant swelling, pharyngeal collapse and a severely compromised airway. Clinicians should be aware of this rare complication of guttural pouch epistaxis.

Ventilation via the 2.4mm internal diameter Tritube® with cuff- new possibilities in airway management.

A small tube may facilitate tracheal intubation and improve surgical access. We describe our initial experience with the Tritube® that is a novel cuffed endotracheal tube with a 2.4mm internal diameter. The Tritube® was used in seven adult Ear-Nose-and Throat surgical patients with airway narrowing or whose surgical access was facilitated by this small-bore endotracheal tube. Ventilation through Tritube® is performed with the manually operated Ventrain® -ventilator that allows active suctioning during expiration, therefore facilitating normoventilation through small diameter airways. The small diameter of Tritube® seemed to improve glottis visualisation during intubations and gave excellent working conditions for surgery. Two patients were intubated awake with a flexible scope and a guide wire or with an angulated video laryngoscope. One patient had almost complete glottic occlusion that just allowed for passage of the Tritube® . Adequate ventilation was achieved in all patients and intratracheal pressure was kept between 5 and 20cm H2 O. The tube was well tolerated after emergence from anaesthesia and kept intratracheally in five awake patients in the post-operative recovery unit, in one case for more than 1h. Ventilating with Ventrain® through Tritube® demands meticulous breath by breath measurement and adjustment of the intratracheal pressure. The 2.4mm internal diameter Tritube® seems to facilitate tracheal intubation and to provide unprecedented view of the intubated airway during oral, pharyngeal, laryngeal or tracheal procedures in adults. This technique has the potential to replace temporary tracheostomy, jet-ventilation or extra-corporal membrane oxygenation in selected patients.

Single-Site Cannulation Venovenous Extracorporeal CO2 Removal as Bridge to Lung Volume Reduction Surgery in End-Stage Lung Emphysema.

Lung volume reduction surgery (LVRS) is an important treatment option for end-stage lung emphysema in carefully selected patients. Here, we first describe the application of low-flow venovenous extracorporeal CO2 removal (LFVV-ECCO2R) as bridge to LVRS in patients with end-stage lung emphysema experiencing severe hypercapnia caused by acute failure of the breathing pump. Between March and October 2015, n = 4 patients received single-site LFVV-ECCO2R as bridge to LVRS. Indication for extracorporeal lung support was severe hypercapnia with respiratory acidosis and acute breathing pump failure. Two patients required continuous mechanical ventilation over a temporary tracheostomy and were bed ridden. The other two patients were nearly immobile because of severe dyspnea at rest. Length of preoperative ECCO2R was 14 (1-42) days. All patients underwent unilateral LVRS. Anatomical resection of the right (n = 3) or left (n = 1) upper lobe was performed. Postoperatively, both patients with previous mechanical ventilatory support were successfully weaned. ECCO2R in patients with end-stage lung emphysema experiencing severe hypercapnia caused by acute breathing pump failure is a safe and effective bridging tool to LVRS. In such patients, radical surgery leads to a significant improvement of the performance status and furthermore facilitates respiratory weaning from mechanical ventilation.

Patients’ experience of temporary tracheostomy after microvascular reconstruction for cancer of the head and neck

A temporary tracheostomy is commonly done in patients who have reconstruction after the ablation of advanced oral cancer to provide easy access to a secure airway in case a haematoma forms or the patient needs a return to theatre. Although relatively simple to do, we know little about the patients’ experience, and to find out, we designed a three-stage study. First, we conducted semi-structured interviews to identify items related to the functional, emotional, and social impacts of the tracheostomy, on the ward and on removal (n=15 patients). Secondly, we used these items to develop a short, one-page questionnaire in collaboration with the Patient and Carer Support Group and Research Forum, and thirdly, we did a cross-sectional postal survey of 125 patients who had had a temporary tracheostomy as part of free tissue reconstruction between January 2013 and July 2015. Of them, 86 responded (69% response rate). Generally patients reported a negative experience. In the cross-sectional survey most responders (n=52, 60%) stated that they would “very much” avoid a tracheostomy if at all possible. The main problems concerned fear and communication, and between one-third and one-half stated that they had had “very much” or “quite a bit” of a problem in regard to choking, discomfort, attracting attention, sleeping, and general management (other than the suctioning). This feedback should form part of the information that is given to patients; it should also enable us to reflect on optimal perioperative care, and help to inform the debate about the selection criteria.

Translaryngeal percutaneous arytenoid lateralization technique in a canine cadaveric study.

To describe the technique for translaryngeal percutaneous arytenoid lateralization (TPAL) and the effect on rima glottidis cross-sectional area using a canine cadaveric model. Ex vivo study. Canine cadavers (n = 9). With the aid of a laryngoscope, the larynx was visualized and a mattress suture (double-armed 2-0 polypropylene) was placed through the right arytenoid cartilage and exited the skin ventral to the jugular vein. The ends of the suture were passed through a button and tied on the skin to lateralize the right arytenoid cartilage. Digital images of the larynx were made before and after suture placement. Mean (±SD) rima glottidis cross-sectional area (mm(2) ) was calculated from the digital images and values before and after suture placement were compared using a paired t-test. A P value < 0.05 was considered significant. Change in cross-sectional area was expressed as percent increase. Suture placement and the degree of arytenoid lateralization was relatively consistent in all dogs. Mean (±SD) cross-sectional area of the rima glottidis was 126.3 mm(2) (±7.74) before and 172.1 mm(2) (±24.7) after suture placement (P = 0.004). Mean percent increase in cross-sectional area was 25%. The TPAL technique was effective at enlarging the rima glottidis in this canine cadaveric model. TPAL is rapid to perform and does not require specialized instrumentation. Results of this study support further investigation of the TPAL technique as an alternative to temporary tracheostomy for dogs in severe respiratory distress due to laryngeal paralysis.

Larynx Trauma and Hyoid Bone Fracture after Bite Injury in Dog: Case Report

An 8-year-old male Jack Russell crossbreed dog was admitted to our hospital with dyspnea and shock following a dog-bite injury on the ventral neck. Radiographs revealed subcutaneous emphysema and bilateral thyrohyoid bone fractures. Intraoperatively, rupture of both sternohyoid muscles, both hyoepiglotticus muscles, both thyrohyoid muscles, and a partial cranial rupture of the superficial sphincter colli muscle were detected. Part of the epiglottis was detached from the thyroid cartilage. The patient’s severed muscles and torn epiglottis were reattached using a simple interrupted suture pattern. Hyoepiglotticus muscles could not be identified. The bilateral thyrohyoid bone fractures were repaired with intraosseous wire suture. A temporary tracheostomy tube and an esophageal feeding tube were placed postoperatively. The dog was discharged after 8 days, re-examined at 2 and 6 months and laryngeal and pharyngeal function were evaluated as normal. To the authors’ knowledge, this is the first report of a dog that presented with laryngeal trauma with hyoid bone fracture and acute dyspnea that underwent surgical treatment resulting in an acceptable outcome.

Long-term results of laryngotracheal resection for benign stenosis from a series of 109 consecutive patients

Long-term results of patients undergoing laryngotracheal resection for benign stenosis are reported. This is the largest series ever published. Between 1991 and March 2015, 109 consecutive patients (64 males, 45 females; mean age 39 ± 10.9 years) underwent laryngotracheal resection for subglottic postintubation (93) or idiopathic (16) stenosis. Preoperative procedures included tracheostomy in 35 patients, laser in 17 and laser plus stenting in 18. The upper limit of the stenosis ranged between actual involvement of the vocal cords and 1.5 cm from the glottis. Airway resection length ranged between 1.5 and 6 cm (mean 3.4 ± 0.8 cm) and it was over 4.5 cm in 14 patients. Laryngotracheal release was performed in 9 patients (suprahyoid in 7, pericardial in 1 and suprahyoid + pericardial in 1). There was no perioperative mortality. Ninety-nine patients (90.8%) had excellent or good early results. Ten patients (9.2%) experienced complications including restenosis in 8, dehiscence in 1 and glottic oedema requiring tracheostomy in 1. Restenosis was treated in all 8 patients with endoscopic procedures (5 laser, 2 laser + stent, 1 mechanical dilatation). The patient with anastomotic dehiscence required temporary tracheostomy closed after 1 year with no sequelae. One patient presenting postoperative glottic oedema underwent permanent tracheostomy. Minor complications occurred in 4 patients (3 wound infections, 1 atrial fibrillation). Definitive excellent or good results were achieved in 94.5% of patients. Twenty-eight post-coma patients with neuropsychiatric disorders showed no increased complication and failure rate. Laryngotracheal resection is the definitive curative treatment for subglottic stenosis allowing very high success rate at long term. Early complications can be managed by endoscopic procedures achieving excellent and stable results over time.

Transoral robotic surgery for early glottic carcinoma involving anterior commissure: Preliminary reports.

Transoral robotic surgery (TORS) for early glottic cancer has been reported, but the issue of anterior commissure involvement has seldom been addressed. Therefore, the purpose of this study was to preliminarily report the treatment results of TORS in this disease entity. Eight patients with T1 and T2 glottic carcinoma with anterior commissure involvement were selected to receive TORS. The clinical parameters, including rates of adjuvant radiotherapy (RT), survivals, as well as organ and function preservation, were retrospectively analyzed. TORS was successfully performed in all patients without temporary tracheostomy. There were no major complications and no patient received adjuvant RT to the larynx after surgery. With a mean follow-up of 40 months, all patients survived with their larynx preserved and no local recurrence, tracheostomy, or tube feeding dependence. TORS is a feasible approach for selected patients with early T classification glottic carcinoma with anterior commissure involvement. The preliminary oncologic and functional outcomes are satisfactory. © 2015 Wiley Periodicals, Inc. Head Neck 38: 913-918, 2016.

Iatrogenic tracheal rent in a Clydesdale colt

A one-month-old Clydesdale colt presented for bilateral scrotal hernia and a patent urachus. Manual reduction of the hernia followed by castration and primary closure of the superficial inguinal rings bilaterally...

Palliative surgery in locally advanced thyroid cancer

The paper analyses the experience in palliative surgery in 137 patients with locally advanced forms of differentiated thyroid cancer. The paper describes the resections of the thyroid gland without the tumor tissue that germinated into the vital organs of neck or mediastinum. In some cases - the tumor was completely removed in patients with distant metastases. Such operations had to be performed in every fourth patient out of 464 patients with locally advanced carcinoma of the thyroid gland. Most of the patients undergoing palliative interventions, were elderly patients, that often had other illnesses. The need for such transactions occurred at the prospect of further treatment of patients with non-surgical methods, and serious complications of life-threatening tumors. In more than one in ten patients the palliative operation had to be completed with a temporary or permanent tracheostomy performed using the original method. The postoperative mortality rate was 4.3 % (6 cases). The causes of death were pulmonary embolism (2 patients), acute myocardial infarction (1 patient), purulent-septic complications (2 patients), acute cerebrovascular accident (1 case). The postoperative complications were: festering wounds (10 cases or 7.3 %), hypostatic pneumonia (21 patients or 15.3 %), bleeding (3 cases or 2.2 %). The 5-year survival rate after palliative surgery in patients with papillary cancer was higher compared to the group of patients with follicular carcinoma (43.0 % and 37.9 %, respectively). The same figures in patients with medullary carcinoma were significantly (p &lt; 0.05) lower compared with those with papillary and follicular thyroid cancer and they amounted to 18.1 %. After the palliative surgery more than a third of patients survived for 5 years or more. That proves the validity of palliative interventions in this group of patients, and the relatively favorable current differentiated forms of thyroid cancer.

Tracheostomy management

Tracheostomy management