Tracheal Granuloma Research Articles

Preliminary results in tracheal replacement using stented aortic matrices for primary extensive tracheal cancer.

Recent studies have demonstrated the feasibility and favorable long-term results of tracheobronchial replacement using stented cryopreserved aortic allografts. We propose to investigate the outcomes of this emerging technique in the subgroup of patients with extensive tracheal cancer. This study was based on 13 patients with primary extensive tracheal cancer extracted from the prospective registry TRITON-01 (ClinicalTrials.gov Identifier: NCT04263129), which included 40 patients in total. We analyzed early and late outcomes in this subset of patients. From March 2019 to September 2022, 13 patients were included in the study. There were 9 female and 4 male patients, with a mean age of 53.9years [36-71 years]. They had tracheal replacement for extended adenoid cystic carcinoma (n=11), squamous cell carcinoma (n=1), and mucoepidermoid carcinoma (n=1). A venovenous extracorporeal membrane oxygenation was used in the 6 last cases. The mean length of resection was 81 mm [50-120 mm]. There was no 30-day postoperative mortality. A complete resection (R0) was achieved in 11 patients. The main late complications consisted of tracheal granulomas related to the stent and requiring repeated bronchoscopies (n=9), pneumonia (n=3), airway infection (n=1), bronchoesophageal fistula (n=1), mechanical stent obstruction requiring change (n=2), and mediastinitis treated by antibiotics, drainage, and omentoplasty (n=1). With a maximal follow-up of 3years and 7months, cancer recurrence was observed in 2 patients. All patients were alive at last follow-up except 2 (84.6%). Airway replacement using stented CAA represents a feasible and promising solution for extensive tracheal cancer.

Bronchoscopy-guided percutaneous tracheostomy during the COVID-19 pandemic.

Assessment of the efficacy and complications associated with performing bronchoscopy-guided percutaneous tracheostomy in COVID-19 and non-COVID-19 patients. Prospective observational study conducted between March of 2020 and February of 2022. All adult patients who underwent elective bronchoscopy-guided percutaneous tracheostomy were included. The efficacy of the procedure was evaluated based either on the success rate in the execution or on the need for conversion to open technique. Percutaneous tracheostomy-related complications were registered during the procedure. We performed 6-month follow-up for identifying late complications. During the study period, 312 bronchoscopy-guided percutaneous tracheostomies were analyzed. One hundred and eighty-three were performed in COVID-19 patients and 129 among non-COVID-19 patients. Overall, 64.1% (200) of patients were male, with a median age of 66 (interquartile range 54-74), and 65% (205) presented at least 1 comorbidity. Overall, oxygen desaturation was the main complication observed (20.8% [65]), being more frequent in the COVID-19 group occurring in 27.3% (50) with a statistically significant difference versus the non-COVID-19 patients' group (11.6% [15]); P < .01). Major complications such as hypotension, arrhythmias, and pneumothorax were more frequently observed among COVID-19 patients as well but with no significant differences. Percutaneous tracheostomy could be executed quickly and satisfactorily in all the patients with no need for conversion to the open technique. Likewise, no suspension of the procedure was required in any case. During 6-month follow-up, we found an incidence of 0.96% (n= 3) late complications, 2 tracheal granulomas, and 1 ostomal infection. Bronchoscopy-guided percutaneous tracheostomy can be considered an effective and safe procedure in COVID-19 patients. Nevertheless, it is highly remarkable that in the series under study, a great number of COVID-19 patients presented oxygen desaturation during the procedure.

A Case Report of Tracheal Granuloma Treated with &lt;italic&gt;Sipyukmiyuki-eum&lt;/italic&gt;

Purpose: The purpose of this study is to report the improvement of tracheal granuloma after herbal medicine treatment.Methods: A patient with tracheal granuloma was treated with &lt;i&gt;Sipyukmiyuki-eum&lt;/i&gt;, and we checked laryngoscopy images to observe the improvement of this condition.Results: After treatment with &lt;i&gt;Sipyukmiyuki-eum&lt;/i&gt; and Korean medicine therapy, we found that tracheal granuloma showed improvements in the laryngoscopy image.Conclusion: This case suggests that &lt;i&gt;Sipyukmiyuki-eum&lt;/i&gt; might be effective for patients who develop tracheal granuloma after tracheostomy. However, additional studies with more patients are required to verify this finding.

Ultra-slippery, nonirritating, and anti-inflammatory hyaluronic acid-based coating to mitigate intubation injury

Endotracheal intubation is a crucial procedure for mechanical ventilation and respiratory support therapy. However, friction mismatch between the tube material and tissues often causes complications, such as laryngopharyngeal airway mucosa injury, tracheal granuloma, and inflammatory reaction. In this work, a highly lubricated coating was designed and applied on the tracheal tube. Hyaluronic acid (HA) and triblock copolymer (Pluronic F127) were co-deposited on the surface-activated tube to form a hydration layer through intermolecular interaction. The coating exhibited high artificial saliva adsorption ratio and water-retention rate, providing excellent lubrication to the tube. The friction coefficient of the coated tube in artificial saliva was 77% less than that observed for the original tube. The efficacy of the lubricated coating on endotracheal intubation was assessed in vivo by using a cynomolgus monkey model. The coating was demonstrated to be effective to alleviate the injury caused by endotracheal intubation.

A Case of Tracheal Granuloma Removal using Potassium-Titanyl-Phosphate Laser

Tracheal granuloma, the most commonly reported sequela of pediatric tracheotomy. A variety of techniques are available for the management of tracheal granuloma. Potassium-titanyl-phosphate (KTP) laser has been previously established as an acceptable technique for removal of laryngeal surgery, which emits a green light with a wave length of 532 nm, which is well-absorbed by hemoglobin and can coagulate and vaporize tissue. The ability to deliver laser energy through a flexible glass fiber makes the technique convenient for use with a rigid bronchoscope, overcoming problems with intraluminal access encountered with earlier attempts at CO2 laser therapy for this problem. Another advantage of KTP laser is the avoidance of the risks and morbidity associated with an open procedure. We report our surgical technique KTP laser in the management of tracheal granuloma removal into the tracheostomy site. KTP laser is good tool for management of tracheal granuloma with low incidence of complications. Key words: Trachea ㆍ Granuloma ㆍ KTP laser 핵심용어: 기관 ㆍ ìœ¡ì•„ì¢ ã† KTP ë ˆì´ì €

Tracheostomy, respiratory support, and developmental outcomes in neonates with severe lung diseases: Retrospective study in one center

ObjectivesPediatric tracheostomy has evolved significantly in the past few decades and the optimal timing to perform it in children with respiratory assistance is still debated. The objective of this study was to describe the indications, timing, complications, and outcomes of infants on respiratory support who had a tracheostomy in a tertiary pediatric intensive care unit (PICU). MethodsAll children younger than 18 months of corrected age requiring respiratory support for at least 1 week and who had a tracheostomy between January 2005 and December 2015 were included. Their demographic and clinical data and their outcomes at 24 months of corrected age were collected and analyzed after approval from the CHU Sainte-Justine ethics committee. ResultsDuring the study period, 18 children (14 preterm infants, 4 polymalformative syndromes, and 2 diaphragmatic hernias) were included. The median corrected age at tracheostomy was 97 days (0–289 days) and 94.4% were elective. The indications for tracheostomy were ventilation for more than 7 days with (61.1%) or without (38.9%) orolaryngotracheal anomaly. The median number of consultants involved per patient was 16 consultants (10–23 consultants). The median hospital length of stay was 122 days (8–365 days) before tracheostomy and 235 days (22–891 days) after tracheostomy. The median invasive ventilation time was 68 days (8–168 days) before tracheostomy and 64 days (5–982 days) after tracheostomy. In terms of complications, there were nine cases of tracheitis and five cases of tracheal granulomas. At 24 months of corrected age, 17 of 18 children survived, one of/17 was still hospitalized, three of 17 were decannulated, three of 17 received respiratory support via their tracheostomy, 11 of 17 were fed with a gastrostomy, and all had neurodevelopmental delay. ConclusionTracheostomy in infants requiring at least 1 week of ventilation is performed for complex cases and is favored for orolaryngotracheal anomalies. Clinicians should anticipate the need for developmental care in this population.

Unilateral Renal Agenesis in Chilean-Flamingo (Phoenicopterus chilensis)

Background: Phoenicopterus chilensis is a South American wild bird classified a species near threatened in the National List of Endangered Species of the International Union for Conservation of Nature. With the increase of the contact between human population and wild animals, this species’ habitat is becoming increasingly vulnerable, with a declining population. Due to the importance of its conservation, the knowledge of abnormalities that affect this species becomes essential. This report aims to describe the first diagnosed case of unilateral renal agenesis in chilean-flamingo.Case: A captive male chilean-flamingo (Phoenicopterus chilensis) was found dead in its enclosure and then was referred at necropsy. The cause of death was the presence of tracheal fungal granuloma, caused by Aspergillus sp. Macroscopically, during the examination of the cellomatic cavity, the absence of the right kidney was noted, also evidencing the absence of the caudal renal vein. Emerging from the caudal division of the kidney was noted a blind-end renal vessel (Figure 1). For the histopathological examination, the remaining kidney was fixed in 10% formalin, processed by paraffin embedding technique and stained with Hematoxylin and Eosin (HE). When analyzing the left kidney parenchyma, preserved histological architecture was noted, without any changes in the tissue structures of the organ. Thus, no hypertrophy by compensatory mechanisms of the remaining kidney was observed (Figure 2).Discussion: Unilateral renal agenesis is a very rare congenital defect in dogs, cats and also in birds. It occurs in the complete absence of one of the kidneys, a situation with which the animal can live satisfactorily if there is a normal kidney to assume the functions. In association, ipsilateral ureteral agenesis and compensatory hypertrophy of the remaining kidney may occur. At the time of necropsy, due to the remaining kidney has normal size and within topographic limits, dorsally in contact with the pelvis and sinsacrum, the absence of compensatory hypertrophy was suspected, which was confirmed by histopathological examination. Clinical signs of unilateral renal agenesis, when present, are related to renal failure. The signs develop when the remaining kidney fails to fully absorb the other's functions and fails to maintain the organism's homeostasis. In the case of this report, the specimen showed no clinical signs related to renal agenesis, probably because was no functional compensation for the single kidney. This condition was only noticed after flamingo necropsy, who death because tracheal fungal granuloma, caused by Aspergillus sp. Other reported ways of diagnosing this malformation in animals while alive were imaging and abdominal cavity surgery. The etiopathogenesis of unilateral renal agenesis in animals is uncertain, however, the hereditary cause is commonly described in rats and small animals. It cannot be concluded that the same happened with the animal of this study due to the fact of lack of data regarding the parents and history of animal. It is concluded that in unilateral renal agenesis, the compensatory hypertrophy of the remaining kidney and any clinical symptoms may not be present. Necroscopic and complementary exams are essential to obtain the diagnosis of unilateral renal agenesis. Knowing that the chilean-flamingo is considered as a species near threatened of extinction, it is important to know the abnormalities that affect this species, because this information may be essential for conservation programs.

The History of Sleep Surgery.

Snoring and the subsequent diagnosis of obstructive sleep apnea (OSA) was a life-threatening medical condition with no available treatment until the late 20th century. An early description of OSA was provided by Charles Dickens in his 1836 novel Pickwick Papers with the description of a "fat boy" who was thought to be lazy and always falling asleep but likely displayed hypersomnolence from OSA. It was not until 1976 that Ikematsu first described uvulopalatopharyngoplasty (UPPP) as an alternative surgical treatment of "snoring," with a reported cure rate of 81%. The only other surgical procedure for OSA was permanent tracheostomy, but patients suffered from social stigma from the visible stoma with skin flaps and complications such as tracheal granulomas and tracheitis. UPPP was introduced in the USA as an alternative to permanent tracheostomy by Fujita in 1981. Since then, multiple surgical approaches and combinations of approaches have surfaced, with variable success rates.

喘息と誤診されたため著明な気道狭窄を来した気管内肉芽腫の1例

喘息と誤診されたため著明な気道狭窄を来した気管内肉芽腫の1例

Anterior tracheal wall mass following longstanding tracheostomy causing airway obstruction: Airway management and an innovative surgical approach

ABSTRACT An important longstanding complication of tracheostomy is tracheal granuloma, others being tracheal stenosis, mucus plug obstruction, etc. These complications may be life-threatening, if the obstruction is significant enough to cause airway compromise. Airway management and adequate access for surgery are mandatory challenges in a compromised airway which is shared between surgeon and anaesthesiologist. Fiberoptic bronchoscopy (FOB) is the gold standard tool for preoperative evaluation and awake intubation using cuffed Microlaryngeal tube in these patients. Trans-stomal approach with short-length wide-lumen endoscope is useful for the safe and complete excision of the anterior tracheal wall mass. Copyright © 2014, Indian Journal of Medical Specialities. Published by Reed Elsevier India Pvt. Ltd. All rights reserved.

Tracheal granuloma after thyroidectomy with difficult intubation

Tracheal complications after endotracheal intubation or tracheostomy include tracheal stenosis, ulcers, granulomas and tracheomalacia [1]. Of these, tracheal granuloma is a rare complication, and common on the anterior wall of the subglottis [2]. We experienced a case in which a patient with symptoms of airway obstruction due to tracheal granuloma after total thy roidectomy underwent resection of a tracheal granuloma and anastomosis under general anesthesia after bronchoscopy. A 55-year-old male patient had undergone total thyroid ectomy due to thyroid cancer. However, symptoms of upper respiratory infection, cough and sputum, continued after discharge. After 4 months, stridor and dyspnea developed, and flexible bronchoscopy was performed to assess. A granuloma about 1 cm × 1 cm in size was found 3 cm below the vocal cords on fiberoptic bronchoscopy. The patient was transferred to our hospital for diagnosis and treatment using interventional rigid bronchoscopy. According to the history of the first operation, the patient was 166 cm tall and, weighed 73 kg, with a body mass index of 26, classified as, mildly overweight. He had had predictive signs of difficult intubation: short neck, Mallampati class III, thyromental distance of 2 fingerbreadths. He had not had any respiratory symptoms. A 1.5 cm × 1.0 cm-sized thyroid cancer was founded, but no abnormal findings at any other sites were noted on neck computed tomography (CT) scan. On laryngoscopy, the patient’s airway was classified as CormackLehane grade IIIa. His trachea was intubated using an ID 6.5 mm endotracheal tube with stylet after trials with an ID 8.0 mm reinforced an endotracheal tube and an ID 7.0 mm plain endotracheal tube with inserted stylet. The cuff volume was about 5 cc. Anesthesia was adequately maintained with N2O-O 2sevoflurane at bispectral index 44 -58 during the thyroidectomy. The surgeon placed a 10 cm high pillow under the shoulder and extended the neck simultaneously for the thyroid surgery. The operating time for the thyroidectomy was 84 minutes. In our hospital, CT scan revealed a polypoid mass about 1 cm in length with erosion of cartilage in the right lateral aspect of the upper trachea, along with tracheal stenosis (Fig. 1A). To facilitate the performance of rigid bronchoscopy, propofol and remifentanil were used with rocuronium as anesthetic agents. However, the rigid bronchoscopy could not be performed because the patient had a short neck and limited neck extension. Therefore, the tracheal granuloma was inspected by flexible bronchoscopy instead of rigid bronchoscopy (Fig. 1B), and the trachea was intubated by guided flexible bronchoscopy using an ID 6.5 mm endotracheal tube. The decision was made to perform surgery on the patient in the Department of Thoracic Surgery on the following day. During the second operation, the tracheal region including the granuloma was resected and the trachea was anastomosed under general anesthesia using N2O-O 2-sevoflurane. A 1.0 cm × 1.0 cm-sized granuloma was located on the lower cricoid car tilage and stenotic change was observed around the granuloma. As a result of this tissue biopsy, the mass was diagnosed as a typical granuloma with ulcer and sclerosis. Because this patient had undergone thyroidectomy due to thyroid cancer, we assumed that a mass in the trachea might be caused by extended cancer. However, the mass was located at the region of the tube-tip and had a yellowish and smooth sur

A Patient with Trisomy 15 and Subglottic Tracheal Granuloma: Anesthetic Management for Emergency Rigid Bronchoscopy

Trisomy 15 is a rare genetic disorder presenting unique anesthetic challenges. This is a case of a patient with Trisomy 15 and unrepaired ventriculo-septal defect presented for emergent removal of a subglottic tracheal granuloma. Developed anesthetic plan allowed the patient to breathe spontaneously with a combination of inhalational and intravenous anesthetics. Our technique offered optimal operating conditions and adequate depth of anesthesia. The important points of the case include an understanding of the physical characteristics of a patient with Trisomy 15 and unrepaired ventriculo-septal defect and an anesthetic plan for emergent removal of an obstructing subglottic granuloma via rigid bronchoscopy.

Causes and Outcome of Tracheostomy in Children

Purpose: Tracheostomy is used to aid airway management in perdiatric respiratory care. This study was designed to review causes and outcomes of pediatric tracheostomy. Methods: We performed a retrospective chart review of 153 patients, less than 18 years of age, who underwent tracheostomy between January 1995 and July 2010. Age at tracheostomy, indications, durations, complications and mortality were evaluated. Results: Subglottic stenosis (19%) was the most common indication for tracheostomy. The median age at tracheostomy was 1.3 years (range, 22 days to 17.8 years). Seventy-three (47.7%) tracheostomies were performed in children under 1 year of age. Respiratory diseases were significantly more prevalent in patients under 1 year of age, while neuromuscular disease were more frequently found in patients older than 1 year (P=0.013). Stoma or tracheal granuloma formation (36.6%) was the most common complication of pediatric tracheostomy. Decannulation was accomplished in 61 (39.9%) patients with median cannulation time of 141 days (range, 1 to 2,529 days). Overall mortality rate was 10.5% (n=16), but only one patient (0.7%) died from tracheostomy-related complications. Conclusion: Respiratory diseases, such as subglottic stenosis and neuromuscular disease, are the main cause of pediatric tracheostomy. Although complications, like stoma or tracheal granuloma formation occur, tracheostomy in children is a safe way to aid airway management. [Pediatr Allergy Respir Dis(Korea) 2012;22:188-196]

Tracheal granuloma pyogenicum with erlotinib treatment for lung cancer

To the Editors: We present the case of a 64 yr-old ex-smoker (20 pack-yrs) with a squamous cell carcinoma of the lung who developed a tracheitis and granuloma pyogenicum during treatment with erlotinib. Among the specific side-effects of epidermal growth factor receptor (EGFR) inhibitors, paronychia with granuloma pyogenicum has been reported frequently; however, granuloma pyogenicum has never been described in the trachea with erlotinib treatment. Monoclonal antibodies against the EGFR ( e.g. cetuximab) and EGFR tyrosine receptor inhibitors (TKIs) ( e.g. gefinitib and erlotinib) have been shown to improve treatment outcomes in nonsmall cell lung cancer. Generally, these agents are better tolerated than classical cytotoxic agents showing a different toxicity profile. Specific side-effects of EGFR-targeting agents include diarrhoea and particularly skin toxicity, such as acneiform eruptions, xerosis, eczema, fissures, teleangiectasia, hyperpigmentation, hair changes and paronychia with granuloma pyogenicum [1]. Skin toxicity has been associated with EGFR inhibitor antitumor activity [1]. A 64 yr-old male was diagnosed with squamous cell carcinoma of the right upper lobe and was treated with a right upper lobectomy in December 2002 (pathological (p)T1 pN1 (three positive lymph nodes out of 33 removed)). No adjuvant …

Subacute Airway Obstruction Caused by a Suprastomal Tracheal Granuloma following Tracheotomy in an Adult

We report a case of a post-tracheotomy suprastomal granuloma in the early postoperative phase that caused subacute airway obstruction in a 28-year-old woman. The patient had undergone the tracheotomy during the surgical treatment of a submental abscess. During recovery, several capping trials had failed. Therefore, direct laryngoscopy was performed on postoperative day 11, and it revealed that the airway was being obstructed by a tracheal granuloma. The granuloma was managed with a partial resection and corticosteroids. The patient was successfully decannulated with no recurrence of the granuloma. To the best of our knowledge, airway obstruction secondary to a tracheal granuloma has not been previously reported as an early complication of a traditional surgical tracheotomy in an adult. In this report, we discuss the presenting features of this case and we propose several possible etiologies.

Tracheostomy timing in traumatic spinal cord injury

The study conducted is the retrospective study and the main objective is to evaluate the benefits and safety of early versus late tracheostomy in traumatic spinal cord injury (SCI) patients requiring mechanical ventilation. Tracheostomy offers many advantages in critical patients who require prolonged mechanical ventilation. Despite the large amount of patients treated, there is still an open debate about advantages of early versus late tracheostomy. Early tracheostomy following the short orotracheal intubation is probably beneficial in appropriately selected patients. It is a retrospective clinical study and we evaluated clinical records of 152 consecutive trauma patients who required mechanical ventilation and who received tracheostomy. The results show that the early placement (before day 7 of mechanical ventilation) offers clear advantages for shortening of mechanical ventilation, reducing ICU stay and lowering rates of severe orotracheal intubation complication, such as tracheal granulomas and concentric tracheal stenosis. On the other hand, we could not demonstrate that early tracheostomy avoids neither risk of ventilator-associated pneumonia nor the mortality rate. In SCI patients, the early tracheostomy was associated with shorter duration of mechanical ventilation, shorter length of ICU stay and decreased laryngotracheal complications. We conclude by suggesting early tracheostomy in traumatic SCI patients who are likely to require prolonged mechanical ventilation.

Tracheal granuloma because of infection with a novel mycobacterial species in an old FIV‐positive cat

A 15-year-old domestic shorthair feline immunodeficiency virus-positive cat was presented with a five day history of productive cough and acute respiratory distress. Physical examination revealed inspiratory dyspnoea and diffuse gingivostomatitis. Radiographs showed an intratracheal mass located at the level of the sixth and the seventh cervical vertebrae. Bronchoscopy revealed a unique intratracheal mass occluding about 85 per cent of the tracheal lumen. The tracheal mass was removed bronchoscopically. A diagnosis of pyogranulomatous inflammation referable to a mycobacterial infection was made based on cytological and histopathological findings. 16S rRNA polymerase chain reaction testing and sequence analysis identified a novel mycobacterial species, likely a slow grower, with 95 per cent identity with Mycobacterium xenopi. To our knowledge, this is the first description of a tracheal mycobacterial granuloma in a cat, and the first time, a mycobacterium with this sequence has been identified.

Coblation removal of large suprastomal tracheal granulomas

The LaryngoscopeVolume 119, Issue 2 p. 387-389 Orginal Article Coblation removal of large suprastomal tracheal granulomas Dennis J. Kitsko DO, Corresponding Author Dennis J. Kitsko DO [email protected] Department of Pediatric Otolaryngology, Children's Hospital of Pittsburgh, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, U.S.A.Department of Pediatric Otolaryngology, Children's Hospital of Pittsburgh, University of Pittsburgh School of Medicine, 3705 Fifth Ave, Pittsburgh, PA 15213Search for more papers by this authorDavid H. Chi MD, David H. Chi MD Department of Pediatric Otolaryngology, Children's Hospital of Pittsburgh, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, U.S.A.Search for more papers by this author Dennis J. Kitsko DO, Corresponding Author Dennis J. Kitsko DO [email protected] Department of Pediatric Otolaryngology, Children's Hospital of Pittsburgh, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, U.S.A.Department of Pediatric Otolaryngology, Children's Hospital of Pittsburgh, University of Pittsburgh School of Medicine, 3705 Fifth Ave, Pittsburgh, PA 15213Search for more papers by this authorDavid H. Chi MD, David H. Chi MD Department of Pediatric Otolaryngology, Children's Hospital of Pittsburgh, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, U.S.A.Search for more papers by this author First published: 26 January 2009 https://doi.org/10.1002/lary.20035Citations: 13Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat Citing Literature Volume119, Issue2February 2009Pages 387-389 RelatedInformation

Endoscopic surgery for treatment of paediatric upper airway diseases

Abstract In September 2005, the 3rd OPBG/Mayo Clinic Joint Conference was held in Rome to highlight current views in paediatric medicine. After an overview of the various pathologies, the Otolaryngology Unit of the Bambino Gesù Children's Hospital of Rome described their own experience with endoscopic surgery for the treatment of upper airway diseases between 2002 and 2004. During this period, 1500 paediatric endoscopies were performed for obstructive upper airway disease. A total of 80% of patients were under 2 years of age. The aetiological causes of upper airway obstruction most frequently cited were: foreign bodies (the most frequent reason for urgent endoscopic treatment), choanal atresia, severe laryngomalacia, laryngeal cysts, neurological lesions (vocal fold paralysis), laryngeal clefts, laryngeal haemangiomas, recurrent respiratory papilloma, tracheoesophageal fistula, tracheal granuloma and tubercular adenobronchial fistula. In all the patients, stridor disappeared following surgery. No complications, such as aspiration or supraglottic stenosis, were identified and no revision surgeries were required. Stenting was necessary in only three cases. This study described the OPBG management of paediatric airway obstruction and outcomes during a 3-year period and was the starting point for reflection on this topic.

Hemorrhage due to tracheoarterial fistula with severe motor and intellectual disability

Tracheoarterial fistula (TAF) is an unusual but highly lethal complication of tracheostomy, and successful surgical intervention for TAF has been reported. Few investigations are available for TAF in severe motor and intellectual disability (SMID). The aim of the present paper was to analyzed TAF in SMID to clarify which clinical variables might predict the occurrence of TAF, and adequate management for lifesaving. Medical records at Metropolitan Fuchu Medical Center were retrospectively investigated for SMID between 1970 and 2000, and 10 TAF patients verified on operation or autopsy were identified. Details were reviewed including clinical status, emergency treatment at the occurrence of TAF, and operation and/or autopsy recordings. Four of 10 patients underwent successful operation and survived, while the other six died from hemorrhagic shock. Eight patients had tracheoinnominate artery fistula, the others had tracheocarotid artery fistula. Characteristic features as SMID such as etiology of brain disease, muscle tonus and convulsion were no apparent relevance to occurrence of TAF. All patients suffered from endotracheal granuloma extending to the arterial walls. Seven of 10 patients had re-bleeding after stabilization of the first massive hemorrhage, especially fiber bronchoscopy to confirm the diagnosis of TAF precipitated to fatal re-bleeding. One patient underwent interruption of the artery at relapse of TAF, the other three underwent suturing and had good outcome. There were no apparent predictors of TAF in SMID. Tracheal granuloma was recognized and consequent on formation of TAF, so control of granuloma may prevent TAF. Fiber bronchoscopy for suspected TAF is not recommended because it precipitates fatal bleeding.