Tracheostomy Tube Research Articles

Decannulation Timing is an Expression of Neurological Recovery Time: The Need to Define a Performance within a Time Frame

Introduction: The factors that influence the likelihood of tracheostomy tube weaning in patients with severe acquired brain injury (sABI) are fairly well known, and recently it has been pointed out that improving swallowing and cough resistance are among the most important. What has not yet been focused on is the “passage of time” factor and how much it affects weaning opportunities. Objective: With this study, we wanted to analyze how the probability of decannulation varies over time, consistent with neurological improvement. Method: We examined the tracheostomy database of our neurological rehabilitation unit, which reports data from 359 patients with sABI, hospitalized between 2000 and 2012, and all carriers of tracheostomy tube upon admission. The sample was divided into two groups based on the time gap between the acute event and admission to rehabilitation, an Early Group = 60 days and a Late Group > 60 days. The probability of decannulation, both overall and subdivided by groups, was then evaluated. Results: The E-Group showed better functional scores at discharge and a better percentage of decannulation compared with the L-Group. The differences were statistically significant, but later decannulations were not unusual: 12% late weanings versus 88% earlier. The probability of decannulation increases over time and is a factor dependent on the degree of neurological and functional recovery. It is of primary importance to consider these aspects when making comparisons between different centers, defining a product standard or performing benchmarking analyses. Conclusions: The rehabilitative prognosis for decannulation can be reliably judged only after a suitable and well-defined period of time, because the probability of tube weaning has been shown to be strongly dependent on the amount of time that passes. This study also showed that effective decannulations can be achieved even more than 6 months after the acute event, although with significantly lower probabilities.

ODP489 Insular Thyroid Cancer: A Rare Case of Undifferentiated Thyroid Carcinoma

Abstract Introduction Insular thyroid cancer (ITC) is a rare form of thyroid cancer derived from follicular cells. ITC requires a histopathologic diagnosis and has an intermediate morphology between well differentiated thyroid cancers (follicular and papillary) and undifferentiated thyroid cancer (anaplastic). The rate of metastasis and mortality are higher compared with well-differentiated thyroid carcinomas. Case presentation A 74-year-old woman presented for a 1 year history of rapidly progressive neck mass associated with neck pain, limited neck motion, loss of appetite, weight loss, and dysphagia. Past medical history included hypertension, type 2 diabetes, dyslipidemia, and vitamin D deficiency. There was no history of neck radiation or family history of cancer. Physical examination revealed a 10×7 cm neck mass with cervical adenopathy. Vital signs were unremarkable. Laboratory studies showed TSH of 0.71 uIU/mL (0.270-4.200), free T4 of 0.57 ng/dL (0.93-1.70) and thyroglobulins of 213.616 ng/dL (1.6-59.9). Neck CT demonstrated a multilobulated mass in the left thyroid lobe measuring 12×5.2×5.6 cm with tracheal deviation, multiple nodules surrounding the carotids and bone metastasis. Fine needle aspiration showed a mixed pattern of thyroid follicles. An excisional biopsy showed nests and sheets of small uniform cells with scattered abortive follicles and mitosis consistent with ITC. There was no necrosis. The Ki67 index was 10-20%. On immunohistochemical analysis TTF1 and thyroglobulin were positive and P63, calcitonin, and PTH were negative. Tracheostomy and PEG tube placement were required due to mass obstructive effect. Radiation and steroids were initiated before starting lenvatinib. The patient was not a surgical candidate due to tumor extension to the carotids. She ultimately succumbed to the disease after a 45-day hospital course complicated by pneumonia. Discussion ITC is a rare type of thyroid tumor with a mortality rate of 12-75%. The diagnosis is based on histopathology, demonstrating solid nests (insulae) of small, uniform carcinoma cells, small follicles containing thyroglobulin, frequent necrotic foci and variable mitotic activity. The tumor cells in ITC are derived from poorly differentiated follicular cells expressing thyroglobulin. The immunostaining of thyroglobulin differentiates ITC from other poorly differentiated thyroid tumors. In this case the immunohistochemical analysis was positive for thyroglobulin and negative for calcitonin, which confirmed that the tumor cells were follicular in origin 1 . ITC behaves differently compared with other thyroid carcinomas, with more frequent metastasis and lower average 20-year post-diagnosis survival. Our patient had other characteristics that conferred a poor prognosis, including advanced age, high rate of mitosis, and multiple metastases. Although surgery and radioactive iodine are first line, this patient's tumor extension required alternative therapies. Radiotherapy and lenvatinib, a tyrosine kinase receptor inhibitor, were employed unsuccessfully. 1. Soza, J., et al. Insular Thyroid Cancer. Cancer, 3260-3267. Presentation: No date and time listed

Prevention of Tracheostomy-Related Pressure Injury: A Systematic Review and Meta-analysis.

In the critical care environment, individuals who undergo tracheostomy are highly susceptible to tracheostomy-related pressure injuries. To evaluate the effectiveness of interventions to reduce tracheostomy-related pressure injury in the critical care setting. MEDLINE, Embase, CINAHL, and the Cochrane Library were searched for studies of pediatric or adult patients in intensive care units conducted to evaluate interventions to reduce tracheostomy-related pressure injury. Reviewers independently extracted data on study and patient characteristics, incidence of tracheostomy-related pressure injury, characteristics of the interventions, and outcomes. Study quality was assessed using the Cochrane Collaboration's risk-of-bias criteria. Ten studies (2 randomized clinical trials, 5 quasi-experimental, 3 observational) involving 2023 critically ill adult and pediatric patients met eligibility criteria. The incidence of tracheostomy-related pressure injury was 17.0% before intervention and 3.5% after intervention, a 79% decrease. Pressure injury most commonly involved skin in the peristomal area and under tracheostomy ties and flanges. Interventions to mitigate risk of tracheostomy-related pressure injury included modifications to tracheostomy flange securement with foam collars, hydrophilic dressings, and extended-length tracheostomy tubes. Interventions were often investigated as part of care bundles, and there was limited standardization of interventions between studies. Meta-analysis supported the benefit of hydrophilic dressings under tracheostomy flanges for decreasing tracheostomy-related pressure injury. Use of hydrophilic dressings and foam collars decreases the incidence of tracheostomy-related pressure injury in critically ill patients. Evidence regarding individual interventions is limited by lack of sensitive measurement tools and by use of bundled interventions. Further research is necessary to delineate optimal interventions for preventing tracheostomy-related pressure injury.

Voice rehabilitation after laryngectomy: problems, complications and ways of their elimination

Voice rehabilitation after laryngectomy: problems, complications and ways of their elimination

Aspiration of a fractured tracheostomy tube, a rare complication of tracheotomy: the factors involved in this incident and literature review

<p class="abstract">Tracheostomy is executed routinely for several indications. It is a safe and life-saving procedure. In some cases, the tracheostomy tube has to be maintained for a long duration. We report a rare case of aspiration of a fractured tracheostomy tube. In the light of the literature, we reported the various factors leading to complications of tracheotomy. A 5-year-old boy, presenting to the emergency department for aspiration of a fractured tracheostomy tube accidentally during a cleaning process by his mother. On clinical examination, the patient was slightly symptomatic. A flexible bronchoscopy was made which objectified the presence of the cannula in the trachea, an additional chest X-ray was taken, which revealed the aspirated tracheostomy tube in the trachea and right main bronchus. Extraction was done by rigid bronchoscopy under general anesthesia. The postoperative course of the patient remain uneventful. In order to reduce the potentially fatal complications of the tracheotomy, it is necessary to insist on a regular medical follow-up.</p>

Development and validation of a nomogram for decannulation in patients with neurological injury: A prognostic accuracy study.

Tracheostomy is a lifesaving procedure provided for patients with severe neurological injury. However, there is a lack of clarity about whether patients can be decannulated within 6 months in those receiving tracheostomy and what factors can be detected as a predictor for decannulation. The objective of this study was to explore predictive factors of decannulation in patients with neurological injury receiving tracheostomy within 6 months and construct a novel nomogram model for clinical diagnosis and treatment. This retrospective observational study enrolled patients with neurological injury who were admitted to the ICU of neurosurgical department in the First Affiliated Hospital of Nanjing Medical University between January 2016 and March 2021. Patients were divided into decannulation group and cannulation group according to whether tracheostomy tube removal was performed within 6 months after tracheostomy. Multivariable logistic regression analysis was performed to determine associated risk factors with a bootstrap backward selection process. The nomogram to assess the probability of decannulation at 6 months was constructed based on the regression coefficients of the associated factors and validated by bootstrap resampling. Model performance was measured by examining discrimination (Harrell's C-index), calibration (calibration plots), and utility (Kaplan-Meier curves stratified by the tertile of the predicted probability calculated and subgroup analysis stratified by age and intervention). A total of 40.1% (147/367) of patients decannulated within 6 months. Significant variables in multivariable logistic regression analysis were age (odds ratio [OR], 0.972; 95% confidence interval [CI], 0.954-0.990), National Institutes of Health Stroke Scale (NIHSS) score (OR, 0.936; 95% CI, 0.911-0.963), early rehabilitation (OR, 5.062; 95% CI, 2.889-8.868), shock (OR, 0.175; 95% CI, 0.058-0.533), and secondary surgery (OR, 0.210; 95% CI, 0.078-0.566). The area under receiver operating characteristic curve estimated with these variables was of 0.793 (95% CI, 0.747-0.838; P < 0.001). A nomogram prediction model was constructed to predict the probability of decannulation in tracheostomized patients with a concordance index of 0.788 after internal validation. We developed a nomogram that can predict the probability of decannulation within 6 months in tracheostomized neurological injury patients. The nomogram, including age, NIHSS scores, early rehabilitation, shock, and secondary surgery, may assist clinicians in estimating patients' prognosis.

Assessing Radiology Practice Patterns for Obtaining MRI in Pediatric Patients with MR-Conditional Tracheostomy Tubes.

Silicone tracheostomy tubes are a popular choice for pediatric patients with chronic tracheostomies due to their pliability and increased comfort. However, the presence of wire reinforcement causes them to be labeled "MR-conditional." The objective of this study was to understand practice patterns across radiology departments for obtaining MRI in children with MR-conditional tracheostomy tubes. A survey consisting of 7 questions aimed at determining a facility's protocol for obtaining MRI in children with tracheostomy tubes was developed and administered via telephone to MRI technologists at US children's hospitals. 182 children's hospitals were identified and 59 responses were obtained across 30 states (32.4%). 19 sites (32%) were excluded as they were unable to perform MRI. All 40 facilities reported that they have a standard questionnaire for medical implants, however only 20 reported that tracheostomy tubes are included on that questionnaire (50%). 6 (15%) reported all MR-conditional tubes are changed to MR-safe ones. Of the remaining 34, protocols were as follows: 1 (2.9%) scans patients with conditional tubes for a maximum of 15 minutes, 5 (14.7%) only use a 1.5T magnet, and 28 (82.3%) reported following the manufacturer conditions. In terms of artifact, 3 sites change MR-conditional tubes to MR-safe if scanning the head, neck, chest, or abdomen (8.8%), 6 (17.6%) change the tube if scanning the head or neck, 15 (44.1%) change the tube only if scanning the neck, and 10 (29.4%) were not aware of issues with artifact. Based on this survey of MRI technologists at US children's hospitals, there is no unified protocol for obtaining MRI in pediatric patients with MR-conditional tracheostomy tubes. A lack of standardized protocols may be contributing to unnecessary tracheostomy changes. Future research includes clearly defining the anatomical regions affected by wire-related artifact and developing a standardized MRI protocol for these patients.

An unusual foreign body in the trachea: A broken PVC tracheostomy tube

In patients with upper airway obstruction and on long-term ventilatory support, tracheostomy is often needed. One rare complication of the same is fracture and aspiration of distal portion into the lower airway, mainly seen in metallic tubes. We report a very rare case, where aspiration of fractured PVC tracheostomy tube occurred, which was successfully removed by rigid bronchoscopy. The etiology and prevention measures are also being reviewed.

Chronic tracheostomy care of ventilator-dependent and -independent children: Clinical practice patterns of pediatric respirologists in a publicly funded (Canadian) healthcare system.

To describe the current clinical practice patterns of Canadian pediatric respirologists at pediatric tertiary care institutions regarding chronic tracheostomy tube care and management of home invasive ventilation. A pediatric respirologist/pediatrician with expertise in tracheostomy tube care and home ventilation was identified at each Canadian pediatric tertiary care center to complete a 59-item survey of multiple choice and short answer questions. Domains assessed included tracheostomy tube care, caregiver competency and home monitoring, speaking valves, medical management of tracheostomy complications, decannulation, and long-term follow-up. The response rate was 100% (17/17) with all Canadian tertiary care pediatric centers represented and heterogeneity of practice was observed in all domains assessed. For example, though most centers employ Bivona™ (17/17) and Shiley™ (15/17) tracheostomy tubes, variability was observed around tube change, re-use, and cleaning practices. Most centers require two trained caregivers (14/17) and recommend 24/7 eyes on care and oxygen saturation monitoring. Discharge with an emergency tracheostomy kit was universal (17/17). Considerable heterogeneity was observed in the timing and use of speaking valves and speech-language assessment. Inhaled anti-pseudomonal antibiotics are employed by most centers (16/17) though the indication, agent, and protocol varied by center. Though decannulation practices varied considerably, the requirement of upper airway patency was universally required to proceed with decannulation (17/17) independent of ongoing ventilatory support requirements. Considerable variability in pediatric tracheostomy tube care practice exists across Canada. These results will serve as a starting point to standardize and evaluate tracheostomy tube care nationally.

PITFALLS OF PERCUTANEOUS TRACHEOSTOMY PLACEMENT

PITFALLS OF PERCUTANEOUS TRACHEOSTOMY PLACEMENT

Response to "An Interprofessional Approach to Preventing Tracheostomy-Related Pressure Injuries".

We read with great interest the recent quality improvement initiative by Urquhart et al,1 focused on preventing tracheotomy-related pressure injuries (TRPIs). The authors addressed an important gap in tracheostomy research, and we are encouraged to see that with the TRPI-prevention bundle, the daily rate of TRPIs decreased by 50%. Although this is a strong improvement in patient care, this effort also indicates that a TRPI-prevention bundle alone may not be enough to prevent TRPIs in patients with tracheostomies. What the initiative did not include was the type of tracheostomy tube used and whether enhanced tracheostomy tube design can impact the incidence of TRPI. Adverse events and outcomes for tracheostomy patients are relatively understudied, particularly for conditions such as skin infections and TRPI. Although pressure injuries are defined by the CMS as “never events,” previous literature has suggested that approximately 11% to 13% of patients requiring a tracheostomy develop TRPIs.2,3 With the arrival of newer tracheostomy tube designs, it is possible that the incidence of some adverse events may decrease. For example, the Shiley flexible tracheostomy tube has a clear, soft flange, which was designed to reduce contact with the stoma site and increase air flow. This enhanced feature may help clinicians detect skin breakdown through visualization of the underlying skin, which could enable clinicians to intervene earlier to prevent TRPI. Other tracheostomy tube manufacturers have developed similar design features and warrant evaluation in a clinical setting. We hope additional clinical research will build off of the work of Urquhart et al and examine adverse events such as TRPIs while incorporating how modern tracheostomy tube designs may impact patient outcomes. —Ulf Borg; Adrian D’Angelo, MSN, RN, FNP; andKatherine E. Liu, PhD Medtronic, Boulder, Colorado

IATROGENIC PNEUMOMEDIASTINUM AND PNEUMOTHORAX AFTER SMALL-BORE FEEDING TUBE PLACEMENT IN A PATIENT WITH EHLERS-DANLOS SYNDROME

IATROGENIC PNEUMOMEDIASTINUM AND PNEUMOTHORAX AFTER SMALL-BORE FEEDING TUBE PLACEMENT IN A PATIENT WITH EHLERS-DANLOS SYNDROME

Coblation Cordotomy for the Management of Bilateral Vocal Fold Immobility

Bilateral vocal fold immobility (BVFI) has an impact on both the voice and breathing. Many procedures have been developed to manage BVFI including the use of a coblator to perform a unilateral posterior cordotomy. This study evaluated the use of unilateral coblator cordotomy for BVFI. Retrospective chart review. Ninety-four patients having undergone coblation cordotomies for BVFI performed by surgeons at two different institutions. Parameters evaluated were etiology of BVFI, prior tracheotomy, the number of revision procedures, postoperative decannulations, breathing outcomes as measured by Dyspnea Index, and voice outcomes as measured by the Voice Handicap Index. The main causes of immobility were thyroidectomy and prolonged endotracheal intubation. Twenty-one procedures were performed in patients who had a tracheotomy already in place, two required concurrent tracheotomy with cordotomy, and two underwent tracheotomy some time after cordotomy. The mean follow up was 16 months (1-38 months). Of the 25 patients who had a tracheotomy tube placed before or during the course of their care, we were unable to decannulate four of them after initial or revision cordotomy. Twenty of our 94 patients required a secondary revision unilateral cordotomy, usually on the previously un-operated vocal fold. This was more common in bilateral fixation than in paralysis. In 44 patients where Voice Handicap Index data was known both pre- and postoperatively, the median VHI scores improved from 62.2 to 37.4, while the VHI worsened in only four patients. Eight patients had a Dyspnea index performed both pre- and post-operatively and the median score dropped from 18.3 to 12.5. Coblation cordotomy is a reasonable option for vocal fold lateralization in BVFI. In our study, this method allowed for decannulation in 21 of 25 patients who had a tracheotomy. The initial coblator cordotomy was sufficient for the majority of patients, with 22% (20/94) requiring a revision procedure. Interestingly, our study also showed promising voice outcomes with improvements in VHI in all but four patients.

Biofilm Producing Pseudomonas Aeruginosa in Patients with Lower Respiratory Tract Infections

Background and Aim: Pseudomonas aeruginosa is a vital pathogen causing major life-threatening infections among respiratory disease patients that leads to higher morbidity and mortality. Lower respiratory tract infections (LRTIs) are amongst these infections commonly found in hospitalized patients. Antibiotic tolerant biofilms formation and bacterium high intrinsic resistance to antibiotics make these infections difficult to treat. The present study aimed to assess the biofilm producing pseudomonas aeruginosa in lower respiratory tract infections patients. Methodology: This cross-sectional study was carried out on 246 Lower respiratory tract infections patients admitted to ICUs of Sharif Medical and Dental College Lahore and Mohi-ud-Din Teaching Hospital, Mirpur Azad Kashmir for the duration from June 2021 to December 2021. The signs and symptoms of LRTIs were investigated in each patient. Prior to study conduction, ethical approval was obtained from the institutes research and ethical committee. Each individual provided written informed consent. Identification of isolated organisms and antimicrobial sensitivity was done. Microtiter method was used for all the isolated, to imperil the isolates of P. aeruginosa for biofilm detection. SPSS version 25 was used for the data analysis. Results: Of the total 246 specimens consisted of sputum 198 (80.5%), pleural fluid 19 (7.7%), suction tube 16 (6.5%), and tracheostomy tip specimens 13 (5.3%). The incidence of positive culture was 78 (31.7%). Out of 78 positive cultures, sputum 56 (71.8%) was the major factor followed by pleural fluid 3 (3.8%), suction tube 12 (15.4%) and tracheostomy tip 7 (9.0%). Of the 78 positive specimens, the prevalence of single bacterium and poly-microbial infection was 58 (74.4%) and 20 (25.6%) respectively. The poly-microbial infection consisted of sputum 10 (50%), pleural fluid 1 (5.0%), suction tube 6 (30.0%), and tracheostomy tube 3 (15%). Out of 78 positive culture specimens, isolated gram-negative bacteria were 102, out of which K. pneumonia and P. aeruginosa were present in 46 (45.1%) and 24 (23.5%) respectively. Regarding the resistance pattern of gram-negative respiratory pathogens, Cefepime (86.9%) and ceftriaxone (91.9%) were given higher resistance by K. pneumoniae. Likewise, higher numbers of Acinetobacter spp provided resistance to cefepime (86.7%) and ceftriaxone (87%). Out of 24 P. aeruginosa isolates, biofilm producers were found in 16 isolates, in which the incidence of strong, moderate, and weak biofilm producers was 3 (18.7%), 5 (31.3%), and 8 (50%) respectively. Sputum in 11 (68.8%) was the prevalent biofilm producer isolates followed by suction tube 4 (25%) and tracheostomy tube 1 (6.3%). The incidence of inpatients and outpatients were 15 (93.8%) and 1 (6.2%) respectively. Conclusion: Our study concluded that gram-negative bacteria was the predominant and had increased resistance to antibiotics in Lower respiratory tract infections (LRTIs) patients. In LRTIs, the most common organism was K. pneumonia. Also, P. aeruginosa isolated in LRTIs patients were susceptible to producing biofilm. Biofilm producers had higher resistance than biofilm non-producers. Keywords: Biofilm producing P. aeruginosa, K. pneumonia, Lower respiratory tract infections

Utility of telemedicine in tracheostomy-dependent children.

Telemedicine can improve access to pediatric otolaryngology care by decreasing travel time and cost, and lowering the risk of viral transmission during the SARS-CoV-2 (COVID-19) pandemic. This study aims to identify the clinical role and outcomes of telemedicine for tracheostomy-dependent children before and during the COVID-19 pandemic. Retrospective chart review of 42 tracheostomy-dependent pediatric patients who utilized telemedicine between October 2013 and April 2020 (pre-COVID-19), and 111 patients who utilized telemedicine between May 2020 and July 2021 (during COVID-19) at a tertiary free-standing children's hospital outpatient clinic. The majority of pre-COVID-19 telecommunication solely addressed tracheostomy stomal concerns as compared with during COVID-19 (99% vs. 3%, p < .001), while telecommunication during COVID-19 was mainly used for routine follow-up as compared with pre-COVID-19 (99% vs. 0%, p < .001). Telemedicine visits during COVID-19 were significantly less likely to result in the need for in-person office visits as compared with those pre-COVID-19 (4% vs. 22%; p < .001). There was no significant difference in urgent emergency department (ED) evaluation following telemedicine pre- and during COVID-19 (16% vs. 11%). The most common reasons for ED presentation both pre- and during COVID-19 following telemedicine visit included respiratory distress, dislodged tracheostomy tube, and tracheostomy bleeding. The clinical role of telemedicine has evolved from problem-based evaluation to routine follow-up during the COVID-19 pandemic. Although telemedicine can decrease the need for in-person office evaluation of routine tracheostomy concerns, respiratory complications and tracheostomy bleeding still require urgent in-person ED evaluation. Level 4.

An Incidental Discovery of a Serious Complication

An Incidental Discovery of a Serious Complication

Virtually Assisted Personalized Tracheostomy Tube Design in Pediatric Complex Airway Anomalies.

We sought to assess the feasibility of virtually assisted personalized tracheostomy tube (vapTT) implementation for patients with congenital airway anomalies (CAAs) and persistent tracheostomy tube (TT)-related respiratory failure at a tertiary pediatric hospital. Three patients (0-18 years) with CAAs and recurrent TT-related respiratory complications were managed with vapTT over 5 years. Patients underwent airway computed tomography acquisition with 3-dimensional reconstruction and TT virtual modeling for shape customization. Models were transferred to Bivona for fabrication based on industry-standard materials and processes. Clinical information and tracheoscopies assessing position, obstruction, and granulation were reviewed. Patients demonstrated resolution of visualized TT-related obstruction, granulation, or ulceration and de-escalation of respiratory support. Clinical events requiring urgent tracheoscopy decreased in all 3 patients. Sufficient relief of critical airway obstruction allowed progression of medical care and/or discharge. VapTTs are feasible for patients with CAA. This new frontier in personalized devices may serve uniquely challenging patient populations for whom standard treatments have failed.

Management of MACROGLOSSIA: Case Series and Suggested Algorithm

Idiopathic macroglossia is a rare entity of true tongue enlargement without an underlying etiology. There are only a few case reports on the diagnosis and management of idiopathic macroglossia. This study's purpose was to present a series of patients with idiopathic macroglossia and suggest a treatment algorithm. This was a retrospective case series of a cohort of patients with macroglossia who were treated by the Oral and Maxillofacial Surgery service at the University of Texas Health Science Center at Houston (UTHealth)and Emory University. The patient's medical comorbidities, history of present illness, clinical presentation, radiographic findings, and disease management were studied. The outcome variables include normalization of the tongue size, dependence on parenteral nutrition, and tolerating tracheostomy decannulation. Five patients with a mean age of 45years were included in the study. All of the patients (n=5, 100%) in our cohort developed macroglossia following prolonged oral intubation, with 3.5weeks being the average length of intubation. All patients presented with difficulty feeding orally and breathing. The average tongue dimension was 12.20 x 6.25cm. All tongue enlargements were located in the anterior 2/3 of the tongue, and all patients had displaced anterior dentition. In addition, 60% of the patients (n=3) experienced altered tongue sensation (pain and/or decreased taste). These patients were surgically managed with tracheostomy and percutaneous endoscopic gastrostomy (PEG) tube placement followed by partial glossectomy (n=5, 100%). We defined successful outcomes as 1) modifying the tongue to a functional, nonprotruding form, 2) tracheostomy decannulation and 3) PEG tube removal. Tracheostomy decannulation and PEG tube removal were achieved in 80% of the patients (n=4). In this patient cohort, we were unable to identify the cause of the pathology based on existing clinical data. When the etiology is unclear or irreversible, management should involve tracheostomy and surgical feeding access for the initial stabilization, followed by modified glossectomy to improve form, function, and cosmesis thereby improving the overall quality of life.

Respiratory pathology in a patient with muscular dystrophy

Abstract Duchenne muscular dystrophy (DMD) is a genetic neuromuscular disorder with X-linked inheritance, characterised by progressive motor deficit, causing loss of the ability to walk and multisystemic complications. Currently, there is no known aetiologic treatment for DMD which seeks to remove or correct its cause. Progressive respiratory muscle damage associates thoracic deformities, and ineffective cough, which leads to significant complications such as hypoventilation, nocturnal desaturation and chronic respiratory failure. Respiratory impairment represents the major cause of mortality in patients with muscular dystrophy. This highlights the importance of early and correct management of this illness. We present the case of a 17-year-old patient, genetically diagnosed with DMD at the age of 5 years that became non-ambulant at the age of 12. He had complications such as iatrogenic Cushing syndrome, anxiety, depressive disorder, mild cardiac dysfunction, severe restrictive respiratory dysfunction, nocturnal hypercapnia and sleep apnoea syndrome treated with BiLevel Positive Airway Pressure Spontaneous/Timed Therapy (BiPAP-ST). In evolution, it was decided to perform a tracheostomy and quasi-permanent ventilation. The clinical and paraclinical presentation of this patient is typical of that of an advanced stage of DMD, with progressive aggravation in the past years, despite the correct multidisciplinary management, following the international care standard of this disease. The particularity of the case is based on the complexity of all the comorbidities associated with the disease and the impact they have on the mental health of the patient, leading to the degradation of his general state. Having limited respiratory function, the patient died secondary to a tracheostomy tube complication. These complications represent a major cause of mortality in patients with neuromuscular disorders. An early and correct management of the respiratory tract pathology of these patients is essential for improving their quality of life and increasing their life span.

Comparison of Treatment Outcomes Between Total and Near Total Glossectomy with Larynx Preservation and Flap Reconstruction: A Single Institution Experience with 23 Patients.

Objective:The purpose of this study was to evaluate the functional and oncological outcomes of total glossectomy with laryngeal preservation (TGLP) compared to near-total glossectomy with laryngeal preservation (nTGLP).Methods:In this retrospective study, the data of 23 patients who underwent either TGLP or nTGLP between January 2010 and December 2020 in a tertiary university hospital were analyzed. The data including demographic findings, tumor stage, extent of surgery and technique, method of reconstruction, complications, overall survival (OS) and recurrence-free survival (RFS), and tracheostomy and gastric tube dependence during follow-up were assessed.Results:Of the 23 eligible patients, 15 had undergone nTGLP (Group 1) and 8 had undergone TGLP (Group 2). Tracheostomy dependence and gastric tube dependence rates at the sixth month were 3/19 (15.7%) and 12/19 (63.1%), respectively, with no significant differences between the two groups. OS and RFS at one year were 47.6% and 27.8%, respectively, for the study population. OS rate showed significance with nodal positivity and extranodal extension (p=0.004 for both) only, but not within patient groups (p=0.734).Conclusion:Both TGLP and nTGLP are feasible treatment options in patients with advanced tongue cancer with no differences in terms of functional and oncological results. Survival rates are still not satisfactory, and recurrences are high despite appropriate treatments. Proper selection of patients who are highly motivated and willing for long-term postoperative rehabilitation is essential.