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Objective: This case series describes the outcomes of airway management, including airway reconstruction, in 6 patients with campomelic dysplasia and tracheostomy/ventilator dependence secondary to multilevel airway obstruction. Methods: Case series and clinical guidelines are provided for the airway management of patients with campomelic dysplasia. Results: Average age of individuals is 19.4 years. Mean follow-up was 12.2 years. Four individuals underwent open airway reconstruction and achieved decannulation. One patient underwent airway reconstruction with improvement of a complete subglottic stenosis but remains ventilator dependent due to severe scoliosis. The remaining 2 patients did not require additional airway reconstruction, have been liberated from ventilator support, and are under evaluation for tracheostomy tube decannulation. Conclusion: Although campomelic dysplasia was historically considered a lethal form of congenital skeletal dysplasia, with many patients succumbing to respiratory failure due to tracheobronchomalacia in the neonatal period, airway reconstruction and long-term survivorship is feasible in children with campomelic dysplasia and significant airway disease. [ABSTRACT FROM AUTHOR]

Abnormalities of tracheal smooth muscle (SM) formation are associated with several clinical disorders including tracheal stenosis and tracheomalacia. However, the cellular and molecular mechanisms underlying tracheal SM formation remain poorly understood. Here, it is shown that the T‐type calcium channel CACNA1H is a novel regulator of tracheal SM formation and contraction. Cacna1h in an ethylnitrosourea forward genetic screen for regulators of respiratory disease using the mouse as a model is identified. Cacna1h mutants exhibit tracheal stenosis, disorganized SM and compromised tracheal contraction. CACNA1H is essential to maintain actin polymerization, which is required for tracheal SM organization and tube formation. This process appears to be partially mediated through activation of the actin regulator RhoA, as pharmacological increase of RhoA activity ameliorates the Cacna1h‐mutant trachea phenotypes. Analysis of human tracheal tissues indicates that a decrease in CACNA1H protein levels is associated with congenital tracheostenosis. These results provide insight into the role for the T‐type calcium channel in cytoskeletal organization and SM formation during tracheal tube formation and suggest novel targets for congenital tracheostenosis intervention. [ABSTRACT FROM AUTHOR]

Background: Tracheobronchial mucormycosis is a fatal opportunistic infection that mainly causes airway stenosis and is difficult to manage clinically. Case presentation: We report a case of severe tracheal stenosis caused by tracheobronchial mucormycosis in a 37-year-old female with a history of hyperthyroidism. She developed agranulopenia after oral methimazole administration and subsequently experienced asthma with dyspnea. Bronchoscopy, sputum culture, colony mass spectrometry, and microscopic cotton orchid staining confirmed tracheobronchial mucormycosis. The patient received venous-venous extracorporeal membrane oxygenation (VV-ECMO) and prolonged intratracheal instillation of amphotericin B (AmBD), combined with amphotericin B liposome (L-AmB) and isavuconazole intravenous infusion, ultimately resulting in successful treatment. Conclusion: VV-ECMO combined with prolonged intratracheal instillation of AmBD is an effective method for the treatment of tracheobronchial mucormycosis. [ABSTRACT FROM AUTHOR]

Background/aim: Benign tracheal stenosis (TS) is a potentially life-threatening condition caused by iatrogenic events resulting from endotracheal intubation and tracheostomy. The study aimed to determine the clinical characteristics, management, and long-term outcomes of patients with simple or complex post-intubation tracheal stenosis (PITS) who were admitted to the intensive care unit (ICU). Materials and methods: Retrospective analysis of patients admitted to the ICU between June 2016 and June 2022 and diagnosed with PITS were performed until June 2023. Results: 76 patients (mean age 54.9 ± 17.3%, 63.2% male, 61.8% complex stenosis) admitted to the ICU were analysed. The diagnosis of PITS was made by fiberoptic bronchoscopy (FOB) in 53.9% and computed tomography (CT) in 46.1%. The most common location of stenosis was the upper trachea area (57.9%, n = 44). The median stenosis length of the TS was 1.9 cm (median 2 cm for complex stenosis, 1 cm for simple stenosis, p < 0.001). Complex stenosis was associated with longer intubation time and multiple intubation history (p = 0.011, p = 0.028). At the same; complex stenosis was associated with prolonged and high stenosis percentage (p < 0.001). While dilatation and cryotherapy were sufficient for treatment in all patients with simple stenosis, the stent was applied to 34% patients with complex stenosis. Recurrence was higher in complex stenosis after bronchoscopic procedure (complex stenosis 95.7%, simple stenosis 17.2%). 19 (25%) patients required surgical operation, and all of these patients had complex stenosis (p < 0.001). Median follow-up was 33 months for simple stenosis and 34 months for complex stenosis. ICU length of stay (LOS) was longer in patients with complex stenosis. There was no statistically significant difference between TS classes in terms of ICU mortality (p = 0.466), 1-year mortality (p = 0.951), and mortality during follow-up (p = 0.608). Conclusion: PITS is a challenging situation in ICU patients. In patients with a preliminary diagnosis of PITS, bronchoscopy should be performed without delay, and it should be known that interventional bronchoscopy is not only a diagnostic tool but an effective strategy in treatment management after the diagnosis is finalised. The advantage of interventional bronchoscopy is that it alleviates symptoms that necessitate hospitalisation in the ICU and eliminates the need for ICU of patients. [ABSTRACT FROM AUTHOR]

Purpose: To assess the effectiveness of a new suturing technique called Dragonfly for the closure of temporary tracheotomies. This technique involves placing two sutures during the tracheotomy procedure and leaving them loose and unknotted until the day of skin closure. Methods: Retrospective case control study. Monocentric study at a department of Otolaryngology and head and neck surgery at a tertiary centre in Italy. A total of 50 patients who underwent temporary tracheotomy between January 2017 and December 2021. Patients were divided into two groups based on the trachea closure method: traditional closure with sutures placed during the skin closure procedure (Group A) and the Dragonfly technique (Group B). The incidence of tracheal stenosis by Computed Tomography (CT), granulation tissue formation, bleeding, procedure duration, patient discomfort were evaluated. Results: The incidence of tracheal complications and tracheal stenosis was reduced in Group B (6%) compared to Group A (24%). Procedure times (3 min vs. 6 min) durations was significantly shorter. No patients had symptoms of tracheal stenosis at the end of the procedures. Conclusion: The Dragonfly suturing technique is effective and safe for tracheotomy closure, reducing the incidence of tracheal stenosis and shortening hospitalization duration compared to the traditional method. [ABSTRACT FROM AUTHOR]

A variety of thoracic imaging modalities and techniques have been used to evaluate diseases of the trachea and central bronchi. This document evaluates evidence for the use of thoracic imaging in the evaluation of tracheobronchial disease, including clinically suspected tracheal or bronchial stenosis, tracheomalacia or bronchomalacia, and bronchiectasis. Appropriateness guidelines for initial imaging evaluation of tracheobronchial disease and for pretreatment planning or posttreatment evaluation are included. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision process support the systematic analysis of the medical literature from peer reviewed journals. Established methodology principles such as Grading of Recommendations Assessment, Development, and Evaluation or GRADE are adapted to evaluate the evidence. The RAND/UCLA Appropriateness Method User Manual provides the methodology to determine the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where peer reviewed literature is lacking or equivocal, experts may be the primary evidentiary source available to formulate a recommendation. [ABSTRACT FROM AUTHOR]

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Introduction: Narrowed tracheal lumen diameter (TLD) in dogs caused by congenital hypoplasia or acquired tracheal stenosis can result in adverse health effects. Standardized tracheal scores calculated from radiographic measurements have been used to assess tracheal diameter however comparisons have not been made to characterize differences in tracheal lumen among breeds. Methods: The main objective of this study was to compare tracheal scores at three regions of the trachea among non-brachycephalic dogs, non-bulldog brachycephalic dogs, and bulldogs. Medical records and thoracic radiographs of clinically normal dogs were reviewed. The TLDs 79 of three different tracheal regions (caudal cervical, thoracic inlet, and intrathoracic) were standardized by the manubrium length (ML) and thoracic inlet distance (Ti-D) to calculate the manubrium and thoracic inlet tracheal indexes (M-TI and Ti-TI) at each region. Statistical analysis was used to analyze the differences in tracheal scores among the three breed populations. Results: Overall, M-TI and Ti-TI varied significantly (p < 0.0001) at the three tracheal levels among the three breed populations. Bulldogs and non-bulldog brachycephalic breeds possessed lower (p < 0.016) M-TI and Ti-TI than nonbrachycephalic breeds at the three tracheal regions, and bulldogs possessed the lowest M-TI and Ti-TI scores at all measured regions. Conclusion: Averaged M-TIs <0.38, <0.34, <0.32 in non-brachycephalic, nonbulldog brachycephalic, and bulldog breeds, respectively, may indicate tracheal hypoplasia. Utilizing M-TI can be recommended for the assessment of canine TLD however further investigation in dogs with concurrent respiratory diseases is warranted. [ABSTRACT FROM AUTHOR]

A 36-year-old female patient diagnosed with asthma at an external center was referred to us after her complaints did not improve, at which point, hoarseness was added to the complaints. Stridor was identified in a respiratory system examination. Tracheal stenosis was seen in a postero-anterior chest X-ray and a fixed airway obstruction in a respiratory function test, upon which, the patient was referred to the ear, nose and throat department. Subglottic stenosis was detected on a neck computerized tomography and a bronchoscopy evaluation. The etiology of subglottic stenosis was evaluated, collagen tissue markers were positive, and the patient was asked to undergo a rheumatology consultation. The patient was subsequently diagnosed with Sjögren syndrome based on a salivary gland biopsy result. This rare case is presented to underline the need to keep Sjögren syndrome in mind as an etiology of subglottic stenosis. [ABSTRACT FROM AUTHOR]

The conventional methods of silicon stent insertion recommend usage of external loading devices, where the stent is folded into the loading device and pushed in to the tracheobronchial tree using an external pusher which is blind, and leads to placement of stent either distally or proximally needing repositioning or is done with fluoroscopy that involves radiation exposure. We demonstrate our experience in 16 cases of successful silicon stent placement using this technique, wherein an Ultrathin flexible bronchoscope or Hopkins Rigid telescope is pushed alongside the forceps that hold upper end of the folded silicon stent allowing stent placement under direct vision with control over the stent. The Proximal end of the stent can be pulled under vision before deployment for appropriate positioning while pulling the rigid barrel. The stent is always under the operator's control providing excellent control over placement, simplifies the procedure and is safe with no reported complications. [ABSTRACT FROM AUTHOR]

Persistent air leak may complicate malignant disease of the thorax, causing significant morbidity and mortality. A 51‐year‐old male with a 30‐pack‐year history of smoking was diagnosed with metastatic esophageal carcinoma with invasion into the right upper lobe of the lung. He developed a large right hydropneumothorax complicated by empyema leading to persistent air leak despite the insertion of two chest drains. Computed Tomography imaging with 3‐dimensional reconstruction showed severe tracheal compression from the enlarging esophageal tumour as well as bronchopleural fistulas in the right upper lobe. Rigid bronchoscopy with metallic tracheal stenting was performed. This was followed by localization and quantification of air leak with an endobronchial collateral ventilation assessment system and a digital chest drain to guide endobronchial valve placement, in a single operative procedure. This novel combination of interventional bronchoscopy techniques enabled successful transition to an ambulatory chest drain and subsequent hospital discharge. [ABSTRACT FROM AUTHOR]

Objective: To characterize the preoperative and intraoperative findings of symptomatic tracheal stenosis associated with COVID-19 related respiratory failure requiring tracheal resection. Method: We performed a retrospective review identifying all patients with a history of tracheal stenosis secondary to COVID-19 related respiratory failure who subsequently received a tracheal resection at our institution between January 2020 and June 2023. Clinical, radiological, pathological, and surgical characteristics were recorded to describe and characterize pre-operative and intraoperative findings associated with tracheal stenosis in the setting of a previous COVID-19 infection. Results: We retrospectively reviewed 11 patients with COVID-19 related tracheal stenosis that required open tracheal or cricotracheal resection. The mean age was 54.1. Patients were hospitalized for a mean of 49.5 days related to COVID-19 complications. Tracheotomy was completed in 10 patients (90.9%) during their initial hospitalization with COVID-19 related respiratory failure. Patients were intubated a mean of 18.6 days prior to tracheotomy completion. Ten patients (90.9%) underwent endoscopic operative interventions for their tracheal stenosis prior to open resection. Intraoperatively, the mean stenosis length was 3.33 cm. The mean tracheal resection length was 3.96 cm. Patients were hospitalized for a mean of 8.27 days post operatively with no significant post operative complications. Conclusions: Symptomatic tracheal stenosis in the setting of prolonged intubation due to COVID-19 is an under-described etiology. This is one of the largest single institution retrospective reviews that identifies 11 patients with prolonged intubation who developed symptomatic tracheal stenosis refractory to conservative management and ultimately requiring tracheal resection. [ABSTRACT FROM AUTHOR]

Background: Tracheostomy is one of the most common procedures done in intensive care unit (ICU) patients. Decannulation is the weaning off from tracheostomy to maintain spontaneous respiration and/or airway protection. However, this step needs a near perfect coordination of brain, swallowing, coughing, phonation, and respiratory muscles. However, despite its perceived importance, there is no universally accepted protocol for this vital transition. In this systematic review of decannulation we focus attention to this important aspect of tracheostomy care. Aim: To compare the two methods of decannulation, with gradual blocking of the tube and reducing the size of the tube and also study and compare the incidental complications associated with both methods. Methodology: This longitudinal, open label, randomized, observational study of 50 patients who were tracheostomized for more than 7 days was carried out in a tertiary health care Centre in central India. Over the course of 2 years demographic data, clinical information was collected and patients divided into 2 groups according to the method of decannulation done by a simple randomization method. The outcomes and the complications associated with the two techniques in the study groups were also be noted down and then compared. Results: Maximum number of patients in both the study groups were males (56% in group with tube blocking, and 52% in group with tube size reduction). 48% cases in group with tube blocking, and 60% in group with tube size reduction were noted to be between 51 and 70 years' age group. The mean duration between tracheostomy and decannulation in group with tube blocking was 16.63 + 8.44 days, and while it was 16.71 + 8.79 days in group with tube size reduction. 36% patients in group with tube blocking had tracheostomy tube number 7.5, while 32% had tube number 8. 36% in group with tube size reduction had tube number 7.5 while 32% had tube size 7. 4 patients in group with tube blocking, and 3 patients in group with tube size reduction required reinsertion of tube. 40% patients in group with tube blocking, and 44% in group with tube size reduction underwent tracheostomy following prolonged intubation. 4 patients in group with tube blocking, and 3 patients in group with tube size reduction required reinsertion of tube. 1 patient in group with tube blocking had trachea-esophageal fistula as post decannulation complication. 1 patient each in group with tube size reduction had granule formation over stoma and tracheal stenosis as complications. Conclusion: The two decannulation methods, viz., gradual blocking of tube and reduction of tube size, showed comparable outcomes in terms of tube reinsertion rate, mechanical ventilation rate after decannulation, successful decannulation, and complications. [ABSTRACT FROM AUTHOR]

The purpose of the current review is to identify the main problems of endotracheal intubation, which will serve as a basis for the design requirements for a novel endotracheal tube. Methodology: A PICO systematic search was conducted in PubMed up to December 2021 to identify issues related both to the endotracheal intubation procedure and device-specific factors. Results: Two primary categories of problems were identified during endotracheal intubation: a) Issues related to laryngotracheal symptoms such as cough, hoarseness, aphonia, dysphonia, dysphagia, swallowing difficulties and the risk of stenosis with long-term intubation. The underlying pressure, abrasion and/or decubitus phenomena should be considered in a new design approach. b) Issues related to the cuff sealing and microaspirations, where the risk of ventilator-associated pneumonia (VAP) highlights the need to improve the design. Discussion & Conclusion: This review has yielded valuable input for rethinking the design of endotracheal tubes to ensure an efficient and safe airway. This new design should focus on the protection of anatomical structures, avoid or reduce the phenomena of laryngotracheal symptoms, and even reduce the risk of ventilator-associated-pneumonia (VAP) and/or prevent the need for certain tracheostomies. [ABSTRACT FROM AUTHOR]

Abstract Introduction Tracheal stenosis is a known complication following intubation. However, owing to its delayed presentation and symptoms of progressive wheezing and respiratory difficulty, it is often misdiagnosed as asthma. Case presentation We present the case of a 10-year-old Asian boy who presented with cough, wheezing, and dyspnea. He was misdiagnosed with severe, uncontrolled asthma and respiratory failure, remaining unresponsive to initial asthma management. During his current admission, he had difficult intubation, necessitating an emergency tracheostomy. Further subsequent examination revealed grade III tracheal stenosis. Conclusion This case highlights the importance of considering tracheal stenosis as a differential diagnosis in children presenting with dyspnea, cough, and wheezing, particularly if there is a history of prior intubation. The airway should be secured immediately in a controlled environment by an otolaryngologist or anesthetist.

Abstract Background Tracheal stenosis results from an altered inflammatory response to mucosal damage, which leads to impairment of breathing and can even be fatal if not treated promptly (Ind J Otolaryngol Head Neck Surg 73(4):447–454, 2020). ENT and head and neck surgeons face difficulties while treating tracheal stenosis. Mechanical stress from extended endotracheal intubation or tracheostomy, combined with hypoxic metabolic disturbances during an underlying event, is the most frequent cause of tracheal stenosis (Al-Azhar Int Med J 3(10):149-57, 2022). The main objective of the study is to assess the outcomes of tracheal resection and anastomosis in patients who presented with tracheal stenosis. This emphasizes the need for proper case selection and timely surgical intervention to relieve the airway obstruction and to ensure the effectiveness of tracheal resection and anastomosis as the less morbid approach by avoiding a midline sternotomy. The study was conducted in a tertiary care center on 25 patients who were admitted in ENT ward from the year 2011 to year 2021. Case records of those patients who underwent tracheal resection and anastomosis were analyzed on a retrospective basis. Detailed history taking and clinical examination with appropriate investigations like flexible bronchoscopy, computed tomography with 3-dimensional reconstruction, video laryngoscopy, direct laryngoscopy, and lung function tests were carried out for all the patients in the study as required. An evaluation of GERD was also done. Appropriate surgical procedure was done with regular post-operative follow-up for 18 months. Results In our study, 92% of patients had satisfactory outcomes following tracheal resection and anastomosis, while some patients experienced minor complications. In 8% of patients, the primary surgery failed, among whom one patient underwent revision surgery and is doing well. The other patient with post-traumatic stenosis with a long stenotic segment underwent Shiann Yann Lee procedure in an outside center which resulted in failure following which T tube insertion was done. The patient showed improvement and was decannulated after a month. In our study of 25 patients with tracheal stenosis, postoperative complications occurred and were managed accordingly. However, there was no significant correlation between these complications and patient age, sex, extent of stenosis, preoperative Cotton-Myer grading, or the type of surgical procedure performed. This lack of correlation may be attributed to the limited sample size. Conclusion Tracheal resection and anastomosis are challenging procedures and should be done only in centers with experience. Standard treatment consists of resection of the stenotic segment with end-to-end anastomosis. The geometry of the ends to be anastomosed is matched properly to avoid gaps or weak points and for air-tight seal anastomosis.

Background: Acquired laryngotracheal stenosis is a challenging condition for the otolaryngologist. The gold standard of treatment for a long time has been open surgical procedure but not without significant morbidities. To avoid morbidities, various endoscopic approaches like balloon dilatation, stenting, CO2 laser, and cryotherapy have emerged in the last decade. Coblation-assisted tracheoplasty is one such novel approach which enables the removal of target tissue with minimal damage to surrounding tissues. Aim and Objectives: The aim of this case series is to evaluate the use of bipolar radiofrequency plasma ablation (Coblation) in the treatment of acquired adult tracheal stenosis. Materials and Methods: This is a retrospective case series in a tertiary care center. The medical records of six patients with tracheal stenosis who were treated with coblation from March 2020 to December 2020 were reviewed. Patient presentation, surgical intervention(s), post-operative course, and complications were analyzed. Result: All six patients had acquired tracheal stenosis post-tracheostomy. Coblation along with balloon dilatation and Mitomycin-C were done for these patients. All six patients could be successfully decannulated without complications, perioperative, or post-operative sequalae. Conclusion: The results of this study suggest that coblation may be an effective endoscopic tool for the treatment of tracheal stenosis. Further studies with a large number of patients are required as this technique comes more in application.

Tracheobronchopathia osteoplastica is a rare condition involving large airways with multiple bone and cartilage nodules in the tracheobronchial submucosa. This can cause tracheal stenosis, leading to difficulty in endotracheal intubation. A 79-year-old female patient, who had a history of successful endotracheal intubation for general anesthesia 8 years prior, was scheduled for abdominal surgery. Preoperative chest computed tomography and bronchoscopy revealed slight progression of tracheobronchopathia osteoplastica. Attempts to intubate with a smaller endotracheal tube failed; even the smaller endotracheal tube could barely pass. Mechanical ventilation was successfully administered and the surgery was completed without complications. The use of a smaller endotracheal tube may be beneficial for managing difficult airways in patients with tracheobronchopathia osteoplastica. Chest CT and bronchoscopic examination may be beneficial for evaluating the airway and determining the most appropriate airway management strategy. However, relying solely on these measures may lead to unexpected challenges because there is no established method to evaluate airway in patient with tracheobronchopathia osteoplastica. It is crucial for anesthesiologists to be aware of the potential existence of rare conditions such as tracheobronchopathia osteoplastica and be prepared to handle anticipated or unanticipated difficult airway management.

Abstract Background Congenital tracheal stenosis is a rare structural obstructive disorder affecting a segment of the trachea. It is often caused by complete or nearly complete cartilaginous rings narrowing the airway. Approximately 50% of cases are associated with abnormal left pulmonary artery rings. Case presentation We present the case of a 4-month-old female infant with complex congenital tracheal stenosis associated with a left pulmonary artery vascular ring and congenital heart disease. The patient underwent successful surgical intervention involving repair of the congenital heart defect and reimplantation of the pulmonary artery, followed by sliding tracheoplasty in one surgery procedure. Postoperative outcomes were favorable, with successful extubating and resolution of respiratory symptoms. Conclusions Sliding tracheoplasty proved an effective treatment option in this complex case, highlighting its reproducibility and favorable outcomes in managing congenital tracheal stenosis.

Background: Tracheal stenosis results from an altered inflammatory response to mucosal damage, which leads to impairment of breathing and can even be fatal if not treated promptly (Ind J Otolaryngol Head Neck Surg 73(4):447–454, 2020). ENT and head and neck surgeons face difficulties while treating tracheal stenosis. Mechanical stress from extended endotracheal intubation or tracheostomy, combined with hypoxic metabolic disturbances during an underlying event, is the most frequent cause of tracheal stenosis (Al-Azhar Int Med J 3(10):149-57, 2022). The main objective of the study is to assess the outcomes of tracheal resection and anastomosis in patients who presented with tracheal stenosis. This emphasizes the need for proper case selection and timely surgical intervention to relieve the airway obstruction and to ensure the effectiveness of tracheal resection and anastomosis as the less morbid approach by avoiding a midline sternotomy. The study was conducted in a tertiary care center on 25 patients who were admitted in ENT ward from the year 2011 to year 2021. Case records of those patients who underwent tracheal resection and anastomosis were analyzed on a retrospective basis. Detailed history taking and clinical examination with appropriate investigations like flexible bronchoscopy, computed tomography with 3-dimensional reconstruction, video laryngoscopy, direct laryngoscopy, and lung function tests were carried out for all the patients in the study as required. An evaluation of GERD was also done. Appropriate surgical procedure was done with regular post-operative follow-up for 18 months. Results: In our study, 92% of patients had satisfactory outcomes following tracheal resection and anastomosis, while some patients experienced minor complications. In 8% of patients, the primary surgery failed, among whom one patient underwent revision surgery and is doing well. The other patient with post-traumatic stenosis with a long stenotic segment underwent Shiann Yann Lee procedure in an outside center which resulted in failure following which T tube insertion was done. The patient showed improvement and was decannulated after a month. In our study of 25 patients with tracheal stenosis, postoperative complications occurred and were managed accordingly. However, there was no significant correlation between these complications and patient age, sex, extent of stenosis, preoperative Cotton-Myer grading, or the type of surgical procedure performed. This lack of correlation may be attributed to the limited sample size. Conclusion: Tracheal resection and anastomosis are challenging procedures and should be done only in centers with experience. Standard treatment consists of resection of the stenotic segment with end-to-end anastomosis. The geometry of the ends to be anastomosed is matched properly to avoid gaps or weak points and for air-tight seal anastomosis. [ABSTRACT FROM AUTHOR]

Background: Self-expandable metallic stents (SEMS) are increasingly used in the management of both malignant and nonmalignant airway stenosis. There are multiple stents available in the market; however, the current literature on the efficacy and safety of newly available 3rd generation SEMS (Bonastent) is extremely limited and only has data from single center studies. Objectives: To report the efficacy and early (<7 days) and late (⩾7 days) complications in patients with central airway obstruction (CAO) treated with Bonastent placement at two institutions. Design: We performed a retrospective analysis of data of consecutive patients who underwent therapeutic bronchoscopy and Bonastent placement at two tertiary care university hospitals between January 2019 and November 2023. Methods: Bonastent deployment was performed in the operating room. Stents were deployed using rigid or flexible bronchoscopy under direct visualization with a flexible bronchoscope and in conjunction with fluoroscopic guidance. We then analyzed the effectiveness, short-term, and long-term complications of Bonastent placement. Results: A total of 107 Bonastents® were placed in 96 patients. The most common etiology of CAO was malignancy, 92.7% (n = 89), followed by excessive dynamic airway collapse (EDAC) and post-intubation tracheal stenosis. Seventy-three patients (76%) had improvement in symptoms or imaging within 7 days of stent placement, including successful liberation from mechanical ventilation in a patient with CAO. Early complications occurred in seven patients (two-airway bleeding, two-mucus plugging that improved with airway clearance, two-stent migrations, and one-cough). Late complications occurred in 23 patients (1-stent migration requiring revision bronchoscopy and replacement of airway stent, 11-mucus plugging, 6-granulation tissue, 2-pneumonia, 1-cough, 1-tumor ingrowth/stent fracture, 1-airway emergency due to excessive granulation tissue obstructing the distal end of the stent and had a failed cricothyroidotomy leading to death). Overall, the early complication rate was 7.3% (7/96) and late complication rate was 23.9% (23/96). Conclusion: Our study is the first multicenter study that found a good safety profile with a low complication rate after tracheobronchial Bonastent placement with improvement in symptoms soon after stent placement. [ABSTRACT FROM AUTHOR]

Background: Understanding the characteristics of pulmonary resistance and elastance in relation to the location of airway narrowing, e.g., tracheal stenosis vs. intrapulmonary airway obstruction, will help us understand lung function characteristics and mechanisms related to different airway diseases. Methods: In this study, we used ex vivo sheep lungs as a model to measure lung resistance and elastance across a range of transpulmonary pressures (5–30 cmH2O) and ventilation frequencies (0.125–2 Hz). We established two tracheal stenosis models by inserting plastic tubes into the tracheas, representing mild (71.8% lumen area reduction) and severe (92.1%) obstructions. For intrapulmonary airway obstruction, we induced airway narrowing by challenging the lung with acetylcholine (ACh). Results: We found a pattern change in the lung resistance and apparent lung elastance as functions of ventilation frequency that depended on the transpulmonary pressure (or lung volume). At a transpulmonary pressure of 10 cmH2O, lung resistance increased with ventilation frequency in severe tracheal stenosis, whereas in ACh-induced airway narrowing the opposite occurred. Furthermore, apparent lung elastance at 10 cmH2O decreased with increasing ventilation frequency in severe tracheal stenosis whereas in ACh-induced airway narrowing the opposite occurred. Flow-volume analysis revealed that the flow amplitude was much sensitive to ventilation frequency in tracheal stenosis than it was in ACh induced airway constriction. Conclusions: Results from this study suggest that lung resistance and apparent elastance measured at 10 cmH2O over the frequency range of 0.125-2 Hz can differentiate tracheal stenosis vs. intrapulmonary airway narrowing in ex vivo sheep lungs. [ABSTRACT FROM AUTHOR]

Objectives: The aim of this study was to retrospectively investigate the tracheal stenosis (TS) etiologies of patients with a diagnosis of TS after intubation who underwent rigid bronchoscopy balloon dilation/rigid bronchoscopy balloon dilatation+stent/tracheal resection and reconstruction at our clinic. Methods: Medical records of all adult patients who underwent procedures for TS between March 1, 2020, and April 30, 2022, at our clinic were retrospectively reviewed. Age, gender, previous ASA score, comorbidities, etiology of TS, type of surgery performed, length of hospital stay after the surgical procedure, morbidity, and mortality data were recorded. Results: It was determined that interventions were performed on a total of 101 patients due to post-intubation TS. Among these patients, it was observed that 37 (36.6%) had experienced intubation due to coronavirus, 19 (18.8%) due to neurological diseases, and 14 (13.9%) due to multiple traumas. Of the patients, 57 (56.43%) were male and 44 (43.57%) were female. The most common accompanying comorbidities were hypertension (25.7%) and diabetes (21.7%). The mean age was 50.3±17.2 years, and the mean duration of intubation was 25.4±17.8 days. Rigid bronchoscopy balloon dilatation was performed a median of 2 times per patient. Rigid bronchoscopy balloon dilatation+stent was performed in four patients, and tracheal resection and reconstruction was performed in 58 patients. Conclusion: In the cross-sectional evaluation of the patients, it was determined that the most common cause of TS developing after intubation was coronavirus. [ABSTRACT FROM AUTHOR]

Surgical resection of the stenotic segment with end-to-end anastomosis is considered the gold standard in postintubation tracheal stenosis. However, outcomes of this concrete aetiology are not well described. With the aim to examine the extent, range and characteristics of the existing evidence, a scoping review was performed. Data sources included MEDLINE, Scopus, Ovid and the Cochrane databases. Inclusion criteria consisted of studies in adult patients with postintubation tracheal stenosis that reported characteristics, surgical management and outcomes. A total of 125 articles were identified, of which 10 were included in the final analysis. All studies were case reports or case series (level 4 evidence) grouping 110 patients, 75 males and 35 females. The age ranged from 15 to 71 years. Cotton–Myer stenosis grade was 1 [1 (0.9%)], 2 [25 (22.7%)], 3 [70 (63.6%)] and 4 [14 (12.7%)]. Stenosis location was in the tracheal upper-third in 108 (98.2%), in the middle-third in 1 (0.9%) and in the lower-third in 1 (0.9%). Stenosis length ranged from 1 to 5.6 cm. Follow-up ranged from 1 to 60 months (2 years for the most). Most frequent complications were transitory dysphagia in 13 (11.3%), granuloma formation in 8 (7.3%), dehiscence or air leak in 5 (4.5%) and wound infection in 4 (3.6%). Restenosis rate ranged from 2% to 25%. There was no perioperative mortality. Tracheal resection and primary anastomosis in postintubation tracheal stenosis appear to be safe and effective in the short and mid-terms; however, the very low level of evidence found prevents definitive conclusions. [ABSTRACT FROM AUTHOR]

A woman in her mid‐60s with recurrent polychondritis was admitted to our hospital due to airway stenosis secondary to an uncovered metallic stent. She underwent a bronchoscopic intervention under general anaesthesia. During the procedure, the stent fracture was cauterized using Argon Plasma Coagulation (APC) cauterisation, performed with argon flow at 1 L/min and power set at 70 W. APC cauterisation caused the stent wire to flex circularly, gradually improving the stenosis. Tracheal dilatation was then performed using an airway balloon. Following the ballooning, a thin bronchoscope was easily passed through the lower trachea, and the left and right main bronchi were observed; therefore, the procedure was completed without any complications. APC coagulation and airway ballooning are viable choices for the temporary treatment of airway stenosis due to broken metallic stents. [ABSTRACT FROM AUTHOR]

Tracheal stenosis is a common complication of endotracheal intubation or tracheostomy, resulting in significant morbidity and mortality. Bronchoscope interventions have been proposed as a safe alternative for the management of post‐intubation post‐intubation tracheal stenosis (PITS). Data for patients diagnosed with PITS across two hospitals, between 2021 and 2022, encompassing demographic, clinical, and procedural details were gathered from electronic medical records, and analysed. Primary outcomes centred on assessing the incidence and severity of PITS through bronchoscope examination and radiological imaging, and the efficacy of bronchoscope interventions, including stenting and the application of mitomycin C. Twelve patients were managed for PITS. Majority of patients were females (9/12) with mean age of 46.41 years. Presenting signs and symptoms were dyspnea, rhonchi and failed extubation, the mean duration of intubation/ tracheostomy is 16.41 days (range: 3–40 days). Most common comorbidity was type 2 diabetes, (5 patients, 41.6%). The lesions mean length was 3.09 cm and Cotton‐Meyer Grade II and III. Prompt evaluation is crucial, in these patients. The Cotton‐Meyer grade is pivotal in treatment decisions, with intubating times correlating with the severity of stenotic disease. Our case series demonstrates the increasing utility of bronchoscopy in managing these cases. [ABSTRACT FROM AUTHOR]

Introduction: Tracheal stenosis is a pathology that is gradually increasing and requires intervention. Surgical treatment has been used as the gold standard for years, but it is difficult to decide on surgery in patients with comorbidities and high surgical risk. We aimed to evaluate the data of both treatment methods applied in our center. Materials: Our study was designed as retrospective and observational. The data of 61 patients who underwent resection & reconstruction and Methods or stent due to tracheal stenosis in our center between May 2002 - May 2019 were analyzed. Tracheal stenosis classifications, etiology, demography and treatment data, imaging measurements, and a satisfaction survey were used. Results: 53 patients who met the inclusion criteria were studied. Both treatment methods were found to be effective in reducing the stenosis and regressing the complaints. The average age in the stent group was higher than in the surgery group. As the intensive care period in the intubated state increases; Severe stenosis and deterioration of cartilage integrity increased. The satisfaction score of the surgery group was higher than the stent group. Conclusion: Both treatment methods are effective in improving respiratory functions and quality of life. The lesion was located higher in the surgical group and was longer in the stent group. Hospitalization times were longer in patients with severe stenosis and antibiotic changes were more frequent in patients using steroids. No statistically significant difference was found. [ABSTRACT FROM AUTHOR]

Background: A straight silicone stent can be used to treat proximal benign tracheal stenosis in non-surgical candidates. However, stent migration is a common complication when placed at a particular location and can lead to major complications. This case series of laryngotracheal stenosis reports a fixation method for straight silicone stents in the subglottic trachea (Stage 3 of the McCaffrey classification). Methods: The medical charts of these patients scheduled for straight silicone stent placement with suture fixation between 2014 and 2020 at the CHU UCL Namur Hospital (Belgium) were retrospectively reviewed. The procedure was performed using a rigid bronchoscope. Details of the procedure were obtained from medical records. Results: This case series included six patients (males: 4, females: 2). The median patient age was 59 years. Two suture fixations were placed following previous silicone stent migration episodes, whereas the others were placed proactively to avoid this risk. All fixations were performed by the device Freka® Pexact II ENFIt®, originally developed for gastropexy in endoscopic gastrostomy. The sutures were subcutaneously buried. Conclusions: During the 6-month follow-up period, complications such as fixation issues and stent migration were reported despite the off-label use of the treatment. The straight silicone stent fixation technique used in this case series was simple and effective for securing the stent in upper benign tracheal stenosis. [ABSTRACT FROM AUTHOR]

Objective: With advancements in respiratory interventional techniques, bronchoscopic intervention technology has emerged as a viable approach for managing postintubation tracheal stenosis (PITS). However, there was a paucity of research investigating the potential impact of stenosis characteristics and morphology (such as stenosis degree, length, type, and morphology) on bronchoscopic intervention treatment prognosis for PITS patients. This study was to assess the impact of various preoperative stenosis characteristic factors on the bronchoscopic cure rate among patients. Methods: This is a retrospective study analyzing the medical records of patients with PITS who received bronchoscopic intervention at the tertiary interventional pulmonology center. Results: Among the cases, 115 individuals achieved a in a success rate of 79.86% for bronchoscopic intervention therapy and were assigned to Group S. On the other hand, 29 cases required surgical intervention, accounting for a surgical treatment rate of 20.14% and were assigned to Group F. The stenosis in the Group F predominantly exhibited irregular shapes with scar granulation accompanied by tracheal chondromalacia collapse. Patients in group S experienced fewer total procedures, rigid bronchoscopy treatment, intraoperative hypoxemia, needed emergency re‐bronchoscopy in 24 h and transferred to ICU postoperatively. Patients with pure scar and granuloma, the rate of bronchoscopic success cure was higher than patients with scar granulation accompanied by tracheal chondromalacia (odds ratio: 8.208; 95% confidence interval: 2.755–24.459), and regular stenosis morphology was associated with a higher bronchoscopic success cure rate (odds ratio: 9.463; 95% confidence interval: 3.128–28.623). Conclusion: Irregular airway stenosis, chondromalacia or airway collapse are key factors affecting the success rate of bronchoscopic treatment for post‐intubation tracheal stenosis. Level of evidence: 4 (historically controlled studies). [ABSTRACT FROM AUTHOR]

Objectives: Rhinoscleroma is classically described as a chronic granulomatous disease caused by Klebsiella rhinoscleromatis which primarily affects the nose and nasopharynx. When present, tracheal manifestations will be seen late in the disease course rather than on initial presentation. We describe a rare case of nonendemic rhinoscleroma that presented with tracheal lesions as an initial manifestation of disease. Methods: Case report and literature review. Results: An 88‐year‐old male presented with longstanding dysphonia. Flexible laryngoscopy demonstrated a septal perforation and diffuse glottic lesions. CT neck demonstrated a nonobstructive polypoid tracheal lesion and mucosal thickening of the paranasal sinuses. Biopsy confirmed an atypical lympho‐histiocytic proliferation and microorganisms within macrophages on Grocott methenamine silver and Steiner stains consistent with rhinoscleroma. He was referred for rheumatology and pulmonology consultation. Conclusion: Systemic diseases rarely affect the trachea, and even less frequently is a tracheal lesion identified as the initial manifestation of disease. The most common systemic diseases that affect the trachea include relapsing polychondritis, granulomatosis with polyangiitis, amyloidosis, and inflammatory bowel disease. The literature surrounding nasolaryngotracheal rhinoscleroma is limited, especially in nonendemic areas. It is necessary to include unusual etiologies of airway lesions in the differential diagnosis, which warrants comprehensive airway evaluation including biopsy. Level of Evidence: 4. [ABSTRACT FROM AUTHOR]

Tracheomalacia is a condition where the tracheal wall is abnormally soft and prone to collapse during increased respiratory efforts. Airway malacia can manifest as segmental conditions like laryngomalacia, tracheomalacia and bronchomalacia, or as diffuse conditions such as tracheobronchomalacia (TBM). Unlike long‐segment congenital tracheal stenosis, where surgery may be the preferred treatment, the management of long‐segment TBM remains controversial. [ABSTRACT FROM AUTHOR]

Objective: Tracheal resection (TR) and cricotracheal resection (CTR) are performed for patients with airway stenosis, tracheal tumor, and tracheoesophageal fistula. Post‐operative complications include airway edema requiring reintubation, hematoma, anastomotic dehiscence, restenosis, and death. Although these complications and associated risk factors have been well described, the time where clinical suspicion should be highest post operatively has not been characterized. Methods: Patients who underwent TR or CTR at a single center between 2015 and 2022 were reviewed. Variables including demographics and comorbidities were recorded. Rate, nature, and time in days of post‐operative complications were evaluated. Results: Sixty‐nine cases were reviewed. Average patient age was 46.8 years old and 63.8% were male. The average follow‐up period was 625 ± 724 days. 19 (27.5%) patients experienced one or more major complications including four (5.8%) who died. Eight (11.6%) patients required reintubation and 4 (5.8%) patients underwent revision tracheostomy. Most complications occurred within 8 days of surgery. Restenosis was noted an average of 42.6 days after surgery, with no new restenosis occurring after 3 months. Conclusions: In this single‐center study, most post‐operative complications after TR or CTR, including hematoma and anastomotic dehiscence, occurred within 8 days post‐operatively. Restenosis was noted approximately 1–3 months after surgery. This may inform clinical decision‐making regarding patient monitoring and surveillance after open airway surgery. Level of Evidence: 4 Laryngoscope, 134:3527–3531, 2024 [ABSTRACT FROM AUTHOR]

Background: One of the most dangerous complications after endotracheal intubation or tracheostomy is tracheal stenosis. Objectives: This study aimed to determine the personal and clinical characteristics of tracheal stenosis following intubation or tracheostomy in intensive care unit patients. Methods: This is a nested case-control study. Thirty-five patients who suffered from tracheal stenosis from March 2016 to March 2021 and had been intubated and tracheostomized in intensive care units (ICU) were selected for the case group. The control group included 105 patients intubated and tracheostomized in ICU during the same period without tracheal stenosis. A demographic and clinical characteristics questionnaire was used to collect data from the patients' medical records. Results: The mean length of intubation (P < 0.001), endotracheal and tracheostomy tube cuff pressure (P < 0.001), chronic obstructive pulmonary disease (COPD) (P = 0.043), intubation history (P = 0.045), and airway management (P < 0.001) showed significant differences between the case and control groups. The logistic regression model revealed that COPD (OR = 8.519, P = 0.037), intubation history (OR = 3.939, P = 0.013), length of intubation (OR = 1.118, P = 0.003), age (OR = 0.960, P = 0.030), and endotracheal and tracheostomy tube cuff pressure (OR = 1.988, P < 0.001) were associated with tracheal stenosis. The time interval between intubation/tracheostomy ranged from approximately 28 to 938 days. Conclusions: Given the impact of certain care practices during hospitalization on the occurrence of tracheal stenosis, such as the mean length of intubation, endotracheal and tracheostomy tube cuff pressure, and airway management, it is recommended that standardized training on these interventions be prioritized for staff in intensive care departments. Additionally, attention must be given to specific patient characteristics, such as age, COPD, and history of intubation. [ABSTRACT FROM AUTHOR]

Background: Congenital tracheal stenosis is a rare structural obstructive disorder affecting a segment of the trachea. It is often caused by complete or nearly complete cartilaginous rings narrowing the airway. Approximately 50% of cases are associated with abnormal left pulmonary artery rings. Case presentation: We present the case of a 4-month-old female infant with complex congenital tracheal stenosis associated with a left pulmonary artery vascular ring and congenital heart disease. The patient underwent successful surgical intervention involving repair of the congenital heart defect and reimplantation of the pulmonary artery, followed by sliding tracheoplasty in one surgery procedure. Postoperative outcomes were favorable, with successful extubating and resolution of respiratory symptoms. Conclusions: Sliding tracheoplasty proved an effective treatment option in this complex case, highlighting its reproducibility and favorable outcomes in managing congenital tracheal stenosis. [ABSTRACT FROM AUTHOR]

Idiopathic subglottic stenosis (ISGS) is a rare fibrotic disease of the upper trachea with an unknown pathomechanism. It typically affects adult Caucasian female patients, leading to severe airway constrictions caused by progressive scar formation and inflammation with clinical symptoms of dyspnoea, stridor and potential changes to the voice. Endoscopic treatment frequently leads to recurrence, whereas surgical resection and reconstruction provides excellent long-term functional outcome. This study aimed to identify so far unrecognized pathologic aspects of ISGS using single cell RNA sequencing. Our scRNAseq analysis uncovered the cellular composition of the subglottic scar tissue, including the presence of a pathologic, profibrotic fibroblast subtype and the presence of Schwann cells in a profibrotic state. In addition, a pathology associated increase of plasma cells was identified. Using extended bioinformatics analyses, we decoded pathology-associated changes of factors of the extracellular matrix. Our data identified ongoing fibrotic processes in ISGS and provide novel insights on the contribution of fibroblasts, Schwann cells and plasma cells to the pathogenesis of ISGS. This knowledge could impact the development of novel approaches for diagnosis and therapy of ISGS. [ABSTRACT FROM AUTHOR]

Tracheal stenosis, which is the decrease in the size of the lumen of the windpipe, presents a set of complex challenges in medical care. The rising incidence and life-threatening complications of tracheal stenosis highlight the growing importance of tracheal reconstruction for its management. We describe a series of 5 cases of tracheal stenosis from a Thoracic Surgery centre in India. Each case required personalized treatment plans due to the specific nature of the traumatic injuries incurred by each of them. The intricacies and preoperative assessments are discussed. Further challenges like postoperative complications are acknowledged, prompting a call for continued research to refine treatments. Ultimately, these cases highlight the importance of an integrative approach, combining surgery and other therapies, to optimally manage tracheal stenosis. [ABSTRACT FROM AUTHOR]

An 82-year-old woman with a remote tracheostomy due to vocal cord paralysis and long-standing erosive, seropositive rheumatoid arthritis (RA) well controlled with methotrexate sought treatment at the ED with 1 month of dyspnea, chest tightness, and cough productive of blood-tinged sputum. She had been treated unsuccessfully as an outpatient with multiple courses of antibiotics. She did not smoke or drink alcohol and had no recent travel outside the country. Given concern for airway compromise, she was admitted to the hospital. [ABSTRACT FROM AUTHOR]

Background: Acquired laryngotracheal stenosis is a challenging condition for the otolaryngologist. The gold standard of treatment for a long time has been open surgical procedure but not without significant morbidities. To avoid morbidities, various endoscopic approaches like balloon dilatation, stenting, CO2 laser, and cryotherapy have emerged in the last decade. Coblation-assisted tracheoplasty is one such novel approach which enables the removal of target tissue with minimal damage to surrounding tissues. Aim and Objectives: The aim of this case series is to evaluate the use of bipolar radiofrequency plasma ablation (Coblation) in the treatment of acquired adult tracheal stenosis. Materials and Methods: This is a retrospective case series in a tertiary care center. The medical records of six patients with tracheal stenosis who were treated with coblation from March 2020 to December 2020 were reviewed. Patient presentation, surgical intervention(s), post-operative course, and complications were analyzed. Result: All six patients had acquired tracheal stenosis post-tracheostomy. Coblation along with balloon dilatation and Mitomycin-C were done for these patients. All six patients could be successfully decannulated without complications, perioperative, or post-operative sequalae. Conclusion: The results of this study suggest that coblation may be an effective endoscopic tool for the treatment of tracheal stenosis. Further studies with a large number of patients are required as this technique comes more in application. [ABSTRACT FROM AUTHOR]

Objectives: To compare the usage of laryngeal mask airway (LMA) and orotracheal intubation (OTI), which are separate airway management methods in tracheal reconstruction surgeries, in terms of perioperative management, mortality, and morbidity. Methods: Adult patients who underwent tracheal reconstruction surgery between June 2020 and June 2022 were included in the study, retrospectively. Patients with lost data or primary tracheal malignancy were excluded. Patients who underwent tracheal reconstruction were divided into two groups: LMA and OTI. Results: Of a total of 57 included patients, the OTI and LMA groups had 30 (52.63%) and 27 patients (47.37%), respectively. The rate of intubated transfer to the intensive care unit and the length of stay in the intensive care unit were significantly higher in the OTI group (p=0. 014, p=0. 031) than those of the LMA group; further, in tracheal cultures, reproduction was also significantly higher in the OTI group (23.33%) (p=0. 007). The postoperative mortality rates were similar in both groups. Conclusion: Since the absence of tension in end-to-end anastomosis of the trachea is vital for successful surgery, the LMA application (which has no tracheal contact) can be considered superior to OTI. In this study, LMA was successfully applied in all patients. Considering that the aim of anesthesia management should be to provide adequate oxygenation and normocarbia with minimally invasive intervention, we suggest airway management using LMA as the first option for tracheal reconstruction surgery because of the advantages described in this study. [ABSTRACT FROM AUTHOR]

Background: Pulmonary tuberculosis (PTB) with tracheobronchial tuberculosis (TBTB) can lead to tracheal stenosis and atelectasis, but the specific risk factors are currently unclear. Therefore, the goal of this retrospective study is to address this issue and help with the early diagnosis of TBTB. Methods: Please include PTB hospitalized in our hospital from January 2021 to October 2023 in the study. After conducting bronchoscopy examinations, the patients were divided into two groups: the PTB group and the PTB&TBTB group. We used the propensity score matching (PSM) to align the baseline data of the two groups of patients, and then performed multiple logistic regression analysis to identify risk factors. Results: 643 patients with PTB were included in the study, 227 of whom (35.30%) were diagnosed with TBTB. A total of 204 pairs of patients were successfully matched using the PSM. After matching, there were no statistically significant differences in basic information between the two groups of patients (P 0.05). Multivariate logistic regression analysis revealed that disease course ≥ 1 month (OR=1.85, 95% CI: 1.21– 2.83), complicated with diabetes (OR=3.00, 95% CI: 1.91– 4.70), and concomitant pulmonary cavity (OR=3.46, 95% CI: 2.23– 5.36) were risk factors for PTB accompanied by TBTB (all P< 0.05). Conclusion: After adjusting for various influencing factors using PSM, the analysis demonstrated that disease course ≥ 1 month, complicated with diabetes, and concomitant pulmonary cavity are risk factors for PTB combined with TBTB. This emphasizes the significance of improving screening and implementing early intervention measures. [ABSTRACT FROM AUTHOR]

Postintubation tracheal stenosis (PITS) is an iatrogenic complication that can often occur due to tracheostomy and prolonged intubation. It can be seen very rarely after short-term intubation. Here, we present a case of PITS that developed in a patient who was operated on twice for subdural and epidural hematoma evacuation. Our case was intubated twice and was followed intubated for a short time (48 hours). Since PITS can often be confused with other respiratory diseases, anamnesis and clinical suspicion are essential in diagnosis. PITS should be considered in patients who are intubated in the intensive care unit, have cardiovascular disease, hypotensive periods, and progressively increasing respiratory complaints. It should be kept in mind that intubation may not be possible in PITS cases with severe tracheal stenosis. Planning the necessary preparations, including emergency front of neck access, to ensure the airway safety of patients is vital in preventing undesirable situations. [ABSTRACT FROM AUTHOR]

Abstract Abnormalities of tracheal smooth muscle (SM) formation are associated with several clinical disorders including tracheal stenosis and tracheomalacia. However, the cellular and molecular mechanisms underlying tracheal SM formation remain poorly understood. Here, it is shown that the T‐type calcium channel CACNA1H is a novel regulator of tracheal SM formation and contraction. Cacna1h in an ethylnitrosourea forward genetic screen for regulators of respiratory disease using the mouse as a model is identified. Cacna1h mutants exhibit tracheal stenosis, disorganized SM and compromised tracheal contraction. CACNA1H is essential to maintain actin polymerization, which is required for tracheal SM organization and tube formation. This process appears to be partially mediated through activation of the actin regulator RhoA, as pharmacological increase of RhoA activity ameliorates the Cacna1h‐mutant trachea phenotypes. Analysis of human tracheal tissues indicates that a decrease in CACNA1H protein levels is associated with congenital tracheostenosis. These results provide insight into the role for the T‐type calcium channel in cytoskeletal organization and SM formation during tracheal tube formation and suggest novel targets for congenital tracheostenosis intervention.

Abstract The conventional methods of silicon stent insertion recommend usage of external loading devices, where the stent is folded into the loading device and pushed in to the tracheobronchial tree using an external pusher which is blind, and leads to placement of stent either distally or proximally needing repositioning or is done with fluoroscopy that involves radiation exposure. We demonstrate our experience in 16 cases of successful silicon stent placement using this technique, wherein an Ultrathin flexible bronchoscope or Hopkins Rigid telescope is pushed alongside the forceps that hold upper end of the folded silicon stent allowing stent placement under direct vision with control over the stent. The Proximal end of the stent can be pulled under vision before deployment for appropriate positioning while pulling the rigid barrel. The stent is always under the operator's control providing excellent control over placement, simplifies the procedure and is safe with no reported complications.

ABSTRACT: Prolonged mechanical ventilation following cardiopulmonary and neurological events oftentimes necessitates a tracheostomy and tracheal granulation is one of its most common late complications. The literature recommends that large granulation be managed through surgical excision or endoluminal techniques. A 6-year-old boy presented with high-grade tracheal stenosis secondary to endotracheal cuff-related injury and prolonged tracheostomy. We present an unconventional yet successful method of management that included multiple sittings of endoscopic rigid bronchoscopic dilation and endoluminal cryotherapy. [ABSTRACT FROM AUTHOR]

Human trachea has variable shapes and the most common are circular and oval-shaped. Other shapes are rare to find and usually related to some diseases. Such as the Saber-sheath shaped trachea, which was commonly attributed to patients with chronic obstructive pulmonary disease (COPD). This case is about a patient who was detected to have dual pathology, bilateral vocal cord abductor palsy, and post-tracheostomy complicated with tracheal stenosis for 40 years. Symptoms worsened in the last three years until he was admitted to the ward. However, upon managing this case with multilevel airway obstruction, we have found out that this patient who did not have COPD, has a Saber-sheath trachea shape. This finding may indicate that the shape is not limited to a certain disease only. [ABSTRACT FROM AUTHOR]