Doğuştan glotto-subglottik stenozun otojen tiroit kartilaj interpozisyonu ile larengotrakeal rekonstrüksiyonu: Bir olgu sunumu
Grade III doğufltan glotto-subglottik stenozlu iki aylık bir kız bebekte aflamalı cerrahi tedavi uyguladık. İlk aflamada, trakeotomiyi takiben anterior tirotomi yo- luyla silikon bir kil yerlefltirildi. İkinci aflamada, önde ve orta hatta longitudinal olarak kesilen krikoid ve üst trakeal halkaların kenarları arasına otojen tiroit kartilaj greftinin interpozisyonu ile larengotrakeal re- konstrüksiyon yapıldı. İki ay süreyle stent uygulandı. Stentin alınmasını takiben glottis ve subglottisin açık ve iyileflmifl olduğu görüldü. On üç aylık izlem sıra- sında anlamlı bir ses ve oldukça rahat solunum göz- lendi. Larengotrakeal rekonstrüksiyonda tiroit kartilaj otogreftinin kullanımı, önemli derecede teknik kolay- lıklar yanı sıra birçok avantaj sağlamaktadır
Anahtar Kelimeler:
Kartilaj/transplantasyon, larenjeal kıkırdaklar/transplantasyon, larenjeal hastalıklar/doğuştan/cerrahi, larengostenoz/doğuştan/cerrahi, trakeal stenoz/cerrahi, transplantasyon, otolog.
Laryngotracheal reconstruction of the congenital glotto-subglottic stenosis with autogenous thyroid cartilage interposition: a case report
Surgical correction of grade III glotto-subglottic stenosis in a two-month-old girl was illustrated in a staged man- ner. Firstly, a silicone keel was placed via anterior thyro- tomy following a tracheotomy. Secondly, laryngotra cheal reconstruction was performed by interposing an autogenous thyroid cartilage anteriorly between the edges of the longitudinally divided cricoid cartilage and the upper tracheal rings. A stentwas maintained fortwo months. The glottis and subglottis appeared patent and healed following removal of the stent. A meaningful voice and rather comfortable respiration were observed during a 13-month follow-up.The use of thyroid cartilage autograft offers many advantages in laryngotracheal reconstruction with considerably less technical difficulty.
Keywords:
Cartilage/transplantation, laryngeal cartilages/transplantation, laryngeal diseases/surgery/congenital, laryngostenosis/surgery/congenital, tracheal stenosis/surgery, transplantation, autologous,
___
- Cotton RT, Prescott CA. Congenital anomalies of the lar- ynx. In: Cotton RT, Myer CM, editors. Practical pediatric o t o l a r y n g o l o g y. 1st ed. Philadelphia: Lippincott-Raven; 1999. p. 497-513.
- Sichel JY, Dangoor E, Eliashar R, Halperin D. Management of congenital laryngeal malformations. Am J Otolaryngol 2000;21:22-30.
- Hartley BE, Cotton RT. Paediatric airway stenosis: laryngotracheal reconstruction or cricotracheal resec- tion? Clin Otolaryngol 2000;25:342-9.
- Lusk RP, Kang DR, Muntz HR. Auricular cartilage grafts in laryngotracheal re c o n s t ruction. Ann Otol Rhinol Laryngol 1993;102(4 Pt 1):247-54.
- Park AH, Forte V. Effect of harvesting autogenous laryngeal cartilage for laryngotracheal reconstruction on laryngeal growth and support. Laryngoscope 1999; 109(2 Pt 1):307-11.
- de Jong AL, Park AH, Raveh E, Schwartz MR, Forte V. Comparison of thyroid, auricular, and costal cartilage donor sites for laryngotracheal reconstruction in an animal model. Arch Otolaryngol Head Neck Surg 2000; 1 2 6 : 4 9 - 5 3 .
- Myer CM 3rd, O’Connor DM, Cotton RT. Proposed grading system for subglottic stenosis based on endo- tracheal tube sizes. Ann Otol Rhinol Laryngol 1994; 103(4 Pt 1):319-23.
- Lesperance MM, Zalzal GH. Assessment and manage- ment of laryngotracheal stenosis. Pediatr Clin North Am 1996;43:1413-27.
- Holinger PH, Kutnick SL, Schild JA, Holinger LD. Subglottic stenosis in infants and children. Ann Otol Rhinol Laryngol 1976;85(5 Pt.1):591-9.
- Cotton RT, Gray SD, Miller RP. Update of the Cincinnati experience in pediatric laryngotracheal re c o n s t ru c t i o n . Laryngoscope 1989;99:1111 - 6 .
- Zalzal GH. Treatment of laryngotracheal stenosis with anterior and posterior cartilage grafts. A report of 41 chil- d ren. Arch Otolaryngol Head Neck Surg 1993;11 9 : 8 2 - 6 .
- Willging JP, Cotton RT. Subglottic stenosis in the pediatric patient. In: Myer CM, Cotton RT, Shott SR, editors. The pediatric airway. An interdisiplinary approach. 1st ed. Philadelphia: JB Lippincott; 1995. p. 111 - 3 2 .
- Cotton RT, Evans JN. Laryngotracheal re c o n s t ruction in c h i l d ren. Five-year follow-up. Ann Otol Rhinol Laryngol 1981;90(5 Pt 1):516-20.
- Stern Y, Willging JP, Cotton RT. Use of Montgomery T- tube in laryngotracheal reconstruction in children: is it safe? Ann Otol Rhinol Laryngol 1998;107:1006-9.
- Montgomery WW, Montgomery SK. Manual for use of Montgomery laryngeal, tracheal, and esophageal pros- theses: update 1990. Ann Otol Rhinol Laryngol Suppl 1990;150:2-28.
- Choi SS, Zalzal GH. Pitfalls in laryngotracheal recon- struction. Arch Otolaryngol Head Neck Surg 1999;125: 650-3.
- Silva AB, Lusk RP, Muntz HR. Update on the use of auricular cartilage in laryngotracheal reconstruction. Ann Otol Rhinol Laryngol 2000;109:343-7.
- Fearon B, Cotton R. Surgical correction of subglottic stenosis of the larynx. Prelimenary report of an exper- imental surgical technique. Ann Otol Rhinol Laryngol 1972;81:508-13.
- Zalzal GH, Cotton RT, McAdams AJ. The survival of costal cartilage graft in laryngotracheal reconstruction. Otolaryngol Head Neck Surg 1986;94:204-11.
- Cotton RT. The problem of pediatric laryngotracheal stenosis: a clinical and experimental study on the eff i c a- cy of autogenous cartilaginous grafts placed between the vertically divided halves of the posterior lamina of the cricoid cartilage. Laryngoscope 1991;101(12 Pt 2 Suppl 56):1-34.
- ISSN: 2602-4837
- Yayın Aralığı: Yılda 4 Sayı
- Başlangıç: 1991
- Yayıncı: İstanbul Üniversitesi