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ABSTRACT: Angioedema related to a deficiency in the C1-inhibitor protein is characterized by its lack of response to therapies including antihistamine, steroids, and epinephrine. In the case of laryngeal edema, mortality rate is approximately 30 percent. The first case of the acquired form of angioedema related to a deficiency in C1-inhibitor was published in 1972. In our paper, we present a case of an acquired form of angioedema of the oropharyngeal region secondary to the simultaneous occurrence of two causative factors: neutralization of C1-inhibitor by an autoantibody and the use of an angiotensin convertin enzyme inhibitor.
Case reports in otolaryngology. 01/2012; 2012:405824.
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ABSTRACT: To assess early oncological and functional outcomes after transoral laser surgery in patients with pharyngeal or pharyngolaryngeal squamous cell carcinoma.
Inception cohort, with a median follow-up of 24 months.
Tertiary university center.
Fifty-five consecutive patients with pharyngeal or pharyngolaryngeal squamous cell carcinoma (T1, 24 patients; T2, 28 patients; and T3, 3 patients) were included. Patients had to be eligible for open functional surgery, and exposure in suspension micropharyngoscopy had to be possible.
The pharynx and larynx were exposed with a bivalved laryngopharyngoscope, and the resection of the tumor was performed with a carbon dioxide laser coupled to a microscope. Neck dissection was performed in 43 patients. It was not attempted in the other 12 patients for the following reasons: N0 neck and severe comorbidities (n = 6), microinvasive cancer (n = 3), patient's refusal (n = 1), inoperable N3 disease (n = 1), and rapid local recurrence (n = 1). Eighteen patients (33%) received adjuvant radiotherapy: 12 for neck disease and 6 for positive resection margins.
Local control and overall survival at the median follow-up visit. Evaluation of complications, pain, and rehabilitation of swallowing capacity.
At a median follow-up of 24 months, the local control rate was 90%, and the overall survival rate was 78%. There were 16 early postoperative complications: recurrent aspiration pneumonia (n = 7); laryngeal obstruction, which required tracheotomy (n = 3); severe postoperative hemorrhage (n = 2); and cervical emphysema, which resolved spontaneously (n = 4). Feeding tubes were necessary in 37 patients. They were removed after a median period of 7 days. The median pain score was 4 of 10 during the first postoperative week and 0 of 10 after 4 weeks. The median hospital stay was 13 days (15 days for patients with neck dissection).
Transoral laser surgery for pharyngeal and pharyngolaryngeal squamous cell carcinoma is a safe and acceptable therapeutic modality in selected cases. Good local control and avoidance of tracheotomy can be expected in most cases. Oral food intake is immediate, but feeding tubes are required to avoid weight loss during the postoperative period. Frequent early problems include transient postoperative bronchoinhalations and pain.
Archives of Otolaryngology - Head and Neck Surgery 03/2007; 133(2):139-44. · 1.63 Impact Factor
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ABSTRACT: We sought to assess the long-term outcome of 57 pediatric patients who underwent partial cricotracheal resection for subglottic stenosis.
Eighty-one pediatric partial cricotracheal resections were performed in our tertiary care institution between 1978 and 2004. Fifty-seven patients had a minimal follow-up time of 1 year and were included in this study. Evaluation was based on the last laryngotracheal endoscopy, the responses to a questionnaire, and a retrospective review of the patient's data. The following parameters were analyzed: decannulation rates, breathing, voice quality, and deglutition.
A single-stage partial cricotracheal resection was performed in 38 patients, and a double-stage procedure was performed in 19 patients. Sixteen patients underwent an extended partial cricotracheal resection (ie, partial cricotracheal resection combined with another open procedure). At a median follow-up time of 5.1 years, the decannulation rates after a single- or double-stage procedure were 97.4% and 95%, respectively. Two patients remained tracheotomy dependent. One patient had moderate exertional dyspnea, and all other patients had no exertional dyspnea. Voice quality was found to improve after surgical intervention for 1 +/- 1.34 grade dysphonia (P < .0001) according to the adapted GRBAS grading system (Grade, Roughness, Breathiness, Asthenia, and Strain).
Partial cricotracheal resection provides good results for grades III and IV subglottic stenosis as primary or salvage operations. The procedure has no deleterious effects on laryngeal growth and function. The quality of voice significantly improves after surgical intervention but largely depends on the preoperative condition.
Journal of Thoracic and Cardiovascular Surgery 10/2005; 130(3):726-32. · 3.41 Impact Factor
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ABSTRACT: The purpose was to evaluate the outcome following the surgical management of a consecutive series of 26 adult patients with laryngotracheal stenosis of varied etiologies in a tertiary care center. Of the 83 patients who underwent surgery for laryngotracheal stenosis in the Department of Otorhinolaryngology and Head and Neck Surgery, University Hospital of Lausanne, Switzerland, between 1995 and 2003, 26 patients were adults (> or = 16 years) and formed the group that was the focus of this study. The stenosis involved the trachea (20), subglottis (1), subglottis and trachea (2), glottis and subglottis (1) and glottis, subglottis and trachea (2). The etiology of the stenosis was post-intubation injury ( n = 20), infiltration of the trachea by thyroid tumor ( n = 3), seeding from a laryngeal tumor at the site of the tracheostoma ( n = 1), idiopathic progressive subglottic stenosis ( n = 1) and external laryngeal trauma ( n = 1). Of the patients, 20 underwent tracheal resection and end-to-end anastomosis, and 5 patients had partial cricotracheal resection and thyrotracheal anastomosis. The length of resection varied from 1.5 to 6 cm, with a median length of 3.4 cm. Eighteen patients were extubated in the operating room, and six patients were extubated during a period of 12 to 72 h after surgery. Two patients were decannulated at 12 and 18 months, respectively. One patient, who developed anastomotic dehiscence 10 days after surgery, underwent revision surgery with a good outcome. On long-term outcome assessment, 15 patients achieved excellent results, 7 patients had a good result and 4 patients died of causes unrelated to surgery (mean follow-up period of 3.6 years). No patient showed evidence of restenosis. The excellent functional results of cricotracheal/tracheal resection and primary anastomosis in this series confirm the efficacy and reliability of this approach towards the management of laryngotracheal stenosis of varied etiologies. Similar to data in the literature, post-intubation injury was the leading cause of stenosis in our series. A resection length of up to 6 cm with laryngeal release procedures (when necessary) was found to be technically feasible.
Archiv für Klinische und Experimentelle Ohren- Nasen- und Kehlkopfheilkunde 09/2005; 262(8):609-15. · 1.29 Impact Factor
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ABSTRACT: Over the last decade, improvement of CO2 lasers with the microspot and ultrapulse technologies has broadened the indications for endoscopic CO2-laser resection of benign laryngotracheal stenosis (LTS). This article reviews 100 patients treated solely by endoscopic means for a LTS. There were 47 grade III, 41 grade II and 12 grade I stenoses according to the Myer-Cotton classification. The postoperative results show that the improvement to a nearly normal (>80% luminal size) airway declines from 92% (11/12 patients) for grade I to 46% (19/41 patients) for grade II and 13% (6/47 patients) for grade III stenoses. When compared to open surgery for more severe grades of stenosis (31 grade IV, 66 grade III and 3 grade II stenoses), the results of the endoscopy group is much less favorable: 36% of patients in the endoscopy group versus 76% of patients in the open surgery group were rehabilitated to a normal respiration without exertional dyspnea and 38% versus 5% patients remained tracheotomy dependent. However, if strict selection and therapeutic criteria are respected, a significant number of grade I and II stenoses, and to a lesser degree of grade III stenoses, can be improved to a nearly normal airway by endoscopic means only. The endoscopic treatment is potentially less invasive and risky and only needs a short hospital stay. To try this as a first treatment modality in a selected group of patients is worthwhile, provided that this endoscopic treatment is not repeated a second time, if the stenosis recurs to its initial grade after a primary CO2-laser treatment. Some guidelines for safe endoscopic treatment modalities with of the CO2 laser, dilatation and/or stenting are proposed.
Archiv für Klinische und Experimentelle Ohren- Nasen- und Kehlkopfheilkunde 08/2005; 262(8):602-8. · 1.29 Impact Factor
