BACKGROUND: Pediatric laryngotracheal stenosis often requires open airway reconstruction. While these surgeries establish an airway for adequate ventilation, many patients develop subsequent dysphonia. Numerous studies have reported outcomes related to voice.
OBJECTIVE: This study aims to evaluate dysphonia in pediatric patients following open airway reconstruction, focusing on acoustic parameters, perceptual voice quality, and voice-related quality of life.
METHODS: A comprehensive search using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines across 6 databases identified articles involving pediatric patients who underwent open airway reconstruction and reported postoperative vocal acoustic parameters, perceptual voice quality, voice-related quality of life, or vocal mechanics. Articles were assessed for bias risk, and common outcomes were synthesized qualitatively and quantitatively using meta-analyses.
RESULTS: Among 4089 articles, 21 were included, involving 497 pediatric patients. Laryngotracheoplasty was the most common procedure followed by cricotracheal resection. The Consensus Auditory-Perceptual Evaluation of Voice (CAPE-V) scale was frequently used to assess voice quality, with a mean score of 55.6 [95% confidence intervals (CIs): 47.9-63.3]. Voice-related quality of life was measured using the pediatric Voice Handicap Index (pVHI) and Pediatric Voice-Related Quality of Life Survey, with mean scores of 35.6 (95% CI: 21.4-49.7) and 83.7 (95% CI: 74.1-93.2), respectively. The fundamental frequency was 210.5 (95% CI: 174.6-246.3). Other common findings included supraglottic phonation, anterior commissure blunting, posterior glottic diastasis, and abnormal vocal cord mobility.
CONCLUSIONS: Pediatric patients experiencing dysphonia after open airway reconstruction exhibited moderately decreased voice quality and reduced voice-related quality of life. However, there was inconsistency in study protocols and outcome measures used. Preserving voice quality during airway reconstruction is crucial to avoid negative impacts on quality of life.

BACKGROUND: Slide tracheoplasty has become the gold standard surgery for congenital tracheal stenosis (CTS). This condition is rare and the surgery can be challenging and is performed by experienced surgeons in tertiary centers. A few reports involving relatively small cohorts have been published. The aim of this review is to evaluate the post-operative mortality and morbidity of pediatric slide tracheoplasty for CTS.
METHODS: A systematic literature review was performed according to PRISMA guidelines. The Medline and EMBASE databases were screened using a search strategy defined in collaboration with a librarian. We included articles reporting the post-operative mortality rate of slide tracheoplasties for treatment of CTS in children, when at least 10 patients were included.
RESULTS: A total of 932 articles were reviewed, and 15 studies were eligible with a total of 845 patients. The overall post-operative mortality rate was 9.3 %, and most deaths were airway related. The open revision surgery rate after surgery was 2.8 % and the endoscopic revision rate was 27.6 %.
CONCLUSIONS: This study highlights key factors to consider before the surgery and helps anticipate post-operative follow-up considerations for children with CTS. Several factors were identified as predictors of mortality including young age, weight at the time of surgery and association with lung hypoplasia or aplasia.
CONCLUSIONS: Although slide tracheoplasty has gained popularity in recent years due to better outcomes, it remains a major surgery with mortality risk and the need for multidisciplinary management.

BACKGROUND: Stenting has become popular to treat tracheal collapse in dogs, but complications might arise and negatively affect treatment outcome.
OBJECTIVE: Determine the overall prevalence of complications of tracheal stenting in dogs.
METHODS: A bibliographic search was performed of publications from 2000 to 2020. Studies were assessed for quality of evidence and measured prevalence of the 8 most commonly reported complications after tracheal stenting in dogs (stent fracture, stent migration, relapsing collapse, granuloma formation, tracheobronchial infections, and early, late, and clinically relevant late cough). Random effects meta-analyses were used to estimate pooled complications prevalence.
RESULTS: Fifteen studies met inclusion criteria. Cough (early: 99%; 95% confidence interval [95% CI]: 95%-100%, late: 75%; 95% CI: 63%-85%, and clinically relevant: 52%; 95% CI: 42%-61%), tracheobronchial infections (24%; 95% CI: 14%-35%), and granulomas (20%; 95% CI: 11%-30%) were common after tracheal stenting. Stent fractures (12%; 95% CI: 5%-20%), relapsing collapse (10%; 95% CI: 5%-15%), and stent migration (5%; 95% CI: 1%-9%) were less frequent. Significant heterogeneity among studies was identified for the estimated prevalence of stent fracture, granulomas, infections, and late cough.
CONCLUSIONS: Tracheal stenting in dogs is associated with a high risk of coughing and a moderate risk of tracheobronchial infections and granuloma formation. Because most complications will impact a dog\'s quality of life, owners must be informed that tracheal stenting is a second-line procedure that does not necessarily alleviate the need for medical treatment and frequent follow-up visits. Additional studies are warranted to identify the risk factors of these complications.

The two patients included in the study had mixed and refractory post-tuberculosis tracheobronchial stenosis (PTTS), having experienced unsuccessful interventional therapies such as balloon dilation and V-shaped stent placement before the operation. Following the secure placement of L-shaped silicone stents, examinations with a fiberbronchoscope during the first and third months post-operation revealed a significant reduction in bronchial mucosa inflammation for both patients. Additionally, the opening diameter of the upper and lower branch segments increased, and chest CT scans indicated a noticeable absorption of left pulmonary lesions. Three months post-operation, fiberbronchoscopy confirmed the stable fixation of the stent without any movement. The patients exhibited substantial improvements in pulmonary function, dyspnea index, and blood gas analysis, with no reported adverse complications. After 7 months, a follow-up fiberbronchoscope for one case revealed excellent stent fixation. Simultaneously, the chest CT scan indicated favorable re-expansion. The placement of L-shaped silicone stents proves effective in preventing displacement, alleviating airway stenosis or obstruction, and ensuring the safety and efficacy of PTTS treatment - particularly in cases where V-shaped silicone stent placement has failed. To our knowledge, this is the first study describing the L-shaped silicone stent in two patients with PTTS.
Successful treatment of severe airway narrowing due to tuberculosis using special L-shaped silicone stentsThis article tells the story of two patients who suffered from a complex lung condition called post-tuberculosis tracheobronchial stenosis (PTTS). Imagine your airways - the tubes that carry air to your lungs - getting severely scarred and narrowed due to a past bout with tuberculosis. These two patients had tried previous treatments like balloon dilation (where a small balloon is inflated inside the narrowed airway to widen it) and using V-shaped stents (flexible supports placed in the airway to keep it open), but these methods didn’t provide lasting relief. In this innovative approach, doctors used L-shaped silicone stents specifically designed to fit in the affected parts of the patients’ airways. After placing these stents, regular checks showed remarkable improvements. The swelling in the airway lining reduced significantly, and the openings leading to the upper and lower parts of the lungs got wider. Chest X-rays (CT scans) even showed that the patient’s left lung was healing well. Three months later, the stents stayed firmly in place, and neither patient experienced any problems. Breathing became easier, lung function tests improved, and blood tests showed better oxygen levels. Seven months down the line, one patient continued to do extremely well, with the stent securely fixed and the chest scan showing good lung expansion. This groundbreaking study shows that using L-shaped silicone stents can effectively treat PTTS when other methods fail. Not only do they stay in place, preventing blockages, but they also safely and effectively alleviate narrowing of the airways. It’s the first time such L-shaped stents have been used successfully in PTTS patients, offering new hope for those facing similar challenges.

SARS-CoV-2 virus has led to an unprecedented amount of tracheal stenosis. Rigid bronchoscopy can serve as a curative measure or bridge therapy to tracheal resection. We also briefly discuss the pathophysiology of tracheal stenosis from prolonged intubation and SARS-CoV-2 virus. This should be differentiated from other forms of airway obstruction such as tracheobronchomalacia which would be considered a pseudo-tracheal stenotic disease. The aim of this study is to evaluate stenosis that is unable to be improved with positive airway pressure or \"PAP\" therapies and required stenting and/or subsequent tracheal resection. By performing Rigid Bronchoscopy and subsequent stenting of airways, we demonstrated outcomes for long term airway patency regarding patients who were intubated secondary to the SARS-CoV-2 virus. We demonstrate superb outcomes in a consecutive case series of 6 patients managed with rigid bronchoscopy, airway stent and tracheal resection. The patients were all managed from a pulmonary perspective by the physicians mentioned in this study.

BACKGROUND: Suprastomal collapse (SSC) is considered a major late complication of paediatric tracheostomy and can be responsible for decannulation failure in up to 20% of tracheostomised children. Depending on the severity of SSC, surgery may be required. Various strategies and techniques are available, of which the treating with airway team should be aware.
OBJECTIVE: This article intends to summarise the aetiology of SSC, its classification, clinical presentation, and the gold standard diagnostic and therapeutic algorithms according to the current literature.
METHODS: A panel of experts reviewed the available literature on SSC. Published evidence on the different surgical techniques and their advantages and disadvantages was reviewed in detail, and a treatment algorithm created.
RESULTS: The gold standard diagnostic procedure for SSC is flexible transnasal laryngotracheoscopy in spontaneous breathing followed by microlaryngoscopy (MLS) under general anaesthesia. Two main types of SSC can be differentiated, which differ in terms of surgical treatment. Purely anterior SSC is usually treated by tracheoplasty using an anterior costal cartilage graft (ACCG). Simple closure of the tracheostomy or excision of SSC with a potassium-titanyl-phosphate (KTP) laser are also described as less invasive approaches. For anterolateral SSC, segmental tracheal resection with end-to-end anastomosis or tracheoplasty with ACCG represent promising treatment options. Tracheal reinforcement with absorbable microplates is also discussed in the literature. With both types of SSC and depending on severity and the age of the child, a watch-and-wait strategy should always be considered.
CONCLUSIONS: Dynamic airway endoscopy in spontaneous breathing followed by MLS in general anaesthesia should always be performed before decannulation. It is particularly important to visualise all segments of the airway during spontaneous breathing. The decision regarding the best surgical option for each child is based on the type and localisation of SSC, as well as on the patient\'s medical and surgical history and age.
UNASSIGNED: HINTERGRUND: Der suprastomale Kollaps (SSC) gilt als eine späte Komplikation der kindlichen Tracheotomie und kann bei bis zu 20 % der tracheotomierten Kinder zu einem Scheitern des Dekanülierungsversuchs führen. Je nach Ausprägung erfordert ein SSC eine chirurgische Therapie. Es stehen einige unterschiedliche Strategien und Verfahren zur Verfügung, die dem behandelnden Team bekannt sein sollten. ZIEL: Ziel der vorliegenden Arbeit war eine Zusammenfassung der Ätiologie des SSC, seiner Klassifikation, klinischen Symptomatik und des Goldstandards in Bezug auf diagnostische und therapeutische Algorithmen gemäß der aktuellen Literatur.
METHODS: Die verfügbare Literatur zum Thema des SSC wurde von erfahrenen HNO-Ärzten in Bezug auf die chirurgischen Techniken, deren Vor- und Nachteile begutachtet und ein Behandlungspfad erarbeitet.
UNASSIGNED: Der Goldstandard zur Verifizierung eines SCC ist die flexible, transnasale Laryngotracheoskopie in Spontanatmung mit anschließender Mikrolaryngoskopie (MLS) in Vollnarkose. Die allgemein gültige Klassifizierung des SSC benennt 2 Hauptformen. Diese unterscheiden sich wesentlich in Bezug auf die chirurgischen Therapieoptionen. Bei einem rein anterioren SSC stehen hauptsächlich die laryngotracheale Rekonstruktion (LTR) anterior mit Rippenknorpel zur Verfügung. Die Pexie der Tracheavorderwand durch Nahttechnik und die Exzision des Kollapses mit dem Kaliumtitanylphosphat(KTP)-Laser werden ebenfalls beschrieben. Beim anterolateralen SSC gibt es die Tracheaquerresektion oder die LTR anterior mit Rippenknorpel als erfolgversprechende chirurgische Verfahren. Die Verstärkung der malazischen Trachea mit resorbierbaren Mikroplatten wird ebenfalls in der Literatur diskutiert. Bei beiden Formen des SSC sollte je nach Alter des Kindes und Ausprägung auch immer ein abwartendes Verhalten erwogen werden.
UNASSIGNED: Vor einem Dekanülierungsversuch sollte immer eine Laryngotracheoskopie in Spontanatmung gefolgt von einer MLS in Vollnarkose erfolgen. Insbesondere auf die Visualisierung sämtlicher Abschnitte des Atemwegs in Spontanatmung ist zu achten. Für die Entscheidungsfindung der besten Therapieoption ist die genaue Diagnosestellung, aber auch das Einbeziehen vorangegangener rekonstruktiver Eingriffe, Begleiterkrankungen sowie des Alters des Kindes entscheidend.

Patients with long-segment airway stenosis not amenable to conventional surgery may benefit from tracheal transplantation. However, this procedure has been only anecdotally reported, and its indications, techniques, and outcomes have not been extensively reviewed.
We conducted a systematic Literature search to identify all original articles reporting attempts at tracheal transplantation in humans.
Of 699 articles found by the initial search, 11 were included in the systematic review, describing 14 cases of tracheal transplantation. Patients underwent transplantation for benign stenosis in nine cases, and for malignancies in five cases. In 12 cases blood supply to the trachea was provided by wrapping the graft in a vascularized recipient\'s tissue, while in 2 cases the trachea was directly transplanted as a vascularized composite allograft. The transplantation procedure was aborted before orthotopic transplantation in two patients. Among the remaining 12 patients, there was 1 operative mortality, while 4 patients experienced complications. Immunosuppressants drugs were administered to the majority of patients postoperatively, and only one group of authors attempted their withdrawal, in five patients. At the end of follow-up, all 11 patients surviving the operation were alive, but 2 had a recurrent tracheal stenosis requiring an airway appliance for breathing.
Human tracheal transplantation is still at an embryonic phase. Studies available in the Literature report different surgical techniques, and information on long-term outcomes is still limited. Future research is needed in order to understand the clinical value of this procedure.

BACKGROUND: Lymphoma can appear in all parts of the body and present with different symptoms. However, bronchial lymphoma is rare and can be misdiagnosed as airway malignancy or lung disease.Patient: An older adult woman with tracheal lymphoma experienced severe breathing difficulties, and chest computed tomography indicated severe narrowing of the airway. She did not respond to repeated antibiotic treatment, and she was eventually diagnosed with lymphoma based on pathology after surgical removal of the tumor.
METHODS: The patient received a diagnosis of thoracic tracheal stenosis due to intratracheal inflammatory granulomatous lesions or a tumor.
METHODS: Treatment involved the use of a high-frequency electrotome, freezing, and argon plasma coagulation.
RESULTS: The patient reported improvements in dyspnea, cough, and other symptoms after the operation. The pathological results confirmed follicular lymphoma. Reexamination by fiberbronchoscopy indicated that the degree of stenosis in the middle and upper tracheal segments was significantly reduced following interventional therapy.
CONCLUSIONS: Endoscopic interventional therapy can be an effective treatment for tracheal lymphoma.

BACKGROUND: Congenital laryngotracheal stenosis (CLS) is a rare cause of stridor among newborns. Evidence has shown that several family members can be affected by CLS. Knowledge of the pathophysiology of familial congenital laryngotracheal stenosis (FCLS) will enable more effective therapeutic strategies.
OBJECTIVE: To determine the clinical course and outcome of familial congenital laryngotracheal stenosis (FCLS).
METHODS: A literature search was conducted over a period of one month (September 2023) by searching several databases to identify studies published from inception to 31st August 2023.
RESULTS: Of 256 papers identified, five articles met the inclusion criteria. A total of 17 patients with slight female predominance (59 %) were identified. Familial congenital tracheal stenosis was reported in female twins (100 %). A variety of clinical presentations were listed. An endoscopic airway study was performed on all patients. 64.8 % of the included children were managed surgically. Genetic studies performed on 41 % of children could not locate genetic abnormalities.
CONCLUSIONS: Consanguinity, twin births, and female gender could be predisposing factors for FCLS, although the quality of evidence is low due to the rarity of the condition.

Tracheal stenosis is a narrowing of the windpipe that can lead to shortness of breath, stridor and even suffocation. The present study reports the clinical course of a patient with this condition in an aim to help clinicians obtain more information about this rare condition and identify potential treatment options. A 2-year-old female child presented with progressive shortness of breath and stridor. She was initially managed with tracheostomy; however, this was unsuccessful in relieving the stenosis. Subsequent interventions, including rigid bronchoscopy and dilatation were successful in relieving the condition. A benign hypertrophy of the bronchial wall was identified through biopsy. The patient was treated with steroids and antibiotics, and she experienced a marked improvement in symptoms and remained asymptomatic after a 1-year follow-up. Tracheal stenosis is a rare, yet serious condition that may be life-threatening. Thus, the early diagnosis and treatment of this condition are essential in order to improve outcomes.