OBJECTIVE: To investigate the role of periostin (POSTN) and the transforming growth factor β (TGF-β) pathway in the formation of laryngotracheal stenosis (LTS) scar fibrosis and to explore the specific signaling mechanism of POSTN-regulated TGF-β pathway in tracheal fibroblasts.
METHODS: Bioinformatics analysis was performed on scar data sets from the GEO database to preliminarily analyze the involvement of POSTN and TGF-β pathways in fibrosis diseases. Expression of POSTN and TGF-β pathway-related molecules was analyzed in LTS scar tissue at the mRNA and protein levels. The effect of POSTN on the biological behavior of tracheal fibroblasts was studied using plasmid DNA overexpression and siRNA silencing techniques to regulate POSTN expression and observe the activation of TGF-β1 and the regulation of cell proliferation and migration via the TGF-β/RHOA pathway.
RESULTS: The bioinformatics analysis revealed that POSTN and the TGF-β pathway are significantly involved in fibrosis diseases. High expression of POSTN and TGF-β/RHOA pathway-related molecules (TGFβ1, RHOA, CTGF, and COL1) was observed in LTS tissue at both mRNA and protein levels. In tracheal fibroblasts, overexpression or silencing of POSTN led to the activation of TGF-β1 and regulation of cell proliferation and migration through the TGF-β/RHOA pathway.
CONCLUSIONS: POSTN is a key molecule in scar formation in LTS, and it regulates the TGF-β/RHOA pathway to mediate the formation of cicatricial LTS by acting on TGF-β1. This study provides insights into the molecular mechanisms underlying LTS and suggests potential therapeutic targets for the treatment of this condition.
METHODS: NA Laryngoscope, 134:4078-4087, 2024.

Objective:To investigate the effect of acellular dermal matrix in preventing laryngeal stenosis in glottic carcinoma patients. Methods:Fifty-five patients with glottic carcinoma（T2, T3） from February 2018 to December 2022 were divided into experimental group（28 cases） and control group（27 cases） according to their wishes. Acellular dermal matrix was placed in the operation cavity in the experimental group after laryngofission, while control group 12 cases were sutured by pulling the upper and lower edges, 15 cases were repaired with sternohyoid muscle fascia flap. Results:In the experimental group, 1 case had laryngeal stenosis caused by laryngeal mucosa swelling after operation, and extubated successfully after symptomatic treatment. In the control group, 7 cases had laryngeal stenosis after operation, of which 3 cases were caused by granulation tissue hyperplasia in laryngeal cavity, and extubated after symptomatic treatment. 2 cases extubated after operation suffered from progressive dyspnea during radiotherapy, and underwent tracheotomy again, extubation successful after treatment. 2 cases caused by laryngeal mucosa swelling, after symptomatic treatment, one case was successfully extubated, and one case had long-term intubation. The laryngeal stenosis rate of the experimental group was 3.6%（1/28） , which was lower than control group 25.9%（7/27）, and the therapeutic effect of the experimental group was significantly better than control group （χ²=5.526, P=0.019）. Conclusion:Implanting acellular dermal matrix in the operation cavity of glottic carcinoma can reduce the occurrence of laryngeal stenosis and have satisfactory preventive effect on laryngeal stenosis.
目的：探讨脱细胞异体真皮在声门型喉癌术中预防喉狭窄的效果。 方法：将2018年2月-2022年12月55例声门型喉癌（T2、T3型）患者按意愿分为实验组（28例）和对照组（27例），采用喉裂开切除肿瘤方式，实验组术后术腔置入脱细胞异体真皮缝合，对照组12例术腔采用上下缘拉拢缝合，15例术腔采用胸骨舌骨肌筋膜瓣修补。 结果：实验组有1例术后出现喉狭窄，系喉腔黏膜肿胀所致，对症治疗后肿胀消退顺利拔管。对照组有7例术后出现喉狭窄，其中3例系喉腔肉芽增生所致，对症治疗后顺利拔管；2例术后拔管后放疗出现进行性呼吸困难，再次行气管切开，治疗后顺利拔管；2例系喉腔黏膜肿胀，对症治疗后1例顺利拔管，1例长期戴管。实验组喉狭窄率3.6%（1/28）低于对照组25.9%（7/27），实验组治疗效果明显优于对照组（χ²=5.526，P=0.019）。 结论：声门型喉癌术腔置入脱细胞异体真皮能减少喉狭窄的发生，对喉狭窄有满意的预防效果。.

Iatrogenic laryngotracheal stenosis (iLTS) is a pathological condition characterized by the narrowing of the laryngeal and tracheal structures due to the formation of abnormal scar tissue. The core of iLTS lies in the fibrosis of the laryngotracheal tissue, and recent research has unveiled novel discoveries regarding the underlying mechanisms of fibrosis. This review provides an overview of the recent advancements in understanding the mechanisms of fibrosis in iLTS. It encompasses various aspects, such as immune system dysregulation, changes in the extracellular matrix (ECM), metabolic alterations, and the role of microbial flora. The review also explores the interplay and relationships between these new mechanisms, establishing a theoretical foundation for the development of multi-target therapies and combination therapies for iLTS.

Objective:To investigate the prognostic impact of different tumor invasion patterns in the surgical treatment of T3 glottic laryngeal cancer. Methods:A retrospective analysis was conducted on the clinical data of 91 patients with T3 glottic laryngeal cancer. Results:Among the 91 patients, 58 cases （63.7%） had anterior invasion and 33 cases （36.3%） had posterior invasion. The posterior invasion was significantly correlated with invasions of the dorsal plate of cricoid cartilage （P<0.001）, arytenoid cartilage （P= 0.001）, and subglottic region（P = 0.001）. There was no statistical difference in survival outcomes between the total laryngectomy group and the partial laryngectomy group. But in the partial laryngectomy group, the 5-year disease-free survival（DFS） of patients with anterior invasive tumors was better than that of patients with posterior invasion tumors （HR: 4.681, 95%CI 1.337-16.393, P=0.016）, and subglottic invasion was associated with worse loco-regional recurrence-free survival（LRRFS）（HR: 3.931, 95%CI 1.054-14.658, P=0.041）. At the same time, we found that involvement of the dorsal plate of cricoid cartilage was an independent risk factor for postoperative laryngeal stenosis in partial laryngectomy patients （HR:11.67, 95%CI 1.89-71.98,P=0.008）. Conclusion:Compared with total laryngectomy, selected partial laryngectomy can also achieve favorable oncological outcomes. Posterior invasion and subglottic extension are independent prognostic factors for recurrence of partial laryngectomy in T3 glottic laryngeal cancer, and the involvement of the dorsal plate of cricoid cartilage is associated with postoperative laryngeal stenosis. The tumor invasion pattern of laryngeal cancer should be further subdivided in order to select a more individualized treatment plan.
目的：研究不同肿瘤扩展模式在T3期声门型喉癌手术治疗中的预后影响。 方法：对91例T3期声门型喉癌患者的临床资料进行了回顾性分析。 结果：91例患者中，前侵犯58例（63.7%），后侵犯33例（36.3%），后侵犯与环状软骨背板（P<0.001）、杓状软骨（P=0.001）、声门下（P=0.001）侵犯显著相关。部分喉切除组与全喉切除组生存结局差异无统计学意义；部分喉切除组中前侵犯肿瘤5年无病生存率优于后侵犯肿瘤（HR：4.681，95%CI 1.337～16.393，P=0.016），声门下侵犯与较差的5年局部区域无复发生存率相关（HR：3.931，95%CI 1.054～14.658，P=0.041）。同时，还发现环状软骨背板侵犯是部分喉切除术后发生喉狭窄的独立危险因素（HR：11.67，95%CI 1.89～71.98，P=0.008）。 结论：经选择的部分喉切除术较全喉切除术同样能获得良好的肿瘤学结果。后侵犯和声门下侵犯是T3期声门型喉癌部分喉手术复发的独立预后因素，环状软骨背板侵犯与部分喉术后喉狭窄相关。应进一步细分喉癌患者的肿瘤侵犯模式，以选择更为个体化的治疗方案。.

OBJECTIVE: To investigate the prognostic impact of different tumor invasion patterns in the surgical treatment of T3 glottic laryngeal cancer.
METHODS: We conducted a retrospective analysis of clinical data of 91 patients with T3 glottic laryngeal cancer.
RESULTS: We found that the posterior invasion being significantly associated with involvement of the lamina of cricoid cartilage (P < 0.001), arytenoid cartilage (P = 0.001), and subglottic (P = 0.001). There was no statistical difference in survival outcomes between the total laryngectomy (TL) group and the partial laryngectomy (PL) group, but in the PL group, tumors with anterior invasion were associated with a better 5-year DFS than tumors with posterior invasion (HR: 4.681, 95% CI: 1.337-16.393, P = 0.016), and subglottic involvement was associated with worse LRRFS (HR: 3.931, 95% CI: 1.054-14.658, P = 0.041). At the same time, we found that involvement of the lamina of cricoid cartilage was an independent risk factor for postoperative laryngeal stenosis in PL patients (HR: 11.67, 95% CI: 1.89-71.98, P = 0.008).
CONCLUSIONS: Selectively performed PL can also achieve favorable oncological outcomes comparable to those of TL. Posterior invasion and subglottic involvement are independent prognostic factors for recurrence after PL in T3 glottic laryngeal cancer, and involvement of the lamina of cricoid cartilage is associated with postoperative laryngeal stenosis. The tumor invasion pattern of patients with laryngeal cancer should be further subdivided to allow for selection of a more individualized treatment plan.

BACKGROUND: Idiopathic subglottic stenosis is a fibrotic condition of unknown origin that results in blockage of the central airway in the subglottic region. It is widely acknowledged that subglottic stenosis is a relatively uncommon structural anomaly that is difficult to operate on and cure due to its anatomical location. Inguinal hernias are well-established to be prevalent in infants and youngsters. We present a case of subglottic stenosis in a child complicated with an inguinal hernia (IH).
METHODS: A 7-year-old female was admitted to our hospital with a 1-month history of progressive bulging in the left lower quadrant of the abdomen. She complained of no stomach discomfort, distension, or dyspnea, but her family reports that the patient usually wheezes during moderate exertion and has no family history of asthma or lung illness. However, for unclear reasons, the infant experienced shortness of breath following training. A chest CT scan was unremarkable. Below the glottis, a membranous stenosis was discovered. The stenosis beneath the glottis was discovered using dynamic laryngoscopy.
METHODS: Idiopathic subglottic stenosis with an IH.
METHODS: An otorhinolaryngologist employed a carbon dioxide laser to eliminate the subglottic stenosis. Following successful intubation by the anesthesiologist, pediatric surgeons performed laparoscopic high ligation of the hernial sac.
RESULTS: After 1 month, a repeat laryngoscopy revealed significant expansion of the subglottic stenosis, accounting for the improvement in respiratory symptoms.
CONCLUSIONS: The present case raises awareness that surgeons should be more vigilant about respiratory complications in patients with an IH. Early diagnosis and treatment of respiratory illnesses are critical for patients undergoing endotracheal intubation.

This patient suffered from severe subglottic stenosis(grade Ⅳb). During partial cricotracheal resection, we cut through the cricothyroid membrane and the cricoid arch along the line from the lower edge of the thyroid cartilage to 5 mm of the inferior thyroid cartilage corner anteromedially. This can protect the cricothyroid joint, effectively protect the recurrent laryngeal nerve, and also support the airway. Strictly adhere to airway separation, avoid excessive separation of scars, and combine with reasonable postoperative management to achieve a safe extubation.
摘要: 本例患者为严重声门下狭窄（Ⅳb级），在实施环气管部分切除术过程中沿着甲状软骨正中下缘及甲状软骨下角下方5 mm之间连线横断环甲膜及环状软骨弓，保留双侧环甲关节，有效保护喉返神经的同时起到了气道的支撑作用，配合合理的术后管理，实现了一期安全拔管。.

UNASSIGNED: The current treatment options for T1b glottic carcinoma often lead to poor treatment outcomes or voice quality.
UNASSIGNED: This study evaluates the therapeutic efficacy of horizontal middle partial laryngectomy with cricothyroidopexy (HMPL-CTP) for stage T1b glottic carcinoma.
UNASSIGNED: A retrospective analysis was conducted on 73 patients with T1b glottic carcinoma. The patients were categorized into three groups: Group A (n = 22) underwent transoral laser microsurgery (TLMS), Group B (n = 21) received frontolateral vertical partial laryngectomy (FVPL), and Group C (n = 30) underwent HMPL-CTP. The study analyzed the 5-year overall survival rate (OS), recurrence rate, phonatory status, and incidence of laryngeal stenosis.
UNASSIGNED: Voice quality scores varied significantly in the three groups, while the 5-year OS were similar. The local recurrence rate is higher in Group A than in the other two groups. The laryngeal stenosis rate in Group B is higher than in Groups A and C. Adhesions in the anterior commissure were observed in 18 cases in Group A and nine cases in Group C.
UNASSIGNED: HMPL-CTP demonstrates efficacy as a treatment for stage T1b glottic carcinoma, offering favorable preservation of laryngeal function and minimal complications.

BACKGROUND: To study the role of microecology and metabolism in iatrogenic tracheal injury and cicatricial stenosis, we investigated the tracheal microbiome and metabolome in patients with tracheal stenosis after endotracheal intubation.
METHODS: We collected 16 protected specimen brush (PSB) and 8 broncho-alveolar lavage (BAL) samples from 8 iatrogenic subglottic tracheal stenosis patients, including 8 PSB samples from tracheal scar sites, 8 PSB samples from scar-free sites and 8 BAL samples, by lavaging the subsegmental bronchi of the right-middle lobe. Metagenomic sequencing was performed to characterize the microbiome profiling of 16 PSB and 8 BAL samples. Untargeted metabolomics was performed in 6 PSB samples (3 from tracheal scar PSB and 3 from tracheal scar-free PSB) using high-performance liquid chromatography‒mass spectrometry (LC‒MS).
RESULTS: At the species level, the top four bacterial species were Neisseria subflava, Streptococcus oralis, Capnocytophaga gingivals, and Haemophilus aegyptius. The alpha and beta diversity among tracheal scar PSB, scar-free PSB and BAL samples were compared, and no significant differences were found. Untargeted metabolomics was performed in 6 PSB samples using LC‒MS, and only one statistically significant metabolite, carnitine, was identified. Pathway enrichment analysis of carnitine revealed significant enrichment in fatty acid oxidation.
CONCLUSIONS: Our study found that carnitine levels in tracheal scar tissue were significantly lower than those in scar-free tissue, which might be a new target for the prevention and treatment of iatrogenic tracheal stenosis in the future.

OBJECTIVE: To discuss the presentation, evaluation, and management of congenital laryngeal webs with subglottic stenosis.
METHODS: The clinical data of six children were retrospectively analyzed.
RESULTS: The median age of these children who came to our hospital was 14 months (range 1-26 months). A tracheotomy was performed in all these six children. The median age of the patients who underwent tracheotomy was 4 months (range 1-11 months). The surgical method was T-tube implantation combined with cricoid cartilage reconstruction. The median age of these patients at the time of operation was 22 months (range 13-35 months). The T-tube remained in place for 3-8 months, with a median time of 6 months. The tracheal tubes in all these children were successfully removed. All patients were followed up for more than 2 years without recurrence.
CONCLUSIONS: Children who have congenital laryngeal webs with subglottic stenosis required early tracheotomy. Open laryngoplasty combined with T-tube implantation and cricoid cartilage reconstruction may play a crucial role in the treatment of these children.