Acute laryngeal dyspnea is a life-threatening emergency often attributed to laryngeal tumors or inflammatory edema in adults. Primary laryngeal lymphomas are especially infrequent. As an aggressive subtype of B-cell non-Hodgkin lymphoma (NHL), mantle cell lymphoma (MCL) cases are particularly complex.  Herein, we present a case of laryngotracheal stenosis secondary to primary MCL. A comprehensive assessment, including in-office flexible laryngoscopy, revealed distinct findings within the supraglottis and subglottis. In the supraglottis, a submucosal lesion with well-defined, rounded edges was observed, while the subglottis exhibited a friable tumor occupying approximately 90% of the airway. This necessitated immediate intervention, leading to microlaryngoscopy, biopsy, and open tracheostomy. Due to the rarity of primary laryngeal lymphomas, they present a significant diagnostic challenge. Timely diagnosis is crucial to enable tailored therapeutic strategies and improved patient outcomes. This case highlights the importance of considering lymphomatous etiologies in the management of laryngotracheal stenosis and emphasizes the need for a multidisciplinary approach to optimize patient care.

OBJECTIVE: Occurrence of post-intubation laryngotracheal stenosis (LTS) with respect to COVID-19 status.
METHODS: Retrospective cross-sectional inpatient database.
METHODS: Eleven Midwest academic and community hospitals, United States.
METHODS: Adults, mechanically ventilated, from January 2020 to August 2022, who were subsequently readmitted within 6 months with a new diagnosis of LTS.
METHODS: None.
RESULTS: Six thousand eight hundred fifty-one COVID-19 negative and 1316 COVID-19 positive patients were intubated and had similar distribution by age (median 63.77 vs. 63.16 yr old), sex (male, 60.8%; n = 4173 vs. 60%; n = 789), endotracheal tube size (≥ 7.5, 75.8%; n = 5192 vs. 75.5%; n = 994), and comorbidities. The ICU length of stay (median [interquartile range (IQR)], 7.23 d [2.13-16.67 d] vs. 3.95 d [1.91-8.88 d]) and mechanical ventilation days (median [IQR], 5.57 d [1.01-14.18 d] vs. 1.37 d [0.35-4.72 d]) were longer in the COVID-19 positive group. The occurrence of LTS was double in the COVID-19 positive group (12.7%, n = 168 vs. 6.4%, n = 440; p < 0.001) and was most commonly diagnosed within 60 days of intubation. In multivariate analysis, the risk of LTS increased by 2% with each additional ICU day (hazard ratio [HR], 1.02; 95% CI, 1.02-1.03; p < 0.001), by 3% with each additional day of ventilation (HR, 1.03; 95% CI, 1.02-1.04; p < 0.001), and by 52% for each additional reintubation (HR, 1.52; 95% CI, 1.36-1.71; p < 0.001). We observed no significant association COVID-19 status and risk of LTS.
CONCLUSIONS: The occurrence of post-intubation LTS was double in a COVID-19 positive cohort, with higher risk with increasing number of days intubated, days in the ICU and especially with the number of reintubations. COVID-19 status was not an independent risk factor for LTS.

OBJECTIVE: Surgical treatment for airway stenosis necessitates personalized techniques based on the stenosis location and length, leading to favourable surgical outcomes. However, there is limited literature on functional outcomes following laryngotracheal surgery with an adequate number of patients.
METHODS: We conducted a retrospective analysis of patients who underwent laryngotracheal surgery at the Department of Thoracic Surgery, Medical University of Vienna, from January 2017 to June 2021. The study included standardized functional assessments before and after surgery, encompassing spirometry, voice measurements, swallowing evaluation and subjective patient perception.
RESULTS: The study comprised 45 patients with an average age of 51.9 ± 15.9 years, of whom 89% were female, with idiopathic being the most common aetiology (67%). Procedures included standard cricotracheal resection in 11%, cricotracheal resection with dorsal mucosal flap in 49%, cricotracheal resection with dorsal mucosal flap and lateral cricoplasty in 24% and single-stage laryngotracheal reconstruction in 16%. There were no in-hospital mortalities or restenosis cases during the mean follow-up period of 20.8 ± 13.2 months. Swallowing function remained intact in all patients. Voice evaluations showed a decrease in fundamental vocal pitch [203 (81-290) Hz vs 150 (73-364) Hz, P < 0.001] and dynamic voice range (23.5 ± 5.8 semitones vs 17.8 ± 6.7 semitones, P < 0.001). However, no differences in voice volume were observed (60.0 ± 4.1 dB vs 60.2 ± 4.8 dB, P = 0.788). The overall predicted voice profile changed from R0B0H0 to R1B0H1.
CONCLUSIONS: Laryngotracheal surgery proves effective in fully restoring breathing capacity while preserving vocal function. Even in cases of high-grade and complex airway stenosis necessitating laryngotracheal reconstruction, favourable functional outcomes can be achieved.

OBJECTIVE: To present a comprehensive flow cytometry panel for idiopathic subglottic stenosis (iSGS).
METHODS: Controlled ex vivo cohort study.
METHODS: Tertiary care academic hospital in a metropolitan area.
METHODS: Flow cytometry and single-cell RNA sequencing were performed on 9 paired normal and scar tissue samples from iSGS patients. Flow cytometry was used to assess the presence of myeloid (CD11b, CD14, CD15, Siglec8), lymphoid (CD3, CD4, CD8, gamma delta [γδ], FOXP3), endothelial (CD31), fibroblast (CD90, SMA), and epithelial (CD326, CK5) markers.
RESULTS: On flow cytometry, iSGS scar is characterized by an increased presence of myeloid, lymphoid, endothelial, and fibroblast cell types, but a decreased presence of epithelial cells. In the myeloid lineage, iSGS scar samples demonstrated increased CD11b+ monocytes (P < .001), Siglec8+ eosinophils (P = .03), and CD14+ monocytes (P = .02). In the lymphoid lineage, iSGS scar demonstrated increased CD3+ T-cells (P < .001), CD4+ helper T-cells (P < .001), γδ+ T-cells (P < .001), and FOXP3+ regulatory T-cells (P = .002). iSGS scar exhibited specific increases in CD90+ (P = .04) and SMA+ (P < .001) fibroblasts but decreased CD326+ (E-cadherin) epithelial cells (P = .01) relative to normal samples.
CONCLUSIONS: We present a comprehensive flow cytometry panel for iSGS. This flow panel may serve as a common platform among airway scientists to elucidate the cellular mechanisms underpinning iSGS and other upper airway pathologies. Scar iSGS samples demonstrate a distinct cellular profile relative to normal iSGS specimens, exhibiting increased fibroblast, endothelial, and inflammatory cell types but decreased epithelium.

BACKGROUND: This study reports our experience with open reconstructive surgery in patients with laryngotracheal stenosis (LTS) following prolonged intubation and/or tracheostomy in the context of COVID-19.
METHODS: All patients underwent a preoperative endoscopic airway assessment. Posterior glottic lesions were graded according to the Bogdasarian classification, subglottic-tracheal lesions according to the Cotton-Myers classification and postoperative complications reported by the Clavien-Dindo classification. We report postoperative outcomes and functional results in this patient subset.
RESULTS: We include 14 patients diagnosed to have post COVID LTS, one female and 13 males. This group was compared with a control group, diagnosed with LTS following prolonged intubation. In the COVID group, mean age of patients at the time of the airway surgery was 52.1 ± 16.8 years (range: 13.7-76.3). More than half the patients were multi-morbid with hypertension and obesity being the most common conditions. Eleven patients had multi-site stenoses. Open surgical interventions performed were tracheal resection and anastomosis, laryngotracheal reconstruction and extended cricotracheal resection, and postoperative complications were seen in 12 (85.6%) patients. 70% patients with pre-existing tracheostomy were decannulated. Oral swallowing was not tolerated in one-fifth of the patients and a significant number of them have poor voice quality.
CONCLUSIONS: Post-COVID pandemic, airway surgeons are seeing an increased number of patients with complex LTS, and we report significant postoperative complications in this patient subset. Decannulation rates, voice and swallowing results are poor in patients with glottic involvement as compared to isolated tracheal stenosis.

UNASSIGNED: Cricotracheal resection (CTR) is considered the standard of care for patients suffering from idiopathic subglottic stenosis (iSGS). Although CTR results in permanent restoration of airway patency, it has a mild to moderate impact on voice quality. Here we propose modifications of the standard CTR technique to make it a voice-preserving procedure.
UNASSIGNED: Five women with iSGS underwent voice-sparing CTR between January 2022 and January 2023. In this procedure, through several technical adaptations, the function of the cricothyroid joint was preserved. Outcomes of these voice-sparing CTRs were compared to outcomes in patients who underwent standard CTR in our institution. All patients underwent full functional preoperative and postoperative workups, including spirometry, voice measurements, patient self-assessment, and fiberoptic endoscopic evaluation of swallowing.
UNASSIGNED: All 5 patients in the study group suffered from iSGS with high-grade Myer-Cotton III° stenosis (100%); 1 patient had previously undergone endoscopic laser resection. Voice evaluation demonstrated a nearly unchanged fundamental pitch (mean preoperative, 191 ± 73.1 Hz; postoperative, 182 ± 64.2 Hz) and dynamic voice range (preoperative, 24.4 semitones; postoperative, 20.4 semitones). This was in contrast to the control group, in which significantly reduced voice quality was observed.
UNASSIGNED: In selected patients suffering from iSGS, excellent functional results can be obtained with voice-sparing CTR.

The main purpose of this study is to evaluate and understand the clinical profile of patients presenting to an Indian tertiary care referral centre with Laryngotracheal Stenosis (LTS) and also to emphasise on the outcomes after treatment in these patients. This is a prospective observational study conducted at a tertiary care referral centre which included 18 patients diagnosed with LTS. All patients were evaluated clinically and radiologically to evaluate the degree of stenosis, site and length of the stenotic segment involved, intervened surgical procedure, intraoperative and postoperative complications following the procedure were all documented and taken into consideration. The data collected was analysed. The most common etiological cause of LTS was post intubation (77.8%). 61.5% among the 13 intubated patients had a history of intubation for more than 10 days. 83.3% of the cases had stenosis at the level of the subglottis and cervical trachea level. Post intubational airway stenosis is the most common cause of LTS. A precise assessment of the laryngotracheal complex is the cornerstone of LTS management. The choice of treatment depends on the location, severity, and length of stenosis, as well as on the patient\'s comorbidities, history of previous interventions, and on the expertise of the surgical team. Application of topical Mitomycin c during surgery reduces the incidence of granulations. Close postoperative follow up for a long time and the necessity of more than one intervention improves results and can spare patients the morbidity and mortality associated with acute airway obstruction.

Recent translational scientific efforts in subglottic stenosis (SGS) support a disease model where epithelial alterations facilitate microbiome displacement, dysregulated immune activation, and localized fibrosis. Yet despite recent advances, the genetic basis of SGS remains poorly understood. We sought to identify candidate risk genes associated with an SGS phenotype, investigate their biological function, and identify the cell types enriched for their expression.
The Online Mendelian Inheritance in Man (OMIM) database was queried for single gene variants associated with an SGS phenotype. The functional intersections and molecular roles of the identified genes were explored using pathway enrichment analysis (PEA) computational methods. Cellular localization of the candidate risk genes was measured via transcriptional quantification in an established single cell RNA sequencing (scRNA-seq) atlas of the proximal airway.
Twenty genes associated with SGS phenotype were identified. PEA resulted in 24 significantly enriched terms including \"cellular response to TGF-β,\" \"epithelial-to-mesenchymal transition,\" and \"adherens junctions.\" Mapping the 20 candidate risk genes to the scRNA-seq atlas found 3 (15%) genes were enriched in epithelial cells, 3 (15%) in fibroblasts, and 3 (15%) in endothelial cells. 11 (55%) genes were expressed ubiquitously among tissue types. Interestingly, immune cells were not significantly enriched for candidate risk genes.
We identify and provide biologic context for 20 genes associated with fibrotic disease of the proximal airway and form the foundation for future detailed genetic study.
N/A Laryngoscope, 133:3049-3056, 2023.

OBJECTIVE: Given the increasing utilization of endoscopic surgery, particularly for airway stenosis management in the era of COVID-19 due to prolonged intubation, it is important to examine whether continuing antithrombotic therapy perioperatively influences bleeding complications. We examined the impact of perioperative antithrombotic use on postoperative bleeding complications following endoscopic airway surgery for laryngotracheal stenosis.
METHODS: Retrospective study from January 2016 to December 2021 of cases of patients ≥18 years who underwent endoscopic airway surgery for posterior glottic, subglottic, and tracheal stenosis at a single institution. Cases were excluded if they were an open airway surgery. The primary outcome was the occurrence of postoperative bleeding complications across cases of patients naive to and on baseline antithrombotic therapy, and those with preoperative continuation versus cessation of antithrombotic therapy.
RESULTS: 258 cases across 96 patients met inclusion criteria. Of these 258 cases, 43.4 % (n = 112) were performed for patients on baseline antithrombotic therapy and 56.6 % (n = 146) for those not on antithrombotic therapy. Likelihood of perioperative continuation of apixaban was 0.052 (odds ratio, 95 % Confidence Interval: 0.002-0.330, p < 0.001). Likelihood of perioperative continuation of aspirin was 9.87 (odds ratio, 95 % Confidence Interval: 2.32-43.0, p < 0.001). Two instances of postoperative bleeding were found: both in patients who were on aspirin without perioperative cessation for COVID-related coagulopathy.
CONCLUSIONS: Our findings suggest that perioperative continuation of aspirin is relatively safe in the setting of endoscopic surgery for airway stenosis management. Prospective investigations to increase understanding of perioperative antithrombotics for COVID-related coagulopathy are warranted.

Laryngotracheal stenosis is a recalcitrant disease with high morbidity. Laryngotracheal stenosis can be defined as a partial or circumferential narrowing of the airway and may be congenital or acquired. Sites involved are supraglottis, glottis, or sub glottis. The goal of treating the patient with laryngotracheal stenosis is to reconstruct an adequate airway while preserving phonation and airway protection. Furthermore, there is no fixed treatment for laryngotracheal stenosis, the choice of surgical procedure is determined by the individual anatomy, involved site, length and luminal narrowing of stenotic segment and function of the larynx and trachea, together with patient factors and available facilities. To determine the most common aetiology of laryngotracheal stenosis and to study outcome of various treatment modalities and their efficacies according to the site of stenosis and time of presentation. We have prospectively studied 25 cases of laryngotracheal stenosis who presented in Department of ENT, Civil Hospital, Ahmedabad from May 2019 to December 2021. All patients with clinical suspicion of laryngotracheal stenosis underwent CECT Neck and Thorax with virtual bronchoscopy, flexible bronchoscopy and graded according to myer cotton classification and then included in study. In our study of 25 patients 19 patients had history of intubation. Out of 25 patients, 5 Powered by Editorial Manager® and ProduXion Manager® from Aries Systems Corporation patients had supraglottic stenosis, 14 had subglottic stenosis and 6 patients had tracheal stenosis. 20 patients were tracheostomised. Bilateral vocal cord mobility is pre requisite for any surgical intervention and for decannulation of tracheostomy tube. Laser ablation is best modality for supra glottis stenosis patients. Treatment options of subglottic and tracheal stenosis patients depends on vocal cord mobility, % of luminal narrowing and type of stenosis on flexible bronchoscopy and CT scan. Patients of subglottic or tracheal stenosis having Myer cotton grading 1 or 2 were successfully treated by Laser + Balloon dilatation while grade 3 or 4 by resection and end to end anastomosis. Endoscopic CO2 laser ablation with/without balloon dilatation gives promising results in cases of supra glottic stenosis and in soft, mucosal, short segment (< 1.5 cm), grade 1 or 2 stenosis patients with subglottic or tracheal stenosis. In patients with subglottic or tracheal stenosis having hard, cartilage framework involvement, > 1.5 cm stenotic segment, Grade 3 or 4 needed external open approach like tracheal resection and end to end anastomosis.