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.

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.

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The treatment of benign subglottic stenoses can be challenging. It requires an experienced multidisciplinary team. It is important to define the aetiology, severity and number/types of any pretreatments of the stenosis. Short-term symptom relief can be achieved with endoscopic techniques; however, this relief comes at the price of a high likelihood of restenosis, which often is more severe than the original stenosis. Successful long-term treatment of subglottic stenosis can be achieved by surgical resection in most cases.  Cricotracheal resection is the established standard technique to treat subglottic stenosis. In patients with advanced disease, it can be extended by a dorsal mucosectomy, a lateral cricoplasty or a partial anterior laryngeal split in order to remove the entire diseased area. In this video tutorial, we describe a modification of cricotracheal resection. In this technique for an extended resection, the cricoid arch is partially preserved. In addition to restoring sufficient airway width, this modification has the advantage that the cricothyroid joint remains intact. Therefore, the reduction in the pitch and volume of the voice associated with the standard resection techniques is avoided.

Evone® Ventilazione a flusso controllato: un nuovo dispositivo per la chirurgia laringo-tracheale.
UNASSIGNED: Il successo della chirurgia laringotracheale è principalmente correlato a un’adeguata esposizione delle vie aeree, con l’utilizzo di un tubo oro-tracheale più piccolo possibile. Il primo tentativo è stato fatto introducendo la tecnologia della ventilazione a getto ad alta frequenza (VGAF) nella pratica clinica. Tuttavia, la VGAF presenta alcuni rischi legati all’alta pressione necessaria per la ventilazione. Innanzitutto, durante la VGAF, l’espirazione dell’aria dai polmoni è un riflusso passivo sulla parete della trachea, che potenzialmente causa ipercapnia e intrappolamento d’aria. In secondo luogo, la VGAF crea un sistema di ventilazione aperto che aumenta il rischio infettivo per il personale sanitario, a causa dei droplets immessi in circolo tramite aerosol. Per superare questi problemi, è stato introdotto nella pratica clinica un innovativo sistema di ventilazione a flusso controllato con catetere a cuffia stretta (Evone®; Ventinova, Eindhoven, Paesi Bassi). Questo articolo descrive la nostra esperienza iniziale con il sistema Evone®, riportando i primi 5 casi di pazienti ventilati con questa tecnologia. In questo studio osservazionale, valutiamo la fattibilità e la sicurezza del sistema Evone® e forniamo una valutazione critica di questo nuovo metodo di ventilazione.
The success of laryngotracheal surgery is mainly related to adequate exposure of the airway lumen. To render airway surgery more efficient, many efforts have been made in recent decades to obtain a safe ventilation system which uses an orotracheal tube that is as small as possible. The first attempt was made by introducing the high frequency jet ventilation (HFJV) technology in clinical practice. Nonetheless, HFJV has some risks related to the high pressure needed for ventilation in the catheter. First, during HFJV, the expiration of air from the lungs is a passive backflow on the trachea wall, potentially causing hypercapnia and air trapping. Second, HFJV creates an open ventilation system that leads to aerosolisation of airborne particles with an increased infectious risk for the surgeon. To overcome these issues, an innovative flow-controlled ventilation (FCV) system with a narrow-cuffed catheter (Evone®; Ventinova, Eindhoven, The Netherlands) was introduced in clinical practice. This paper describes our initial experience with the Evone® FCV system, reporting the first 5 cases ventilated with this technology. In this observational study, we evaluate the feasibility and safety of the Evone® system and deliver a critical appraisal of this novel method of ventilation.

Background: Nowadays, head and neck surgical approaches need an increased level of anatomical knowledge and practical skills; therefore, the related learning curve is both flat and long. On such procedures, surgeons must decrease operating time as much as possible to reduce the time of general anesthesia and related stress factors for patients. Consequently, little time can be dedicated for training skills of students and young residents in the operating theater. Fresh human cadavers offer the most obvious surrogate for living patients, but they have several limitations, such as cost, availability, and local regulations. Recently, the feasibility of using ex vivo animal models, in particular ovine ones, have been considered as high-fidelity alternatives to cadaveric specimens. Methods: This comprehensive review explores all of head and neck otolaryngology applications with this sample. We analyzed studies about ear surgery, orbital procedures, parotid gland and facial nerve reanimation, open laryngeal and tracheal surgery, microlaryngoscopy procedures, laryngotracheal stenosis treatment, and diagnostic/operative pediatric endoscopy. For each different procedure, we underline the main applications, similarities, and limitations to human procedures so as to improve the knowledge of this model as a useful tool for surgical training. Results: An ovine model is easily available and relatively inexpensive, it has no limitations associated with religious or animal ethical issues, and it is reliable for head and neck surgery due to similar consistencies tissues and neurovascular structures with respect to humans. However, some other issues should be considered, such as differences about some anatomical features, the risk of zoonotic diseases, and the absence of bleeding during training. Conclusion: This comprehensive review highlights the potentials of an ex vivo ovine model and aims to stimulate the scientific and academic community to further develop it for other applications in surgical education.

Background Apneic oxygenation can be applied to select laryngotracheal procedures to improve operative visualization and avoid potential complications associated with intubation and jet ventilation.  Aims/objectives The authors sought to determine if apneic oxygenation using a high-flow nasal cannula could be used as a safe alternative airway management strategy for the duration of select laryngotracheal procedures. Methods Single institution, multi-site retrospective review of 38 adult (>18 years old) patients undergoing apneic oxygenation in the setting of various laryngotracheal procedures from January 2017 through January 2018. Humidified oxygen was delivered via a high-flow nasal cannula. The data was collected and analyzed using SAS version 9.4 (SAS Institute, Cary, NC). Results Twenty-four women and 14 men, mean age 60.0 years (SD 16.1; 36-89) and 70.1 years (SD 7.2; 56-81), respectively, underwent a mean total apneic time of 23.9 minutes (13-40). A statistically significant correlation existed between apneic time and minimum oxygen saturation (Pearson correlation coefficient 0.38; p=0.018). Twenty-one patients resumed spontaneous ventilation without the need for jet ventilation, mask ventilation, or placement of a definitive airway during the procedure.  Conclusions and significance Apneic oxygenation allows for extended periods of operating without the need for the placement of an endotracheal tube in patients undergoing general anesthesia for select laryngotracheal procedures.

Surgical treatment of benign subglottic stenoses can be challenging. It requires the close cooperation of an experienced team that includes various specialist disciplines. The treatment success will be evaluated with an extensive documentation of voice quality, lung function and swallowing function. The stenosis has to be analyzed in terms of its etiology, severity and pretreatment. Endoscopic removal of the stenotic tissue often leads to good short-term results. However, the proportion of re-stenoses is very high, which are often even more severe. Long-term treatment success can often only be achieved by surgical resection. The surgical technique used must be strictly adapted to the individual stenosis. In principle, a distinction can be made between classic cricotracheal resections and those that receive an expanded operative component. Particularly in the case of high-grade side-to-side stenoses, complex reconstruction with cartilage graft may be necessary. It is important not just to restore the airway flow. Maintaining the vocal function is an equally important treatment goal. Experienced centers can achieve very satisfactory long-term results with regard to functional outcome and voice quality.

OBJECTIVE: Incidence of surgical site infection (SSI) after laryngotracheal (LT) surgery is relatively high, especially in children.
METHODS: Retrospective and prospective cohort study.
METHODS: Clinical records of children who underwent open LT surgery at the Istituto Giannina Gaslini Children\'s Hospital from January 2008 to August 2017 were reviewed for development of SSI. Standard antibiotic prophylaxis was administered until February 2015. In March 2015, an antibiotic treatment tailored on pathogens isolated from surveillance cultures and prolonged until extubation was introduced. Incidence and risk factors for SSI before and after the new protocol implementation were analyzed by means of univariate and multivariable analyses.
RESULTS: A total of 57 procedures were analyzed. SSI incidence was 36% in patients receiving standard prophylaxis and 4% in those treated with the new strategy (P = .004), with an absolute benefit increase of 32% (95% confidence interval: 11%-52%), in absence of any difference in clinical conditions between the two groups.
CONCLUSIONS: The new management protocol had a highly favorable impact on the development of an SSI.
METHODS: 2b Laryngoscope, 129:2634-2639, 2019.