Composite hyoid-sternohyoid interposition graft in the surgical treatment of laryngotracheal stenosis.

This article reports six patients with severe laryngotracheal stenosis. The causes of stenosis were tracheotomy (two cases); prolonged endotracheal intubation (one case); laryngeal trauma (two cases); and surgery with postoperative chemo- and radiotherapy, addressing a thyroid gland follicular adenocarcinoma (one case). Two patients were already tracheotomized. The main postoperative complication was necrosis of the graft in a female patient who had previously undergone treatment for thyroid follicular adenocarcinoma. All patients were decannulated 6 months postoperatively. Five patients were then regularly followed up, but we lost contact with one patient. Comparison between pre- and postoperative pulmonary function testing revealed an increased maximum inspiratory flow (Vi max50) in five cases between 0.57 l/s and 2.18 l/s. A helical scan with 3-dimensional reconstruction of the cervical area in four patients confirmed the presence and preservation of the hyoid bone graft. Four patients remained satisfied with their postoperative voice quality, one patient was dissatisfied, and one patient was not followed up. This technique is effective in adults with severe laryngotracheal stenosis, restricted to the first tracheal rings, providing one takes into consideration the main contraindications of the procedure: past history of radiotherapy and thyroid surgery

Use of injectable autologous collagen for correcting glottic gaps: initial results.

We report our results pertaining to the use of injectable autologous collagen for the correction of dysphonia resulting from a glottic gap. To date 20 cases have been treated, 13 of which were for unilateral vocal fold immobility and 7 for sulcus vergeture and/or scar. Collagen is extracted from the skin. Approximately 5 cm2 is necessary to yield 2 ml. Injection must take place in the deep layer of Reinke's space. No patient suffered from any local or general intolerance. The phonatory glottic gap was totally or partially closed. In the paralysis group, the improvements were the following: the median maximum phonation time improved from 5.8 seconds to 11 seconds, the median mean flow rate from 0.13 ml/s to 0.09 ml/s, the median glottic gap from 8.4 to 4.5 ml/dB per s, the median intensity range from 21 to 29 dB, and the median frequency range from 141 to 195 Hz. The spectral analysis layout classification improved from 2 to 3

[Laryngeal metastasis of a colonic adenocarcinoma].

We report the case of a 63 year old man with laryngeal metastasis of a colonic adenocarcinoma recurrent after partial cordectomy by CO2 Laser microlaryngoscopy. This patient was followed for this condition between 2009 and 2010. The rarity of metastatic laryngeal metastases, particularly when the primary tumor is colic, justifies this presentation

Palliative treatment for tracheal stenoses using carbon dioxide laser and the Gianturco stent. Long-term results.

Between September 1992 and March 1998, the self-expandable Gianturco prosthesis was inserted in 23 patients suffering from tracheal stenosis. After radial incision and dilation of the stenosis as described by Shapshay, the positioning of the stent was performed during an endoscopic procedure under optical control. The prosthesis used was a double-ring stent 50 mm long and 20 mm in diameter. The follow-up period ranged between 0.5 and 67 months with an average of 31 +/- 18 months. Pulmonary function tests showed an average improvement of the peak expiratory flow (50%) from preoperative results of 1.06 +/- 0.60 L/s to short-term postoperative results of 2.08 +/- 0.78 L/s and long-term postoperative results of 2.11 +/- 0.78 L/s. The mean peak inspiratory flow (50%) improved from 1.43 +/- 0.85 L/s to 2.40 +/- 1.29 L/s at short term and to 2.56 +/- 1.20 L/s at long term. Eight patients out of the 23 had to undergo a second endoscopic procedure: 3 patients for granuloma vaporization; 1 patient to change a malpositioned stent; 2 patients to add a second stent because of insufficient tracheal enlargement; and 2 patients to resect mucosal membranes between the 2 stent rings and to place a second stent. Optical control of the accurate positioning and use of this model of Gianturco prosthesis helped to avoid the severe complications described in the literature (migration, extrusion, fracture, wall erosion. and hemorrhage). The follow-up must particularly target the prevention of granulomas. The self-expandable Gianturco prosthesis can be advocated for long-term palliative treatment of tracheal stenoses that are inoperable by an external surgical approach