Raúl Cicero

Laryngotracheal Reconstruction in Subglottic Stenosis: An Ancient Problem Still Present

BACKGROUND: Subglottic stenosis is an ancient but persistent problem as a cause of airway obstruction. The etiology and the results of surgical treatment with thyrotracheal anastomosis were reviewed. METHODS: Fifty-six patients with subglottic stenosis were studied. All were subjected to laryngotracheal reconstruction by thyrotracheal anastomosis with partial resection of the cricoid. RESULTS: Of all 56 cases of subglottic stenosis, 48 (86%) had history of previous tracheal intubation, and only 8 (14%) had different non-neoplastic obstructive processes such as scleroma, direct injury, hamartoma, and amyloidosis. Immediate results were good in all cases. After 1 year follow-up, results of thyrotracheal anastomosis were successful in 44 (91%). In 4 other cases a restenosis was observed. Eight patients were lost to follow-up. CONCLUSIONS: Subglottic stenosis is still frequent after tracheal intubation, but other causes must be considered. Laryngotracheal reconstruction with thyrotracheal anastomosis with partial cricoid resection was feasible with good results in 91% of the cases with follow-up, but this procedure must be performed by a skilled surgical team.

Endotracheal Intubation with Flexible Fiberoptic Bronchoscope (FFB) in Cases of Difficult Airway

Endotracheal intubation is a procedure whereby a tube is inserted into the trachea to warrant and maintain adequate ventilation with good respiratory gas exchange in patients who undergo anesthesia for surgery or require invasive mechanical ventilation.Since 1967 the flexible fiberoptic bronchoscope was considered as an advanced device to intubate patients with difficult airway having surgery,“fiberoptic assisted tracheal intubation”.1