Search Results (30)

Background/Objectives: Hypoglossal nerve palsy is a rare but disabling complication of general anesthesia, typically associated with tracheal intubation and head and neck surgery. This study evaluated the incidence, clinical characteristics, and potential mechanisms of postoperative tongue deviation after breast reconstruction and other surgeries performed under general anesthesia with orotracheal intubation. Methods: We retrospectively reviewed 240,646 consecutive general anesthetic procedures with orotracheal intubation performed at two tertiary hospitals between September 2011 and October 2025. Eighteen patients who developed new-onset postoperative tongue deviation were identified, and demographic features, surgical department, breast reconstruction status, anesthetic details, patient positioning, laterality of deviation, symptom duration, and recovery outcomes were analyzed. Results: Postoperative tongue deviation was documented in 18 patients, corresponding to an overall incidence of approximately 0.01%, most frequently after breast reconstruction (7/18, 38.9%), followed by vascular (27.8%), head and neck tumor (16.7%), neurosurgical (11.1%), and hepatobiliary–pancreatic surgery (5.6%). All seven breast-reconstruction cases occurred at the breast-cancer center hospital, corresponding to 0.31% of 2256 breast reconstructions. The median age was 58.0 years; 66.7% patients were female. Most patients (77.8%) achieved complete recovery, whereas 16.7% had residual deviation. Conclusions: Postoperative hypoglossal nerve palsy with tongue deviation is an exceptionally rare event after general anesthesia. In our two-center cohort, it was observed most frequently among patients undergoing breast reconstruction at one participating center; this pattern is confounded by institution-specific anesthetic and positioning practices and should not be interpreted as evidence that the procedure itself carries inherent risk. The findings are hypothesis-generating and suggest that prolonged operating time, repeated intraoperative position changes, and specific head-fixation and tube-fixation practices warrant prospective investigation. Meticulous head–neck alignment, careful tube fixation, and a structured postoperative cranial-nerve check (tongue-protrusion and voice-quality assessment in the recovery room and on postoperative day 1) may aid the early detection of this complication. Full article

Accurate and rapid detection of anatomical structures, such as the glottis, is critical during tracheal intubation (TI) to ensure patient safety and procedural success. However, it remains a challenge due to the limited field of view and computational resources of video laryngoscopy, especially for difficult airway situations. Existing deep learning (DL) models struggle to balance high accuracy and real-time clinical deployment. To address these issues, we propose TI-YOLO (TI-You Only Look Once), a lightweight and efficient object detection model built upon the YOLOv11 architecture. TI-YOLO introduces the Bidirectional Feature Pyramid Network (BiFPN) module for multi-scale feature fusion, effectively enhancing the ability to detect anatomical structures of different sizes. TI-YOLO integrates the Deformable Attention Transformer (DAT) module to enhance the perception of crucial regions, improving detection accuracy and robustness. To further reduce the consumption of computational resources while maintaining efficiency, TI-YOLO is optimized by reconstructing the backbone based on MobileNetV4. Furthermore, TI-YOLO employs the Slide Weight Function (SWF) as a loss function during model training to mitigate the class imbalance within the dataset. One self-built dataset is used to validate the effectiveness of TI-YOLO. Compared to the original YOLOv11, TI-YOLO achieves mean Average Precision at IoU 0.50 (mAP50) scores of 0.902, with improvements of 3.8%. Meanwhile, TI-YOLO balances detection accuracy and computational efficiency with a 10.5% reduction in floating-point operations (FLOPs) and a 28.9% reduction in parameters, and the model weight is only 4.6 MB. Additionally, to evaluate TI-YOLO real-time inference capability, we quantize and deploy it on a low-cost embedded OrangePi 5 platform. The inference speed reaches over 50 frames per second (FPS), meeting real-time clinical requirements. Full article

Traumatic injury, stenosis, and malignancy involving large segments of the airway are difficult to reconstruct and require novel solutions. Despite advances in surgical techniques, the reconstruction of long-segment tracheal defects remains a significant challenge. Several bioengineering approaches have been explored for tracheal regeneration in vitro and in vivo, using cells in combination with three dimentional (3D) biological or synthetic scaffolds. This paper reviews recent advances in developing bioengineered trachea and the technologies utilized toward generating transplantable tracheal grafts. Specifically, the review will focus on the recellularization of tissue-engineered grafts using natural or synthetic scaffolds, highlighting relevant cell types used to reconstitute tracheal epithelium and cartilage. The promise of newly explored paradigms, including the application of pluripotent stem cells, will be discussed with an overview of associated challenges and necessary steps for future translation. Overall, these advances provide a foundation for the development of clinically viable tracheal grafts, bringing engineered tracheal reconstruction closer to reality. Full article

Three-dimensional (3D) bioprinting provides new options for airway reconstruction by enabling the fabrication of customizable, biodegradable scaffolds designed to support in situ tissue regeneration. Building on our established large-animal platform, in which two cm bioprinted tracheal grafts combined with refined surgical techniques and adjunctive laser intervention have achieved long-term survival exceeding three months, the present study aims to explore long-segment (≥four cm) tracheal transplantation. We evaluated the fabrication feasibility and regeneration patterns of extrusion-based 3D bioprinted polycaprolactone (PCL) tracheal grafts in a porcine model. The grafts were implanted via end-to-end anastomosis with adjunctive mechanical stabilization and followed by serial bronchoscopic surveillance, gross examination, and histological analysis. The two cm PCL tracheal grafts achieved reproducible survival exceeding three months when combined with refined surgical techniques, structured postoperative airway management, and optimized wound coverage. Histological analysis revealed multi-lineage tissue formation—including cartilage, muscle, glands, and epithelium—was observed. Cartilage regeneration followed a staged maturation process, compared to epithelial regeneration, although continuous by 12 weeks, remained developmentally immature. A single long-segment transplantation was explored in a single preliminary case, providing an initial technical observation of feasibility; however, definitive conclusions regarding long-term survival or regeneration cannot be drawn. These findings further characterize regenerative responses in a large-animal model and highlight critical translational barriers—fabrication constraints, airway biomechanics, and delayed epithelial maturation—that require systematic investigation before long-segment tracheal reconstruction can advance toward clinical application. Full article

The paper is concerned with experimental investigations and numerical simulations of airflow in a rigid model of human tracheal bifurcation during a respiratory cycle in the presence of cough. The main goal of the study is to calculate the velocity and tracheal wall shear stress (WSS) distributions under the time variation in the pressure difference. A sequence of inspiration-expiration of measured flow rates and pressure is used to calibrate the 3D unsteady numerical solutions for different imposed boundary conditions at the edges of the bifurcation. The experimental data are obtained using commercial medical devices: (i) a spirometer and (ii) a mechanical ventilator, respectively. CT images of the lung airways were used to reconstruct the tracheal test geometry by 3D printing techniques. Flow spectrum, vortical structures, and the wall stresses are analyzed for the computed cases. Four turbulence models (k − ɛ, k − ω SST, k − ɛ R, and LES) are compared, and all indicate an increase in peak WSS and vortex intensity during coughing versus normal expiration. The present work confirms the importance of CFD simulations to model and quantify airflow throughout the respiratory cycle. The paper proposes a method to calculate wall shear stress, one of the most relevant parameters for characterizing airway function and the mechanical response of tracheal endothelial cells. Full article

Background: Tracheal breathing sounds (TBS) have demonstrated strong potential as a non-invasive, wakefulness-based diagnostic tool for obstructive sleep apnea (OSA); yet the relationship between specific upper airway anatomical features and the resulting TBS spectra remains insufficiently understood. This study aims to enhance the diagnostic utility of TBS in OSA by investigating how the upper airway anatomy influences TBS spectral characteristics. Method: Patient-specific computational models of the upper airway were reconstructed from high-resolution CT scans of a healthy subject and an individual with OSA. Additional variants were generated with targeted constrictions at the velopharynx, oropharynx, and trachea, based on clinically reported anatomical ranges. Airflow dynamics were simulated using Large Eddy Simulation (LES), and the resulting acoustic responses were computed via Lighthill’s acoustic analogy within a hybrid aero-acoustic framework. Results: Oropharyngeal constriction generated the most spatially concentrated vorticity patterns among single-region constricted models. Airway Resistance analysis revealed that severe velopharyngeal and oropharyngeal constrictions contributed most to regional airway resistance. Spectral analysis showed that velopharyngeal narrowing produced a progressive downward shift in the third resonance peak (1000–1700 Hz), while oropharyngeal narrowing induced an upward shift of the third peak and a downward shift of the fourth peak (1700–2500 Hz). These frequency shifts were attributed to the effective role of acoustic mass and airway compliance. Conclusions: Anatomical modifications of the upper airway produce region-specific changes in both flow and acoustic responses. These findings support the use of TBS spectral analysis for non-invasive localization of airway obstructions in OSA. Full article

The aim of this paper is to evaluate the correlation between the coronary calcium score (CCS) and coronary artery disease (CAD), patients underwent coronary CT angiography (CTA). Four hundred and five patients who underwent a coronary CT with CCS analysis were considered for this retrospective study. Coronary CTA was performed using a dual-source (256-slice) CT scanner (SOMATOM Definition Flash, Siemens Healthcare, Forchheim, Germany). Before injecting the contrast medium, non-contrasted cardiac CT was performed in a longitudinal scan field from the tracheal carina down to the diaphragm. The corresponding images for calcium scoring were reconstructed with a slice width of 1.5 mm and a slice interval of 1 mm, and the tube voltage was 120 kVp. The total calcium score was calculated using dedicated software. The calcium score based on the Agatston method was defined as the presence of a lesion with an area greater than 1 mm² and peak intensity greater than 130 Hounsfield Units, which was automatically identified and marked with color by the software. From the radiological report, the degree of coronary stenosis was retrieved. A score of 1 corresponds to the absence of stenosis, a score of 2 to mild stenosis (<50%), and a score of 3 to moderate/severe stenosis (>50%). The total coronary gravity score (CGS) for each patient was calculated by summing the score of each coronary artery. The Spearman test was used for correlation. Out of the 405 patients, 217 were male. The mean and standard deviation age was 72 ± 11 years. The overall amount of calcium was an Agatston score of 393 ± 709. A positive correlation between CCS and CGS was found (r = 0.835 and p < 0.001). A ROC curve with AUC 0.917 (p ≤ 0.001) was obtained. The optimal cutoff point of the calcium score for discriminating CGS < 2 was 112, yielding sensitivity of 90% and specificity of 81%. This study confirms the important relationship between the coronary artery calcium score and the presence and extension of coronary artery disease. Full article

The global rise of antimicrobial resistance (AMR), exacerbated by the COVID-19 pandemic, has led to a surge in infections caused by multidrug-resistant (MDR) bacteria. A key driver of this phenomenon is co-selection, where exposure to one antimicrobial promotes resistance to others via horizontal gene transfer (HGT) mediated by mobile genetic elements (MGEs). Carbapenem-resistant Enterobacteriaceae, known for their genomic plasticity, are particularly worrisome; yet genomic data from Latin America—especially Ecuador—remain scarce. This study investigated four carbapenem-resistant clinical isolates (two Klebsiella pneumoniae ST1440 and two Serratia marcescens) from tracheal aspirates of three ICU patients during a COVID-19 outbreak at Hospital IESS Quito Sur, Ecuador. Phenotypic profiling and whole-genome sequencing were performed, followed by bioinformatic reconstruction of plasmid content. Nineteen plasmids were identified, carrying 70 resistance-related genes, including antimicrobial resistance genes (ARGs), metal resistance genes (MRGs), integrons, transposons, and insertion sequences. Hierarchical clustering revealed six distinct gene clusters, with several co-localizing ARGs and genes for resistance to disinfectants and heavy metals—suggesting strong co-selective pressure. Conjugative plasmids harboring high-risk elements such as blaKPC-2, qacE, and Tn4401 were found in multiple isolates, indicating potential interspecies dissemination. These findings emphasize the importance of plasmid-mediated resistance during the pandemic and highlight the urgent need to enhance genomic surveillance and infection control, particularly in resource-limited healthcare settings. Full article

Background/Objectives: The field of tracheal reconstruction has undergone significant developments in the last few decades. Accordingly, this bibliometric review aims to identify the most influential publications within the field and their citation characteristics. Methods: A comprehensive search for “tracheal reconstruction” was conducted with the Clarivate’s Web of Science database. The resulting search results were filtered for relevant publications and evaluated to identify the 50 publications with the highest citation counts. Further analysis of these publications was conducted based on the following parameters: authorship, institutional affiliations, country of origin, citation density, year of publication, article type, and level of evidence. VOSviewer (version 1.6.20) was utilized to create co-occurrence maps of authors and keywords. Results: The top 50 publications were cited a total of 6449 times with an average of 128.98 citations per publication. The top three most cited articles were all by Grillo (primarily focused on tracheal stent repair and post-oncologic reconstruction). The majority of the top cited publications articles featured in The Annals of Thoracic Surgery (n = 10) were basic science in nature (32%) and had a level of evidence of Level IV (62%). The publication with the greatest citation density was by Kang et al. focusing on tracheal tissue engineering (TTE). Conclusions: This bibliometric review provides a thorough overview of the key publications that have influenced the field of tracheal reconstruction. Most predominantly, our analysis highlights a shift in focus from primary tracheal reconstruction techniques to more innovative repair paradigms such as TTE. Full article

Tracheal reconstruction remains a formidable clinical challenge, particularly for long-segment defects that are not amenable to standard surgical resection or primary anastomosis. Tissue engineering has emerged as a promising strategy for restoring the tracheal structure and function through the integration of biomaterials, stem cells, and bioactive molecules. This review provides a comprehensive overview of recent advances in tissue-engineered tracheal grafts, particularly in scaffold design, cellular sources, fabrication technologies, and early clinical experience. Innovations in biomaterial science, three-dimensional printing, and scaffold-free fabrication approaches have broadened the prospects for patient-specific airway reconstruction. However, persistent challenges, including incomplete epithelial regeneration and mechanical instability, have hindered its clinical translation. Future efforts should focus on the design of modular biomimetic scaffolds, the enhancement of immunomodulatory strategies, and preclinical validation using robust large animal models. Sustained interdisciplinary collaboration among surgical, engineering, and biological fields is crucial for advancing tissue-engineered tracheal grafts for routine clinical applications. Within this context, biomimetic approaches, including three-dimensional bioprinting, hybrid materials, and scaffold-free constructs, are gaining prominence as strategies to replicate the trachea’s native architecture and improve graft integration. Full article

Tracheal defects have been the focus of research since the 19th century, but reconstructing this complex structure remains challenging. Identifying a safe, effective tracheal substitute is a key goal of surgery. This integrative review explores current tracheal substitutes and tissue engineering techniques. Data were collected from June 2024 to March 2025 from electronically available databases. Articles published between 2015 and 2025 were selected using the individualized protocol for each database. After screening 190 articles, 82 were excluded, and 108 were reviewed, with 100 meeting the final inclusion criteria. Recent substitutes include three-dimensional synthetic grafts made from polycaprolactone and copolyamide with thermoplastic elastomer, thermoplastic polyurethane and polylactic acid. Additionally, models using decellularized and recellularized tracheal matrix scaffolds and bioprinting techniques are being developed. Comparative studies of synthetic grafts and tracheal scaffolds, as well as cell self-aggregation methods to create tracheal analogues, are discussed. Advances in hybrid approaches combining synthetic polymers with extracellular matrix components aim to improve biocompatibility and functional integration. The importance of selecting appropriate preclinical animal models, such as goats, is also highlighted for translational relevance. Further research is required to refine protocols, overcome challenges related to vascularization and immune response, and ensure the development of clinically viable, long-lasting tracheal substitutes. Full article

Tumors located at the tracheal bifurcation constitute a heterogeneous group of neoplasms whose treatment poses significant challenges due to their anatomical location, the requirement for radical resection, the need to restore local anatomy, and the necessity of maintaining adequate oxygenation throughout the entire procedure. Advances in airway reconstruction surgical techniques, anesthesia, and complementary therapies have progressively expanded indications for radical treatment of these neoplasms, resulting in significant improvements in both short- and long-term outcomes in recent years. Full article

Background: This paper presents the outcomes of employing the inferiorly based rotated sternocleidomastoid muscle flap in complex tracheal reconstruction/repair scenarios, focusing on the key objectives of ensuring stable airway, functional digestive tract and patient survival. Methods: A retrospective analysis was performed for patients treated at two medical centers (A.O. San Camillo Forlanini, Rome, and A.O.U. Careggi, Florence) from 2011 to 2023, in which the sternocleidomastoid muscle (SCM) flap, detached from the mastoid and basicranium, was rotated on the lower pivot directly onto the repair site and pedicled to the sternal origin to ensure the continuity of the airway. Average postoperative hospital stay, follow-up period and patient survival were analyzed. Follow-up assessments encompassed bronchoscopies and CT scans conducted at intervals of 15 and 28 days, and subsequently at 3 and 9 months. Results: A total of five patients were enrolled in this study. These cases included one patient with anterior tracheal wall lesions with abundant tissue loss, one patient with an anterior wall necrosis due to descending cervical mediastinitis and three patients with extra-long tracheoesophageal fistulas (TEFs) (greater than 4.5 cm or >30% of the total tracheal length). In the case of the direct repair of a TEF with a proximal tracheal stenosis, the sternocleidomastoid muscle was used to reconstruct the tissue deficit caused by extensive loss of substance in the left lateral side of the tracheal wall. In case of repair through exclusion of the TEF, the sternocleidomastoid muscle was interposed between the visceral sutures after exclusion of the TEF by an endomechanical device, in one case even substituting the membranous part of the tracheal wall. Our technique allows rotation on the sternal head of the sternocleidomastoid muscle with the lowest rotation radius, pedicled to the sternal origin, detached from the mastoid process and superior nuchal line, thus providing optimal vascularization from the superior thyroid artery/external carotid artery and accessory vasculature from the suprascapular artery. Patients exhibited uneventful postoperative recovery concerning airway and digestive patency. The mean postoperative hospitalization duration was 41 days. The follow-up assessments were negative for postoperative complications. Conclusions: The use of sternocleidomastoid muscle flap was proposed to ensure repair and protection of the suture margin or to constitute a portion, as a scaffold, of the wall by leveraging the muscle’s vascularization and thickness. This technique may be considered a leading component in managing complex situations in tracheal surgery. Full article

Background: Tracheal grafts have been investigated for over a century, aiming to replace various lesions. However, tracheal reconstruction surgery remains a challenge, primarily due to anatomical considerations, intraoperative airway management, the technical complexity of reconstruction, and the potential postoperative morbidity and mortality. Due to research development, the amniotic membrane (AM) and Wharton’s Jelly (WJ) arise as alternatives within the new set of therapeutic alternatives. These structures hold significant therapeutic potential for tracheal defects. This study analyzed the capacity of tracheal tissue regeneration after 60 days of decellularized WJ and AM implantation in rabbits submitted to conventional tracheostomy. Methods: An in vivo experimental study was carried out using thirty rabbits separated into three groups (Control, AM, and WJ) (n = 10). The analyses were performed 60 days after surgery through immunohistochemistry. Results: Different immunomarkers related to scar regeneration, such as aggrecan, TGF-β1, and α-SMA, were analyzed. However, they highlighted no significant difference between the groups. Collagen type I, III, and Aggrecan also showed no significant difference between the groups. Conclusions: Both scaffolds appeared to be excellent frameworks for tissue engineering, presenting biocompatibility and a desirable microenvironment for cell survival; however, they did not display histopathological benefits in trachea tissue regeneration. Full article

The complex structure, chemical composition, and biomechanical properties of craniofacial cartilaginous structures make them challenging to reconstruct. Autologous grafts have limited tissue availability and can cause significant donor-site morbidity, homologous grafts often require immunosuppression, and alloplastic grafts may have high rates of infection or displacement. Furthermore, all these grafting techniques require a high level of surgical skill to ensure that the reconstruction matches the original structure. Current research indicates that additive manufacturing shows promise in overcoming these limitations. Autologous stem cells have been developed into cartilage when exposed to the appropriate growth factors and culture conditions, such as mechanical stress and oxygen deprivation. Additive manufacturing allows for increased precision when engineering scaffolds for stem cell cultures. Fine control over the porosity and structure of a material ensures adequate cell adhesion and fit between the graft and the defect. Several recent tissue engineering studies have focused on the trachea, nose, and ear, as these structures are often damaged by congenital conditions, trauma, and malignancy. This article reviews the limitations of current reconstructive techniques and the new developments in additive manufacturing for tracheal, nasal, and auricular cartilages. Full article