Search Results (5)

Introduction: Tracheotomy as a surgical procedure has existed and evolved since ancient times. In modern medicine, surgical techniques for performing this procedure in adults and children have reached a high level of perfection. However, pediatric tracheotomy remains a challenging surgical intervention, performed in only a limited number of centers by a small number of surgeons. This is due to several unresolved issues related to the procedure—such as indications, timing, decannulation protocols, and the care of tracheotomized children—which are still usually left to the individual judgment of the physician. Additionally, there is a significant psychological barrier associated with performing tracheostomy in a child (particularly in those under the age of one). Aim: This article aims to present in detail the modern surgical approach to performing tracheotomy in pediatric patients, examine the different types of tracheotomy, and highlight its specific features related to the anatomical differences between children and adults. Discussion: After the decision to perform a tracheotomy is made, the exact surgical technique and type of tracheostomy to be created are selected alongside the patient’s preoperative preparation. Factors such as the child’s age, the surgeon’s experience, and the underlying disease for tracheotomy play crucial roles in determining the appropriate approach. Conclusions: Pediatric tracheotomy has undergone significant development over the years. Nowadays, the exact type of surgical intervention depends on the individual needs of young patients. Full article

Background: Transoral robotic surgery (TORS) is nowadays considered a valuable minimally invasive approach to treat oropharyngeal squamous cell carcinoma (OPSCC). The aim of this technique is to improve functional preservation and reduce morbidity with excellent oncologic outcomes compared to the traditional transoral approach and chemoradiotherapy (CRT). The purpose of this systematic review is to assess an exhaustive overview of functional outcomes of TORS for OPSCC by evaluating several parameters reported in the available literature, such as the prevalence and dependence of tracheotomy, feeding tubes (FTs) and percutaneous endoscopic gastrostomy (PEG), the length of hospitalization, swallowing scores, speech tests and quality of life (QoL) questionnaires. Methods: A systematic literature review has been performed following the PRISMA 2020 checklist statement. A computer-aided search was carried out using an extensive set of queries on the Embase/PubMed, Scopus and Web of Sciences databases relating to papers published from 2007 to 2024. Results: A total of 28 papers were systematically reviewed, reporting 1541 patients’ data. The mean time of hospitalization was 6 days. A planned tracheotomy was performed in 8% of patients with a mean time of removal of 8 days. The prevalence and dependence of FT was 60% and 10%, respectively. Moreover, the presence of a high-stage T tumor with the contextual requirement of adjuvant therapies, the involvement of base tongues and the patient’s age being >55 years increased the risk of requiring an FT and PEG. Swallowing and long-term QoL outcomes highlight the superiority of the TORS approach alone compared to TORS with adjuvant therapies. Conclusions: TORS presented various favorable functional outcomes compared to other surgical approaches and primary CRT. However, adjuvant therapies after TORS strongly reduced the advantage of the robotic procedure, thus suggesting that T1 and T2 tumors may benefit mainly from TORS alone. Full article

Objectives: Our aim was to investigate the diagnostic challenges and management of relapsing polychondritis (RP) with airway involvement, highlighting the need for accurate diagnosis and effective intervention to prevent severe complications. Methods: In this retrospective study, medical records from January 2011 through June 2024 at a single tertiary-care institution were reviewed. This study was approved by the institutional review board. A total of 34 patients were diagnosed with RP, among whom 4 presented with significant airway complications. This study focused on these four patients, detailing their clinical presentations, diagnostic processes, and outcomes following various interventions. Results: All patients were initially misdiagnosed with asthma and later developed severe airway issues necessitating interventions such as tracheotomy and endotracheal intubation. Diagnostic imaging, microlaryngoscopy and bronchoscopy (MLB) were crucial for identifying subglottic stenosis and other airway alterations. Treatments included high-dose steroids, rituximab, and surgical interventions such as balloon dilation and tracheostomy. Only one patient could be decannulated; the other three remained dependent on tracheostomy and experienced significant complications due to emergency medical interventions. Conclusions: RP can manifest with nonspecific respiratory symptoms similar to asthma, which may delay correct diagnosis and appropriate treatment, leading to critical airway complications. The early, precise identification of RP, particularly with airway involvement, is vital. MLB and dynamic expiratory CT scans play significant roles in clinical diagnosis and management. A multidisciplinary approach involving otolaryngologists, rheumatologists, and pulmonologists is essential for optimizing patient outcomes and minimizing complications. Full article

The base of the tongue (BOT) is the second most common site for squamous cell carcinoma (SCC) in the oropharynx. There are currently no clear guidelines for the management of BOT SCC. Our main objective was to compare the oncological outcomes of two minimally invasive approaches, transoral laser microsurgery (TLM) and transoral robot-assisted surgery (TORS). This was a retrospective French GETTEC (Groupe d’Études des Tumeurs de la Tête et du Cou) multicenter study of patients with BOT SCC removed surgically either by TLM or TORS between 2005 and 2021. The study group included 16 patients treated by TLM and 38 by TORS, with median follow-up times of 14.4 and 37.2 months, respectively. The overall survival (OS) rates at 2 and 3 years were 67% in the TLM group and 90% at 2 years and 86% at 3 years in the TORS group (p = 0.42, p = 0.20). There was no significant difference in recurrence-free survival (RFS) between the two techniques after 2 and 3 years. The tumors removed by TORS were significantly larger. Operative times were significantly shorter in the TLM group. There were no differences in feeding resumption; none of the patients in the TLM group required a tracheotomy. Postoperative hemorrhagic complication rates were similar in the two groups (12% for TLM and 13% for TORS). Both TORS and TLM showed encouraging oncological, functional, and safety results in BOT SCC even in recurrence or second primary cancer patients, without a technique being found superior in terms of OS or RFS. Tumors removed by TORS were larger without an increase in postoperative bleeding, extending the possibilities of transoral treatment. Full article

Dysphagia after stroke impacts quality of life and is a risk factor for respiratory infections. Patients frequently require prophylactic measures including nasogastric tube or percutaneous endoscopic gastrostomy. Until recently, therapy for dysphagia was limited to training with a speech and language specialist. Intraluminal pharyngeal electrical stimulation (PES) is a new technique that stimulates the pharyngeal sensory afferents to the higher swallowing center in cortex. The clinical trials published to date involved stimulation for 10 minutes over three days. We present a case of brainstem infarction with severe dysphagia in a 53-year-old woman with preserved cognitive functions. For airway protection, she had a surgical tracheotomy. The initial swallowing training achieved slight improvements, but stagnated after three months so PES was tried. Under good PES tube tolerance, a prolonged and repeated stimulation protocol was administered, with the main purpose of relieving her of the tracheal tube. Although the swallowing improved, she stayed tube-dependent with minimal attempts with puréed food during therapy, and could not be decannulated. Further studies are required to assess the value of this promising approach for the treatment of dysphagia. Full article