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Laryngotracheal augmentation using titanium mesh

Published online by Cambridge University Press:  14 May 2007

A A Gaafar ,
A A El-Daly  and
H A Gaafar
A A Gaafar*
Affiliation:
Department of Otolaryngology Head & Neck Surgery, University of Alexandria, Egypt
A A El-Daly
Affiliation:
Department of Otolaryngology Head & Neck Surgery, University of Alexandria, Egypt
H A Gaafar
Affiliation:
Department of Otolaryngology Head & Neck Surgery, University of Alexandria, Egypt
*
Address for correspondence: Dr Alaa Gaafar, Fakhry Hospital, 251 Al-Khobar, Saudi Arabia. Fax: +966 3 8641107 E-mail: gaafar_a@hotmail.com
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Abstract

Background:

The management of laryngotracheal stenosis is still a serious surgical challenge. The fact that there are currently numerous reconstruction procedures indicates that there is at present no standard treatment.

Study design:

Titanium mesh was used instead of traditional homografts in reconstruction of the anterior laryngotracheal wall in 12 tracheostomised patients with benign chronic laryngotracheal stenosis. The anterior laryngotracheal wall was split, followed by excision of scar tissue and fixation of the titanium plate at the split end. A Silastic® stent was inserted above the tracheostomy tube and fixed in place by running sutures fixed to the skin by buttons. The stent was removed endoscopically six weeks later and a trial of decannulation was undertaken.

Results:

Endoscopically, good epithelisation was seen on the inner surface of the mesh in 10 cases and decannulation was possible. Four of these patients required endoscopic debulking of granulation tissue. Decannulation was impossible in two cases, one due to excessive granulation tissue and the other due to prolapse of the titanium mesh into the tracheal lumen (the mesh was removed endoscopically and a Montgomery T-tube inserted).

Conclusion:

Titanium mesh was found to be a good alternative for augmentation of the anterior laryngotracheal wall. It offered rigid support, with fewer of the complications reported with other grafts.

Keywords

TracheaPathologic ConstrictionTitaniumReconstructive Surgical Procedures
Type
Main Article
Information
The Journal of Laryngology & Otology , Volume 122 , Issue 4 , April 2008 , pp. 391 - 396
Copyright
Copyright © JLO (1984) Limited 2007

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References

1 Kimura, K, Mukohara, N, Tsugawa, C, Matsumoto, Y, Sugimura, C, Murata, H et al. Tracheoplasty for congenital stenosis of the entire trachea. J Pediatric Surg 1982;17:869–71CrossRefGoogle ScholarPubMed
2 Biller, HF, Lawson, W, Weisberg, V. Staged repair of extensive tracheal and laryngotracheal stenosis. Ann Otol Rhinol Laryngol 1986;95:586–9CrossRefGoogle Scholar
3 Ward, PH, Canalis, R, Fee, W. Composite hyoid-sternohyoid muscle grafts in humans. Arch Otolaryngol 1977;103:531–4CrossRefGoogle ScholarPubMed
4 Backer, CL, Mavroudis, C, Dunham, ME, Lauren, DH. Repair of congenital tracheal stenosis with a free tracheal autograft. J Thorac Cardiovasc Surg 1998;115:869–74CrossRefGoogle ScholarPubMed
5 Toohill, RJ. Panel discussion: the management of advanced laryngotracheal stenosis. Composite septal graft in the management of advanced laryngotracheal stenosis. Laryngoscope 1981;91:233–7CrossRefGoogle ScholarPubMed
6 Heatley, DG, Randell, RA, Garner, FT. Auricular cartilage versus costal cartilage as a grafting material in experimental laryngotracheal reconstruction. Laryngoscope 1995;105:983–7CrossRefGoogle ScholarPubMed
7 Agora, JA, Spector, GH. Reconstructive surgery of the larynx. In Hinchliffe, R. Scientific Foundation of Otolaryngology. Chicago: W Heinemann Medical Publications, 1976;894–919Google Scholar
8 Gubbels, SP, Richardson, M, Trune, D, Bascom, DA. Tracheal reconstruction with porcine small intestine submucosa in a rabbit model. Otolaryngol Head Neck Surg 2006;134:1028–35CrossRefGoogle ScholarPubMed
9 Eck, KR, Bridwell, KH, Ungacta, FF, Lapp, MA, Lenke, LG, Riew, KD. Analysis of titanium mesh cages in adults with minimum 2-year follow-up. Spine 2000;25:2407–15CrossRefGoogle Scholar
10 Kuttenberger, JJ, Hardt, N. Long-term results following reconstruction of craniofacial defects with titanium micro-mesh systems. J Craniomaxillofac Surg 2001;29:75–81CrossRefGoogle ScholarPubMed
11 Ioannis, D, Dilip, O, Unnikrishnan, RN. Single stage sternal reconstruction using titanium mesh for dehiscence following open-heart surgery. Interact Cardiovasc Thorac Surg 2005;4:49–51Google Scholar
12 Verschueren, DS, Bell, RB, Bagheri, SC, Dierks, EJ, Potter, BE. Management of laryngo-tracheal injuries associated with craniomaxillofacial trauma. J Oral Maxillofac Surg 2006;64:203–14CrossRefGoogle ScholarPubMed
13 Mello, F, Francisco, VC, Ricardo, L. The management of laryngeal fractures using internal fixation. Laryngoscope 2006;110:2143–6Google Scholar
14 Hans, FM. Practical applications of laryngeal framework surgery. Otolaryngol Clin North Am 2006;39:55–75Google Scholar
15 Vinograd, I, Klin, B, Brosh, T, Weinberg, M, Flomenblit, Y, Nevo, Z. A new intratracheal stent made from Nitinol, an alloy with “shape memory effect”. J Thorac Cardiovasc Surg 1994;107:1255–61CrossRefGoogle ScholarPubMed
16 Yauagihara, K, Mizuro, H, Wada, H, Hitomi, S. Tracheal stenosis treated with self-expanding Nitinol stent. Ann Thorac Surg 1997;63:1786–90CrossRefGoogle Scholar
17 Casiano, RA, Patete, M, Lindquist, T. Tracheoplasty using titanium reconstructive plates with strap-muscle flap. Otolaryngol Head Neck Surg 1994;111:205–10Google ScholarPubMed
18 Schultz, P, Vautier, D, Chluba, J, Marcellin, L, Debry, C. Survival analysis of rats implanted with porous titanium tracheal prosthesis. Ann Thorac Surg 2002;73:1747–51CrossRefGoogle ScholarPubMed
19 Zalzal, GH. Use of stents in laryngotracheal reconstruction in children: indications, technical considerations and complications. Laryngoscope 1988;98:849–54CrossRefGoogle ScholarPubMed
20 Ward, RF, April, MM. Mitomycin-C in the treatment of tracheal cicatrix after tracheal reconstruction. Int J Ped Otorhinolaryngol 1998;44:221–6CrossRefGoogle ScholarPubMed
21 Cotton, RT, O'Conner, DM. Pediatric laryngotracheal reconstruction: 20 years experience. Acta Otorhinolaryngol Belg 1995;49:367–72Google Scholar
22 Freeland, AP. The long term results of hyoid-sternohyoid grafts in the correction of subglottic stenosis. J Laryngol Otol 1986;100:665–74CrossRefGoogle Scholar
23 Thawely, SE, Ogura, JH. The use of the thyroid graft for treatment of laryngotracheal stenosis. Laryngoscope 1981;91:226–32CrossRefGoogle Scholar
24 Cotton, RT, Richardson, MA, Seid, AB. Management of advanced glottic and subglottic stenosis in infancy and childhood. Laryngoscope 1981;91:221–5CrossRefGoogle ScholarPubMed
25 Eliachar, I. Reconstruction of pediatric larynx and upper trachea with the sternohyoid rotary door flap. Arch Otolaryngol Head Neck Surg 1991;117:316–20CrossRefGoogle ScholarPubMed
26 Eliachar, I. The rotary door flap: a breakthrough in laryngotracheal reconstruction. Ear Nose Throat J 1992;71:584–6CrossRefGoogle ScholarPubMed