• Korean Journal of Bronchoesophagology
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• v.13 no.1
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• pp.23-28
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• 2007

Background and Objectives: Since intractable aspiration in patients with impaired protective function of the larynx often results in multiple episode of aspiration pneumonia, repeated hospitalizations and expensive nursing care. The authors reported the preliminary results of laryngotracheal separation(LTS) in patient with chronic intractable aspiration. The purpose of this study was to report the follow up results of patient outcome with the LTS. Materials and Methods: A retrospective review of 15 patients who underwent LTS between 1996 and 2006 was conducted. Ages ranged from 3 to 72 years. Results: Eight patients had morbid aspiration as a consequence of acquired neurologic injuries and seven patients with congenital neurologic injuries. Two patients had a postoperative fistula, which was well controlled with local wound care. Following LTS, aspiration was effectively controlled in all patients and eight were able to tolerate a regular diet. Conclusion: LTS is a low-risk, successful, definitive procedure which decreases the potential for aspiration, pulmonary complications, duration of hospitalizations and increases quality of life, especially in patent with irreversible upper airway dysfunction and poor speech potential.

• Korean Journal of Bronchoesophagology
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• v.7 no.2
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• pp.140-145
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• 2001

Background and Objectives： Intractable aspiration in patients with impaired protective function of the larynx often results in multiple episode of aspiration pneumonia, repeated hospitalizations and expensive nursing care. The purpose of this study was to review the authors’experience and Patient outcome with the laryngotracheal separation (LTS) procedure. Materials and Methods A retrospective review of 9 patients who underwent LTS between 1996 and 2001 was conducted. Ages ranged from 3 to 72 years. Results : Seven patients were expected to have morbid aspiration as a consequence of acquired neurologic injuries and two were congenital neurologic injuries. Two patients had a postoperative fistula, which was well controlled with local wound care and minor procedure. Following LTS, aspiration was effectively controlled in all patients and four were able to tolerate a regular diet. Conclusion : LTS is a low-risk, successful. definitive procedure which decreases the potential for aspiration, pulmonary complication, hospitalizations and increases quality of life, especially in patent with irreversible upper airway dysfunction and Poor speech potential.

• Journal of Chest Surgery
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• v.31 no.8
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• pp.792-798
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• 1998

Background: There are various tracheal diseseas which cause the obstruction of the trachea: postintubation tracheal stenosis, tracheal cancer, thyroid cancer, endotracheal tuberculosis, et al. Recently surgical resection and reconstruction of the trachea has been adopted as the safe method for tracheal lesions. Materials and methods: We report our experience and results of resection and reconstruction for various obstructive tracheal lesions in 38cases from 1985 to 1996. Length of resection of the trachea was up to 6 cm. Twenty lesions were approached by cervical collar incision, 12 lesions by cervicosternal incision and 4cases needed transthoracic approach. Surgical procedures consisted of resection and tracheotracheal anastomosis in 32 cases, resection and laryngotracheal anastomosis in 6cases and in addition laryngeal release was necessary to release anastomotic tension in 3cases. Results: The complications were 4 minor wound infections, 2 mild suture line granulomas, 1 vocal cord palsy, 2 pneumonias and 1 systemic candidiasis. Two patients who had poor consciousness and pnemonia and one who developed systemic candidiasis were expired after operation. Conclusion: We suggests resection and reconstruction of trachea is optimal procedure for up to 6cm long tracheal lesions. However, for the patients with poor consciousness or poor general conditions would be the conservative treatment preferred to the tracheal reconstruction because of high serious complications and mortalities.

• Journal of Chest Surgery
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• v.36 no.4
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• pp.267-272
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• 2003

Background: Common treatment modalities for tracheal stenosis include conservative methods such as repeated balloon dilatation, removal of obstructive material through bronchoscopy and T-tube insertion as well as operative treatment methods. Recent advances in surgical approaches through tracheal resection and end-to-end anastomosis have been reported to give better functional and anatomical results. Material and Method: Between March 1990 and July 2002, 41 patients who received tracheal resection and end-to-end anastomosis at Asan Medical Center, University of Ulsan were studied retrospectively. Result: The causes for tracheal resection and end-to-end anastomosis included 26 cases of postintubation stenosis, 10 cases of primary tracheal tumors (3 benign, 7 malignant), 1 case of endobronchial tuberculosis, 2 cases of traumatic rupture, and 2 cases of tracheal invasion of a thyroid cancer, Of the 41 patients who received tracheal resection and reconstruction, 29 received tracheal resection and end-to-end anastomosis, and 12 received laryngotracheal anastomosis with cricoid or thyroid cartilage resection. Four of these patients received supralaryngeal release. The average length of the resected trachea was $3.6{\pm}1.0$cm. Of the 41 patients who received tracheal resection and end-to-end anastomosis, 30 (73.2%) experienced no postoperative complications, and 8 (19.5%) experienced granulation tissue growth and/or minor infections which improved after conservative management. Good or satisfactory results were therefore achieved in 92.7%. Complications included repeated granulation tissue growth in 7, wound infection in 2, anastomotic site dehiscence in 2, restenosis resulting in dyspnea on exertion in 1, and repeated postoperative aspiration requiring retracheostomy in 1. There was no early postoperative mortality. There were 3 cases of hospital death. Conclusion: In cases of proper length of tracheal lesion, excellent results were obtained after tracheal resection and end-to-end anastomosis. But, granulation tissue growth is so serious complication, it is necessary for continuous study and efforts to prevent it.

• Proceedings of the KOR-BRONCHOESO Conference
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• 1991.06a
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• pp.11-12
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• 1991

편측 성대마비의 음성개선을 위하여 현재까지 알려진 치료방법은 teflon 또는 silicone 주입술, 외과적 성대 내전술, 갑상연골 성형술, 신경재식술, 등이 있으며, 근래까지는 Teflon 또는 Gelform 주입술이 제일 효과적인 방법이라 알려져 있으나, 이는 음의 높낮이 조절능력의 한계가 있고, 신경재식술의 결과 역시 만족스럽지 못한 경우가 많다. 따라서 저자는 발성기능의 생리학적인 측면에서, 보다 효과적인 음성개선의 방법을 찾기 위하여, 사람의 후두와 비교적 유사한 특성을 가진 개를 사용하여 실험을 하였다. 반회신경을 절단하여 편측 성대 마비를 유발한 뒤, 동측의 유일한 외전근인 후윤상피열근을 절제후 절단된 신경을 문합하여, 성대의 외전근 작용의 소실과, 발성시에 주로 작용하는 내전근만의 작용을 유도하여, 공동운동의 차단과, 내전운동의 향상을 기대하였다. 본 실험에 앞서, 임의적으로 신경을 자극시킬 수 있는 신경자극기와, 주위조직으로부터 신경만을 분리하여 자극할 수 있는 전극을 개발하여 사용하였으며, 또한 성대의 발성음을 임의대로 유발시킬 수 있는 생체 내 후두발성 모형(in vivo laryngeal phonation model)을 Moore(1987, 1988)등이 발표한 모형을 토대로 자체 개발하여 사용하였다. 실험은 13마리의 개를, 반회신경 절단군(3 마리), 반회신경 절단 및 후윤상피 열근 절제군(3 마리), 후윤상피열근 절제군(3 마리), 반회신경 문합 및 후윤상피 열근 절제군(4 마리)등으로 나누어 실험하였으며, 3 개월 후, 현수후두경, 후두 내시경, videolaryngoscopy, 신경자극 검사 등으로 성대의 내전운동 및 위치 변화의 관찰, 발성음의 음향분석 및 갑상피열근의 형태학적 변화를 관찰하여 다음과 같은 결과를 얻었다. 1. 반회신경 절단군과 반회 신경 절단 및 후윤상피열근 절제군은, 수술후 3 개월에 성대의 움직임이나 각도의 변화가 없었으며, 음향분석 결과 발성음이 아닌 잡음만이 포착되었다. 즉, 절단된 신경의 문합 없이 후윤상피열근 절제 만으로는 음성개선은 기대할 수 없었다. 2. 후윤상피열근 절제군에서는 수술 후 3 개월에 정상적인 성대의 내전운동이 관찰되었으며, 음향분석상 기본주파수 동요율 및 발성음의 강도는 약간의 증가를 보였다. 즉, 반회신경이 절단되지 않은 상태에서 후윤상피 열근 만을 절제하면, 발성음의 변화는 거의 없었다. 3. 반회신경을 절단후 문합하고 후윤상피열근을 절제한군 에서는 수술후 3 개월에, 성대의 정상적인 내전운동을 보였고, 음향분석상 수술직후에는 잡음만이 포착되었으나, 3 개월 후에는 잡음이 아닌 발성음을 들을 수 있었으며, 이 발성음의 기본주파수 및 강도는 수술전보다 감소되어 있었으나, 기본주파수 동요율은 증가되어 있었다. 즉 이 술식으로 인한 뚜렷한 발성음의 향상이 있었다. 이상의 결과로 미루어, 편측 신경 절단으로 인한 성대마비시, 절단된 신경을 봉합하고 성대의 유일한 외전근인 후윤상피열근을 절제하면, 공동운동의 차단과, 내향운동의 향상으로, 음성개선에 효과적이라고 사료되었으며, 이 방법이 편측 성대마비 환자의 효과적인 음성개선의 치료방법의 하나로 응용될 수 있으리라 생각된다.