• Journal of the Korean Society of Laryngology, Phoniatrics and Logopedics
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• v.23 no.1
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• pp.21-27
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• 2012

Laryngotracheal stenosis is a congenital or acquired narrowing of the airway, representing a continuum of disease that may affect the glottis, subglottis, and/or trachea. The larynx and trachea are semirigid tubular structures in which concentric scar contraction - a normal wound healing process - tends to narrow the lumen. The diversity of causes, severity, location of stenosis, and association with swallowing and phonation make this disease difficult to compare across patient populations and treating otolaryngologists. The wide array of surgical techniques for any given stenosis attests to the complexity and less than perfect results of the treatment. This review will address the etiology, diagnosis, and management of laryngotracheal stenosis.

• Korean Journal of Bronchoesophagology
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• v.1 no.1
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• pp.55-63
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• 1995

Gastroesophageal reflux is thought to be an important etiology of the various upper aerodigestive tract disease. To investigate the role of gastric acid and pepsin as an etiologic factor of laryngotracheal stenosis, and the difference of injury by synthetic gastric juice between in ciliated respiratory epithelium and in squamous epithelium, experimental study was carried out using rabbits. Mucociliary transport affected by synthetic gastric juice was also studied in dogs. Synthetic gastric juice of low pH caused serious damage and Impairment of mucociliary transport in the epithelium of the larynx and trachea. Gastric acid played major role in the mucosal damage. Squamous epithelium of vocal folds and pharynx was more resistant to synthetic gastric juice than respiratory epitheium. In conclusion, gastroesophageal reflux may be an etiologic factor in the developement of laryngotracheal stenosis, so the adequate management is necessory In patients of laryngotracheal stenosis.

• Journal of the Korean Society of Laryngology, Phoniatrics and Logopedics
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• v.25 no.1
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• pp.31-35
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• 2014

Objectives : The aim of this study was to evaluate the effectiveness and feasibility of coblation resection for the treatment of laryngotracheal disease. Methods : We conducted a retrospective review, evaluating 7 patients with laryngotracheal disease treated using coblator. Information collected included demographic data of the patients, diagnosis, size and location of the disease, procedure time, the number of previous operation, and the postoperative complication. Results : Among the etiology, granulation is most frequent (n=4), followed by recurrent repiratory papillomatosis (n=2) and tracheal stenosis (n=1). The location of lesions was peristomal area (n=2), glottis (n=2), subglottis (n=2) and mid-trachea. Coblation resection could remove the lesions completely and there was no significant complication including local burn, bleeding, and hypertrophic scar. The procedure time was shorter than the previous operation using $CO_2$ laser. Conclusion : Coblation resection is an effective and safe method for layngotracheal disease and can substitute the classic method such as $CO_2$ laser.

• Korean Journal of Bronchoesophagology
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• v.4 no.1
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• pp.52-58
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• 1998

BACKGROUND： Aspiration is defined as the laryngeal penetration of secretions below the level of the true vocal cords. Aspiration can result in life-threatening complications, such as bronchospasm, airway obstruction, pneumonia, pulmonary abscess, sepsis, and death. The patient with high vagal palsy had significant aspiration and dysphagia OBJECTIVE： To formulate a step-by-step management paradign for the patients with high vagal palsy MATERIALS AND METHODS : The medical records of 23 patients who were diagnosed as high vagal palsy from September, 1995 to April, 1998 in Seoul National University Hospital were reviewed retrospectively. Eleven patients were managed conservatively and 12 patients were operated to treat chronic aspiration. RESULTS : The main etiologies of high vagal palsy were mass lesions of the skull base such as neurogenic tumor, pseudotumor, meningioma or nasopharyngeal carcinoma. Aspiration and dysphagia improved in 7 out of 11 patients who were managed conservatively after 2.2 months on the average. The patients who were refractory to the conservative management underwent surgery and showed improvement in 10 out of 12 patients. The employed surgical modalities were vocal cord medialization combined with cricopharyngeal myotomy in 7 patients, laryngotracheal separation in 3 patients and arytenoid adduction only in 2 patients. Two patients still had gastrostomy tube due to the persistent symptoms. Two patients had improved after surgery, but died of underlying disease. CONCLUSION : The patients with high vagal palsy are recommended to be managed conservatively for the first 2 months. If aspiration and dysphagia are persisting after conservative management, vocal cord medialization combined with or without cricopharyngeal myotomy should be considered. If failed, laryngotracheal separation or gastrostomy will be the next option based on the control of the oropharyngeal secretion.

• Korean Journal of Bronchoesophagology
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• v.4 no.2
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• pp.165-170
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• 1998

Background and Objectives : Decannulation failure may result from factors such as inadequate ability 0 clear secretion, mucosal induration, granulation tissue, restenosis, tracheal wall depression and vocal cord palsy. We were to evaluate the effectiveness of surgical treatment on the basis of site and type of stenosis. Materials and Method : A series of 44 cases of decannulation difficulty between 1993 and 1997 were reviewed. The following data were collected on each of these patients : primary disease, indication for tracheostomy, site of stenosis, endoscopic findings of stenosis, surgical techniques used for treatment. Results : Primary diseases were 30 head trauma, 4 neck injury, 10 other diseases. Indication for tracheostomy were 37 prolonged intubation, 4 emergency tracheostomy, 3 laryngeal trauma. Endoscopic findings of stenosis were 24 granulation tissue, 16 laryngotracheal collapse, 4 combined with granulation tissue and collapse. Site of stenosis were 3 glottic, 9 subglottic, 24 stomal, 1 substomal, 7 mixed. 22 of 24 cases were decannulation using endoscopic treatment. Conclusion : The most common cause of failed decannulation was sternal granulation tissue. The most effective treatment of granulation tissue was endoscopic technique.

• Journal of the Korean Society of Laryngology, Phoniatrics and Logopedics
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• v.20 no.2
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• pp.118-125
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• 2009

Bilateral vocal fold immobility (BVFI) is a challenging condition which may result from diverse etiologies including vocal fold paralysis, synkinesis, cricoarytenoid joint fixation, and interarytenoid scar. Most patients present with dyspnea and stridor, but sometimes with a breathy dysphonia. Careful history taking, laryngoscopic evaluation under general anesthesia or awaken status, laryngeal EMG, and imaging studies with CT and/or MRI are helpful for providing a precise diagnosis and planning appropriate managements. In children, congenital neurological disorder is one of the most common etiologies, and spontaneous recovery has been reported in more than 50% of cases. Therefore, observation for more than 6 months while securing the upper airway with tracheostomy if needed is a generally accepted rule before deciding any destructive procedure to be undertaken. In children with advanced posterior glottic stenosis, laryngotracheal reconstruction with rib cartilage graft should be considered. In contrast to children, BVFI most commonly occurs as sequalae of surgical complication in adults. Diverse static or dynamic procedures can be applied; posterior cordotomy, vocal fold lateralization, endoscopic or open arytenoidectomy, arytenoid abduction, and reinnervation, electrical laryngeal pacing, which need to be carefully selected according to each patient's needs and pathophysiology of BVFI.

• Korean Journal of Bronchoesophagology
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• v.1 no.1
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• pp.151-158
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• 1995

Anaplastic carcinoma of thyroid gland account for no more than 10% of thyroid cancer, but it shows extremely poor prognosis. The purpose of this study is to review the outcome of patients with anaplastic carcinoma over the span of 5 years and to determine the patterns of clinical presentation, age, sex and other possible prognostic variables. We analyzed 30 cases of anaplastic carcinoma retrospectively from 1991 to 1995. There were 14 men and 16 women. There age ranged 33 to 75 years with a mean of 61.0 years. Sixteen patients presented with transformationqr of well differentiated carcinoma to anaplastic carcinoma, 1 with rapid in-crease in the size of long standing goiter, 8 with rapidly growing neck mass and 4 with meta static disease. Twenty-eight patients(93.3%) showed cervical lymphnode metastasis at presentation and twenty three patients(76.6%) showed laryngotracheal invasion. Nine patients (30.3%) showed distant metastasis. Treatment modalities included surgical resection, external irradiation, radioactive iodine and systemic chemotherapy. At decision making of treatment plan, we considered completeness of initial surgery, uptake rate of whole body radioactive io-dine scan, locoregional progression and distant metastasis. The median survival was 6.8 months and three cases survived beyond 12 months.

• Proceedings of the KOR-BRONCHOESO Conference
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• 1993.05a
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• pp.80-80
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• 1993

Airway stenosis in children may be classified into congenital and acquired forms. The incidence of acquired forms is increasing mainly due to increase in prolonged intubation and trauma. In congenital stenosis with significantly compromised airway, the patient may be tracheotomized and allowed some waiting period while expecting spontaneous resolution as the child grows. However, with this treatment policy, there is a considerably higher mortality and morbidity for the acquired disease as to often warrant surgical reconstruction. The authors reviewed the medical records of 22 pediatric patients under the age of 15 who have had airway reconstruction at the authors' department from the beginning of January, 1988 through the end of December, 1992. The prognosis was analyzed in light of the etiology, site and severity of the stenosis, and the type of reconstructive measures.

• Tuberculosis and Respiratory Diseases
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• v.50 no.3
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• pp.353-358
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• 2001

Relapsing polychondritis (RP) is rare, chronic, relapsing, and multisystemic inflammatory disease targeting the cartilaginous structures. Respiratory track involvement occurs in approximately half of the cases. Subglottic stenosis is a rare manifestation of RP. Here, we report a case of RP with a subglottic stenosis, resulting in acute respiratory failure. A 63-year old man was admitted complaining of multiple joint pain, general weakness, weight loss, throat pain, hoarseness, exertional dyspnea, and hearing difficulties. A laryngoscopy and neck CT revealed a subglottic stenosis. Four days after admission, he complained severe dyspnea resulting in acute respiratory failure. Immediately, a tracheostomy was done for airway preservation. After high dose steroid therapy, the general symptoms were improved. However, the subglottic stenosis was sustained. Thus, a laryngotracheal augumentation and stent insertion was performed. The speech valve was then replaced. The subglottic stenosis was managed with low dose steroid and monthly cyclophosphamide pulse therapy, and the patient has been followed up regularly.

• Journal of the Korean Society of Laryngology, Phoniatrics and Logopedics
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• v.31 no.1
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• pp.19-26
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• 2020

Background and Objective Endoscopic airway dilation is the primary treatment for pediatric subglottic stenosis (SGS) due to its feasibility and non-invasiveness. The aim of this study is to evaluate the risk factors for the failure of endoscopic airway dilation in pediatric patients with SGS. Materials and Methods This study reviewed medical records of 38 pediatric patients had endoscopic dilation from a single and tertiary referral center, retrospectively. The success of the endoscopic dilation procedure was defined as no dyspneic symptom without tracheostomy or laryngotracheal reconstruction. Demographic profiles, underlying disease, and Myer-Cotton SGS severity grade were recorded. Success rates and risk factors for the failure of treatment were analyzed. Results The SGS patients with severity grade I was most common. After mean 1.8 numbers of procedures, there were 23 patients (60.5%) in the success group and 15 patients (39.5%) in the failure group. Age, sex, underlying diseases, and SGS severity grade were not significantly different between two groups. In patients who had multiple endoscopic procedures, the failure group showed SGS deteriorated after procedures in 66.7%, compared to 11.1% of the success group. In multivariable analysis, a long-term intubation (≥1 month) was identified as an independent risk factor for failure of endoscopic dilation procedure. Conclusion Although endoscopic dilation procedure is safe and effective for the management, repetitive endoscopic dilation may not give clinical benefit in patient with long-term intubation. Other airway procedures must be considered in those group of patients.