• Korean Journal of Bronchoesophagology
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• v.16 no.2
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• pp.131-137
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• 2010

Background: Montgomery T-tube is widely used to maintain airway in many cases. Market-available tubes are not always fit to the trachea of each patient and need some modification such as trimming. Complications do happen in prolonged use like tracheostomy tubes. To overcome above limitations, we designed custom-made T-tube using CT data with the aid of 3D reconstruction software. Material and Method: Boundaries were extracted from neck CT data of normal person and processed by surface rendering methods. Real laryngotracheal model and tracheal inner surface-mimicking tube model were made with plaster and rubber. The main tube was designed by accumulation of circles or simple closed curves made from boundaries. Stomal tube was made by accumulation of squares due to limitation of software. Measurement data of tracheal lumen were used to custom-made T-tubes. Tracheal lumen residing portion (vertical limb) was made like circular cylinder or simple closed curved cylinder. Stomal portion (horizontal limb) was designed like square cylinder. Results: Custom made T-tube with cylindric vertical limb and horizontal limb of square cylinder was designed. Conclusion: CT data was helpful in making custom made T-tube with 3D reconstruction technique. If suitable materials are available, commercial T-tube can be printed out from 3D printers.

• Proceedings of the KOR-BRONCHOESO Conference
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• 2001.12a
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• pp.29-30
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• 2001

• Tuberculosis and Respiratory Diseases
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• v.55 no.3
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• pp.239-249
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• 2003

Multi-detector row CT (MDCT) provides faster speed, longer coverage in conjunction with thin slices, improved spatial resolution, and ability to produce high quality muliplanar and three-dimensional (3D) images. MDCT has revolutionized the non-invasive evaluation of the central airways. Simultaneous display of axial, multiplanar, and 3D images raises precision and accuracy of the radiologic diagnosis of central airway disease. This article introduces central airway imaging with MDCT emphasizing on the emerging role of multiplanar and 3D reconstruction.

• Journal of Chest Surgery
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• v.8 no.2
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• pp.149-152
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• 1975

In spite of great advances in surgical treatment during past several decades, surgery of the trachea failed to develop correspondingly, partly because of relative rarity of the tracheal lesions and partly because of difficulties in surgical technique and anesthesia. Surgical diseases of the trachea are largely obstructions due to neoplasm or cicatrical stenosis and tracheal malacia. The present treatment of respiratory failure, using cuffed endotracheal and tracheostomy tubes, has produced, apparently with increasing frequency, tracheal stenosis, tracheomalized tracheal erosion. Surgery is presently the only reasonable way to treat stenotic lesions of the tracheobronchial tree. In the case of tumors, the current trend has been that of radical excision. Primary end-to--end reconstruction of the trachea has been generally recognized as the ideal method of repair following resection. However, for decades it was believed that a maximum of four tracheal rings only might be excised and primary healing achieved with safety. A great variety of procedures, developed by numerous investigations and directed at tracheal substitution, have almost invariably met with discouraging results. A meticulous study done by Grillo and associates on autopsy specimens has shown that an average 6.4cm of mediastinal trachea can be safely resected by full mobilization of the right lung and transplantation of the left main bronchus into the bronchus intermedius. Recently, we experienced a case of successful resection of a tumor of the tracheal carina and primary tracheo-left main bronchial anastomosis at the Department of Thoracic & Cardiovascular Surgery, the National Medical Center in Seoul. The patient, a 29-year-old man, was admitted to the hospital with complaints of dyspnea and cough. On admission, chest film showed hydropneumothorax on the right. After closed thoracostomy, hydropneumothorax disappeared, but hazy densities, developed in the right middle and lower lung fields, resisted to treatment. Bronchoscopy uncovered irregular tumor covering the carina and the right main bronchus, and biopsy indicated well differentiated squamous Cell carcinoma. Operation was performed on July 2, 1975. A right postero-lateral thoracotomy was used. Excision involved the lower trachea, the carina, the left main bronchus and the right lung. This was followed by direct anastomosis between the trachea and the left main bronchus. Bronchography was done on 17th postoperative day revealed good result of operation without stricture at the site ofanastomosis. About one month after the operation symptoms and signs of bronchial irritation with dyspnea developed, and these responded to respiratory care. On 82nd postoperative day, sudden dyspnea developed at night and the patient expired several hours later. Autopsy was not done and the cause of death was uncertain.

• Journal of Chest Surgery
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• v.27 no.4
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• pp.324-327
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• 1994

Resection and reconstruction of distal trachea or carina have posed tremendous technical challenges for surgeons. Successful outcome depends on thorough preoperative evaluation, careful anesthetic management,strict attention of surgical technique and postoperative care. We report a successful case of revision of tracheal stenosis using femoro-femoral bypass on a 13~year-old boy. The patient complained severe dyspnea about I month following right sleeve pneumonectomy. Preoperative CT scan and intraoperative bronchoscopy showed pin-point tracheal stenosis at a tracheo-bronchial anastomosis site about 1.2cm in length.At operation the lesion was severely adhesed and the lumen was nearly obstructed. The stenotic segment was resected and direct end-to-end anastomosis was done under femoro-femoral bypass for adequate oxygenation. The patient was discharged at postop. 16 days without specific complications and has continued to do well.

• Korean Journal of Bronchoesophagology
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• v.1 no.1
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• pp.82-93
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• 1995

Three-dimensional reconstruction of computed tomographic image(3D CT) is a well-established imaging modality which has been investigated in various clinical settings. It is commonly performed in case of congenital or developmental abnormalities, and traumatic fracture of skull and face that requires reconstruction of osseous structure. However reporting the 3D CT in laryngeal or tracheal stenosis is rare and its results are obscure. The authors performed 3D CT in six cases of tracheal stenosis and found diagnostic value of 3D CT. A Comparision of diagnostic information obtained from plain X-ray, 2D CT and 3D CT has performed in total six cases of tracheal stenosis. Surgical treatment of the tracheal stenosis was following in these cases : tracheal end to end anastomosis In 1 case, laryngotracheal end to end anastomosis in 2 cases. 3D CT information was compared with operative finding. In two of six cases, satisfactory information was not obtained from 3D CT in evaluating an exact stenosis of trachea. Future, it will be helped in evaluating of tracheal stenosis by 3D CT.

• Journal of Chest Surgery
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• v.30 no.6
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• pp.636-640
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• 1997

The common cause of tracheoesophageal fistula(T-I fistula) after tracheal intubation is ulceration and necrosis of the posterior wall of trachea by compression pressure generated by cuff. We experienced a young woman sustaining a T-I fistula which was found on the 12th day of intubation for cardiopulmonary resuscitation. Because spontaneous closure of the fistula is far uncommon, operative closure should be aimed for and should be done as soon as diagnosis is conformed. We delayed ope ative closure because of poor general condition of the patient. In spite of delayed reconstruction, the tracheal reconstruction itself was successful, but the patient died of peritonitis induced sepsis on the postoperative 41th day.

• Tuberculosis and Respiratory Diseases
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• v.70 no.1
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• pp.10-20
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• 2011

Various diseases can diffusely involve central airways, including the trachea and main stem bronchi. Central airway abnormalities are frequently not apparent or are overlooked on chest radiographs, even though the patient may have significant symptoms. Recent advances in spiral and multi-detector computed tomography (CT) with multi-planar reconstruction and three-dimensional demonstration, including virtual bronchoscopy, allow for excellent display of central airway anatomy and abnormalities with visualization of accurate locations of lesions. Early detection and proper diagnosis of airway diseases based on various radiographic findings will help determine appropriate treatment, including surgical planning and evaluation of treatment response. Herein we describe and illustrate the imaging findings of a wide spectra of diffuse central airway diseases.

• Korean Journal of Bronchoesophagology
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• v.4 no.1
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• pp.101-104
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• 1998

Partial splitting of the upper sternum provides an excellent surgical view in reconstruction of the intrathoracic trachea. However, when deep-seated mediastinitis develops postoperatively, it is difficult to manage especially when combined with sternal osteomyelitis. It also needs an additional consideration compared to the usual treatment modality applied to mediastinitis following a standard median stemotomy because the lower part of the stemum remains intact. We treated a 50 year old female patient with deep-seated mediastinitis and sternal osteomyelitis following resection and end-to-end anastomosis of the trachea through an upper midline sternotomy. The patient underwent extensive stemectomy, omental free grafting, and pectoral myocutaneous flap. Postoperative viability of the free-grafted omentum was evaluated by angiography and CT scan.

• Journal of Chest Surgery
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• v.34 no.7
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• pp.534-538
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• 2001

Background: Knowledge of size and morphology of the normal trachea is important for airway management and tracheal reconstruction. Conventional radiography is a simple method used to measure the tracheal diameter, but it is not accurate because of the artifacts related to image magnification and overlapping by the shoulder. The purpose of this study was to provide the normal values of the tracheal size and anatomy in Korean adults using Computerized Topography. Material and Method: There were 43 men and 34 women included in this study. They were divided into three age groups(group 1, 20-39 years ; group 2, 40-59 yeas , groups 3, $\geq$60 years). The anteroposterior and transverse diameters and cross - sectional areas of the trachea were measured at the level of the thoracic inlet(Level 1) and the aortic arch(Level 2). These values obtained at each level were compared between age groups and sexes. Result: In 43 men, the anteroposterior / transverse diameters(mean SD in millimeters) of the trachea at levels 1 and 2 were 19.95$\pm$2.99 / 17.72$\pm$2.13 and 19.77$\pm$2.57 / 18.02$\pm$2.19, respectively. In 34 women, those values at levels 1 and 2 were 15.56$\pm$2.12 / 14.18$\pm$2.07 and 15.35$\pm$1.82 / 15.00$\pm$1.60, respectively. At both levels, the anteroposterior and transverse diameters were significantly greater in men than in women (p<0.05). The cross-sectional area of the trachea at levels 1 and 2 were 279.14$\pm$61.37 / 281.93$\pm$63.97 $\textrm{mm}^2$ in men and 173.29$\pm$35.81 / 181.88$\pm$34.74 in women, respectively. They also showed significantly greater values in men than in women(P<0.05). There was no significant difference in diameters and cross-sectional areas of the trachea between age groups. Conclusion: There are significant differences in the internal diameter and cross- sectional area of the trachea between men and women in normal Korean adults, while the age difference was insignificant. We believed CT is a relatively accurate and safe way to measure the internal diameter and cross-sectional areas of the trachea.