• 대한기관식도과학회지
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• 제4권2호
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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 Chest Surgery
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• 제8권2호
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• pp.119-124
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• 1975

This is a case report of the rupture of the trachea and the esophagus following external blunt trauma without any associated injury. A 7 year old male patient was brought to the emergency room. Hanyang University Hospital, on 23 Jul, 1974 while he played under the pile of pingpong table A table was fall down over the patient accidentally. The patient was injured by the table and found lying in unconsciousness on the ground.There was subcutaneous emphysema on his anterior chest and neck. A contusion on the upper part of the sternum was noted. The breathing sound were diminished over the left side of the chest. Ronchi were heard over the right lung field. This patient was suffered from vomiting, dypsnea, and irritable mental state after this accident. On the chest roentgenogram in A-P view, hyperlucency at the mediastinum and parapericardiac area suggested the pneumomediastinum. On the next day, a diagnosis of the tracheal and esophageal rupture was confirmed by the esophagogram with Lipiodol swallowing. A right thoracotomy was performed and ruptured orifice of the trachea and the esophagus were closed with interrupted sutures. Postoperative course was uneventful and primary closure of the rupture of the trachea and the esophagus were succeeded.

• 한국응급구조학회지
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• 제9권1호
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• pp.95-99
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• 2005

Penetrating neck trauma by gunshot injury involving tracheobronchial tree is rare in Korea. Extensive tissue damage by cavitation, tissue fragmentation and shock wave transmission of high-velocity projectile along with associated organ injury renders high rate of mortality and morbidity. A 28 year old man in military service with gunshot wound in left cervical area presented initial symptoms of severe dyspnea and subcutaneous emphysema. Computed tomography of chest and cervical region as well as bronchoscopic evaluation was performed to confirm highly suspected injury to cervical trachea. Surgical exposure was established through a low collar incision; the damaged segment of 3.5 cm length including 2-4th tracheal rings was resected out and end-to-end anastomosis was performed. Bleeding from lacerated anterior jugular vein was controlled by ligation of both ends and a K2 bulllet was found upon inner border of body of first rib, medial to right carotid sheath and removed out. Cervical esophagus, carotid artery, internal jugular vein and recurrent laryngeal nerve were spared. Extubation was done on the first postoperative day and postoperative course until discharge on nineth postoperative day remained uneventful.

• 한국응급구조학회지
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• 제14권1호
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• pp.5-18
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• 2010

Objective : This study compares Video laryngoscope and Direct laryngoscope in tracheal Intubation on rapidity and accuracy by paramedic and aims to improve efficiency of airway management and survival rate in pre-hospital treatment for the patients with severe trauma, cardiac arrest or dyspnea caused by acute diseases. Methods : 60 paramedics were recruited from 13 fire stations located in C province. With the consent of the paramedics, likelihood ratio test was carried out and they were divided into two different groups; DL group (30) and GVL group (30). Regarding intubation conditions, difficult airway grade I, grade II and grade III as well as sniffing position and neutral position were examined. This study also compared between ambulance in motion and in stand still. Frequency, average and standard deviation were analyzed with statistics program, SPSS WIN 17.0 and repeated measure design was introduced to examine inter-relations between position, grade and groups. Results : Intubation was performed more rapidly in neutral position and GVL than in sniffing position and DL(F = 15.260, p = .000). Rapidity value was better with grade I and grade II than grade III and better with GVL than DL(F = 32.629, p = .000). Accuracy value was higher with neutral position and GVL than sniffing position and DL(F = 5.008, p = .011). grade III was less accurate than grade I, grade II and GVL was more accurate than DL(F = 10.966, p = .000). Ambulance motion status did not show any statistically significant differences in accuracy and rapidity. Conclusion : Given this study results, neutral position is better for the patient with severe trauma. For a better survival, GVL intubation can be considered since GVL can enhance accuracy as well as rapidity regarding difficult airway. Since there is no significant differences in ambulance motion factors, intubation can be recommended even in moving ambulance for shortening traveling time to a hospital.

• Journal of Chest Surgery
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• 제51권3호
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• pp.216-219
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• 2018

We report the case of a 16-year-old male patient who was involved in a traffic accident and transferred to the emergency department with mild chest pain. We initially did not find evidence of tracheal injury on computed tomography (CT). Within an hour after presentation, the patient developed severe dyspnea and newly developed subcutaneous emphysema and pneumoperitoneum were discovered. Abdominal CT showed no intra-abdominal injury. However, destruction of the right main bronchus was identified on coronal images of the initially performed CT scan. Emergency exploratory surgery was performed. The amputated right main bronchus was identified. End-to-end tracheobronchial anastomosis was performed, and the patient recovered without any complications.

• Tuberculosis and Respiratory Diseases
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• 제45권5호
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• pp.1087-1093
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• 1998

Mucormycosis is the common name given to several different diseases caused by fungi of the order Mucorales. The mucoraceae are ubiquitous fungi and are common inhabitants of decaying matter. In contrast to the widespread distribution of these fungi, disease in humans is limited, in most cases, to people with severe immunocompromised, diabetes mellitus, or trauma. 1be fungus gains entry to the body through the respiratory tract. The spores are presumably deposited in the nasal turbinates and may be inhaled into the pulmonary alveoli. The manifestations of mucormycosis are rhinocerebral, pulmonary, cutaneous, gastrointestinal, central nervous system, and miscellaneous. Sporadic reports can be found of mucormycosis involving other areas : heart, bones, kidney, bladder, mediastinum, and trachea. However, isolated tracheal mucormycosis is very rare. Therefore, we report a 57-year old, noninsulin dependent diabetic woman who presented with acute, severe degree of upper airway obstruction due to isolated mucormycosis of the trachea.

• Journal of Chest Surgery
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• 제40권1호
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• pp.79-82
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• 2007

둔상에 의한 기관-기관지 파열은 발생빈도가 낮은 질환이나, 점차 그 빈도가 증가하는 추세이다. 일단 기관-기관지 파열이 발생하면 매우 심각한 증상을 유발하여 생명의 위협을 초래하고, 많은 합병증을 야기하기 때문에 조기에 진단하여 외과적으로 치료하는 것이 바람직하다 본 저자들은 35세의 남자 환자에서 교통사고 후 발생한 기관 완전 절단의 한 예를 보고하는 바이다. 환자는 수상 후 심한 호흡곤란과 경부, 전흉부에 생긴 피하기종을 주소로 내원하여 양측 긴장성 기흉 진단하에 응급 흉관 삽관술 시행 후에도 대량의 공기 유출이 지속되었고, 피하기종은 복부와 음낭까지 진행되었으며, 호흡부전은 더욱 심화되어 기관-기관지 파열이 강력히 의심되어 응급 수술을 시행하였다. 수술실에서 시행한 술 전 기관지내시경상 성대 하에서 기관의 횡단 절단을 확인하였으며, 수술은 목에 칼라 절개를 가한 후 절단된 기관을 확인하여 4-0 바이크릴(Vicryl) 봉합사를 이용하여 단속봉합에 의한 단단 문합술을 시행하였다. 술 후 흉관을 통한 공기유출은 없었고 기관지내시경 추적 검사상 양호한 소견을 보였으며 특별한 합병증 발병 없이 퇴원하였다.

• 대한기관식도과학회지
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• 제7권1호
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• pp.5-8
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• 2001

Background and Objectives： Complications arising from endotracheal intubation are uncommon but, when they do occur, can be significant. Placement of an endotracheal tube frequently results in trauma to the underlying laryngeal and tracheal tissue, although the trauma is usually reversible. Occasionally, these changes can be of a more permanent nature and result in severe impairment of the airway and/or voice. It is proposed that a common factor-gastroesophageal reflux-might be responsible. This study was performed in order to develop the animal model of LPRD using rats and investigated that LPRD could produce significant damage to larynx especially vocal cords. Materials and Methods : The each four rats were used in the experiment and control study. Each was anesthetized and larynx was exposed and injured in the unilateral aritenoid. Injured site was contact with normal saline(control group) and synthetic gastric juice(experimental group). The larynx was examined after 7days in normal environment. Results : All was survived in the control group and two was survived in the experimental group. In the control group, some inflammation cells was found but in the experimental group, granulation was found. Conclusion : We developed animal model of LPRD using rat and thought LPRD may Play an important role in the development of permanent laryngeal injury.

• 대한기관식도과학회:학술대회논문집
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• 대한기관식도과학회 1983년도 제17차 학술대회연제순서 및 초록
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• pp.14.1-14
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• 1983

기관발거 곤란증은 주로 외상으로 인한 경우가 많으나 의인적인 기관손상, 즉 high tracheostomy, 부적절한 cannula사용, 2 차감염, 육아조직생성 및 기관전벽의 광범위한 절제 등과, 기타 정신적인요소등이 그 원인으로 알려져 있으며 치료로는 steroid사용, stent삽입, 기관공확장술 및 협착부위를 절제한 후 단단봉합하는 등의 방법이 알려져 있다. 최근 저자들은 2세된 남아에서 기관지 이물제거를 위해 기관절개술을 시행한 후 발생한 기관발거 곤란증 환자에서 Silicon T-tube를 사용하여 치유한 예를 문헌고찰과 함께 보고한다.

• Journal of Chest Surgery
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• 제18권4호
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• pp.812-816
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• 1985

In the past several years the popularity of the motor cycle has produced an increasing incidence of the injuries to the larynx and trachea. Most of all on accidents come to death and survivors to the hospital are rare. Early diagnosis and to keep air way are necessary to initiate proper treatment in injury of upper air way. Meticulous apposition of mucous membrane and reconstitution of laryngeal skeleton are important. We experienced a rare case of 26 year old men with cricothyroidal transection after trauma. On Oct. 17, 1985, the patient struck his neck on baggage frame of truck when dropping from his motor cycle on sudden stop. Emergency tracheal intubation on distal segment of trachea was accomplished by otolaryngologist in a local clinic. He was transferred to our hospital. Exploration 2 hours later revealed complete separation of cricoid cartilage from thyroid cartilage. The recurrent laryngeal nerve could not be identified. Anastomosis of thyroid and cricoid was accomplished and Portex endotracheal tube was inserted as splint for 10 days. No stenosis developed. The air way appeared adequate for moderate physical activity though paramedian fixation of vocal cord paralysis. Postoperative follow-up course has been good after he discharged on POD 14 days.