• Journal of Chest Surgery
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• v.33 no.7
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• pp.581-584
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• 2000

Because the penetrating cervical tracheoesophageal injury may be associated with significant morbidity and mortality, it is important to choose the optimal method of diagnosis and management in patient with tracheoesophageal injury. We obtained a satisfactory result from repair of tracheoesophageal injuries using cardiopulmonary bypass. If the bleeding from the unidentified deep injury and the spread of infection could be controlled, the repair using CPB might increase the margin of safety during operation in the similar cases.

• Journal of Chest Surgery
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• v.27 no.10
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• pp.888-892
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• 1994

Acquired, traumatic tracheoesophageal fistula [TEF] is rare and difficult problem to manage. This 55 years old man met with a roller accident of a tractor. During accident, he received a penetrating injury on the left upper sternal border. At local clinic, he received closed thoracotomy drainage [CTD]for relief of pneumothorax[left]. Three days after CTD, he complained abdominal pain and hematemesis. The endoscopy revealed large ulcer at the stomach, so he received subtotal gastrectomy. On 10th day post subtotal gastrectomy, he developed aspiration and coughing from a TEF. The esophagogram showed large TEF at the mid-trachea level. So he transfered to our hospital for operation. This patient was operated on for late TEF three weeks after injury. We have used absorble 4-0 Vicryl sutures to repair trachea. We repair all esophageal injuries with two layers of nonabsorbable silk suture. Where suture line on the esophagus, the strap muscle was interposed for reinforcement. And for feeding, the feeding jejunostomy was performed. Postoperatively the osteomyelitis of the manubrium site was developed, so on the 30th postoperative day, an ostectomy of manubrium, both clavicle and fight 1st, 2nd ribs, and the pectoralis major musculo-cutaneous flap coverage were performed.

• Advances in pediatric surgery
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• v.16 no.1
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• pp.37-42
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• 2010

Tracheal injury is a rare complication of endo-tracheal intubation. However in neonates, the rates of morbidity and mortality are high. Recommendations for treatment are based on the several reports of this injury and are individualized. Conservative management can be effective in some cases. We describe the case of a neonate who presented with subcutaneous emphysema after intubation in a neonatal intensive care unit. This patient suffered full VACTERL syndrome and had 1.7 mm diameter subglottic stenosis. Conservative management resulted in no further increase in subcutaneous emphysema and after 10 days the patient was stable.

• Journal of Chest Surgery
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• v.27 no.1
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• pp.68-71
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• 1994

A tracheo-esophageal fistula following from blunt chest trauma is one of less common lesion and few guidelines are available to direct its optimal management. Herein, we report a 24-year-old man injured in a motor vehicular accident sustained a nonpenetrating double blowout injury of the thorax and large tracheoesophageal fistula occurred. Tracheal defect required resection and reconstruction, of which the membranous portion underwent closure with borrowed adjacent esophageal wall primarily and substernal left colon interposition was performed 4 weeks later.

• Journal of Chest Surgery
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• v.25 no.6
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• pp.581-587
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• 1992

Tracheoesophageal fistula[TEF] is a rare but life-threatening lesion that may occur from ventilation with a cuffed tube. It occurs most frequently when an inlying esophageal tube is also being used-usually for feeding purposes. The mechanism of injury appears to be pressure experted on the tracheal wall by the cuff, which then compresses the "party wall" of the trachea and esophagus against the foreign body that lies in the esophagus. The patient was 32 years old female who had been receiving a treatment of respiratory failure induced by postoperative sepsis with assist ventilator and nasogastric tubal feeding. Sudden attack of abdominal gas distention and massive drainage of gas through N-G tube were developed during assist ventilation in that patient, so we diagnosed as tracheal stenosis with a tracheoesophageal fistula induced by prolonged endotracheal intubation We performed tracheal reconstruction and primary closure of perforated esophagus after weaning ventilator. The postoperative course was uneventiful.eventiful.

• Korean Journal of Bronchoesophagology
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• v.18 no.2
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• pp.41-44
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• 2012

Acquired tracheoesophageal fistula (TEF) can occur rarely from various causes. Recently, cuff-related tracheal injury after endotracheal intubation with the orotracheal tube and tracheostomy cannula is the most common etiology of nonmalignant TEF. Since cuff-related TEF is usually preventable with proper selection of the cuffed tube and close monitoring of cuff pressure. Although most patients present increased secretions, recurrent pneumonia, or coughing after swallowing, a high index of suspicion is required in patients at risk for developing a TEF. Surgical correction for the defectis required. In most cases, primary closure of the esophageal defect and tracheal resection and end-to-end anastomosis give the best results.

• Journal of Chest Surgery
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• v.23 no.2
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• pp.382-385
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• 1990

In recent era, the incidence of combined injury of cervical trachea and esophagus by penetrating wound has been increased considerably. If initial operative repair is unsatisfied, devastating complications and even death may be considered. A 5 years old boy and 67 years old female were admitted to our department for deep cervical stab wounds. On exploration, cervical trachea and esophagus was nearly total transected anteroposteriorly. Emergent reconstructive surgery for trachea and esophagus had done. Postoperative course was uneventful without any complications.

• Journal of Chest Surgery
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• v.29 no.2
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• pp.235-238
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• 1996

Acquired tracheoesophageal fistula, a life threatening lesion, is rare but occurs most frequently alter prolonged mechanical ven ilation using a cuffed endotracheal tube. The mechanism of injury seems to be ischemia and inflammation of compressed trachea and esophagus by cuffed endotracheal tube. The patient was a 25 years old pregnant woman who was on prolonged mechanical ventilation for bacterial meningitis secondary to untreated otitis media. 40 days after mechanical ventilation, sudden subcutaneous empysema and pneumomediastinum ocurred and these were due to tracheoesophageal fistula. It was diagnosed with bronchoscopy and CT We performed tracheal repair with TA 60mm stapler and esophageal repair by interruted two layer suture with 410 vicryl and 510 prolene. A flap of sternocleidomastoid muscle was inserted between trachea and esophagus. Postoperative course was uneventful and the result of operation was acceptable by esophagography.

• 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.

• Journal of the Korean Society of Laryngology, Phoniatrics and Logopedics
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• v.11 no.2
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• pp.178-184
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• 2000

Laryngeal evoked EMG is the objective and quantitative method to measure the innervation of laryngeal muscle. If there is a mobility disorder of vocal cords, the cause and location of neural lesion co be understood by the laryngeal evoked EMG and if there is a vocal cord paralysis, the degree of recovery and the policy of treatment can be determined by it. Recently, the studies of reinnervation after recurrent laryngeal nerve injury have been actively carried out. Laryngeal evoked EMC is useful to these studies. The aim of study is to know whether noninvasive methods for stimulating the recurrent laryngeal nerve and for recording of compound action potential(CAP) using surface electrode are as useful as the invasive method using needle electrode. We obtained EMG of laryngeal muscle by various stimulating and recording methods : 1) Direct nerve stimulation by placing nerve cuff electrode made out of silastic tube and platinum wire and recording by insertion of hook wire electrode into posterior cricoarytenoid(PCA) and thyroarytenoid(TA) muscles, respectively. 2) Recording of compound action potential by surface electrode after stimulation of recurrent laryngeal nerve by the insertion of 27 gauge of needle electrode. 3) Recording of compound action potential by surface electrode after stimulating the recurrent laryngeal nerve by transcutaneous blunt rod electrode at tracheoesophageal groove. The amplitude, duration and latency of the CAP evoked by recurrent laryngeal nerve stimulation were compared among the three groups. The amplitude of CAP was smallest in the group recorded from posterior cricoarytenoid and hyroarytenoid muscle, and that recorded by surface electrode after stimulation by needle electrode was largest. The difference in amplitude between the group by hook wire recording and the two groups by surface electrode recording was significant statistically. There is no significant difference in duration and latency among three groups. Since the waveform of CAP from all three methods has similar duration, latency, we concluded that noninvasive method is a useful as invasive methods.