Ex vivo ovine model for teaching open laryngotracheal surgery

Objective: To develop an animal model for teaching open laryngotracheal surgical procedures. Methods: The heads and necks from 5 pre-pubescent sheep were harvested after humane anesthesia. After 2—5 days to allow for rigor mortis to resolve, a specimen was supported with sandbags on an operating table. Operative procedures including tracheotomy, medialization laryngoplasty, anterior cartilage grafting, tracheal resection with primary anastomosis, and laryngectomy with closure of the pharynx were attempted. Results: The ovine head and neck provided an accurate model for simulation of all attempted procedures. Ovine tissue resembled that of humans in mechanical properties and handling. Postsurgical endoscopy confirmed graft alignment. Conclusions: The sheep head and neck provides an inexpensive, realistic, and safe model for surgical training for a variety of open laryngotracheal procedures. This is particularly relevant given the recent emphasis on surgical simulation and the relative rarity of some of these pro-cedures in residency training.

Laryngotracheal stenosis in burn patients requiring mechanical ventilation

Objective: To identify the incidence of laryngotracheal stenosis (LTS) in burn pa-tients requiring mechanical ventilation at a regional academic burn center. Methods: A retrospective review of all burn patients requiring endotracheal intubation or tra-cheostomy for airway management between 2003 and 2009 was performed. A group of trauma patients requiring similar airway instrumentation during the same period of time was used as a control. Results: None of the trauma patients and 2 of the burn patients developed LTS. Both presented with stridor and were diagnosed within 2—5 weeks after extubation. One patient underwent successful carbon dioxide laser radial incision and dilation and continues to do well. The other patient failed endoscopic treatment and required T-tube placement. The incidence of LTS in burn patients requiring mechanical ventilation was 2.98％ overall and 4.76％ among those with inhalational injury. Conclusions: Patients become symptomatic within weeks of the initial injury. Treatment is challenging and multiple surgical procedures are often required. A larger study is necessary to determine if the incidence is higher among burn patients.

The role of serial physical examinations in the management of angioedema involving the head and neck:A prospective observational study

Objective:To elucidate the progression of angioedema of the head and neck with routine management and to assess the utility of serial physical exams and fiberoptic laryngos-copy in its management. Methods:This study was a prospective observational research. From 2013 to 2014, a prospec-tive observational study was conducted at a tertiary referral center. Forty patient were ap-proached, 7 refused, 33 (18e90 years old) were enrolled. Patients presented with angioedema involving the head and neck over a 12 month period were asked to participate in the study. Physical examination and fiberoptic laryngoscopy were performed at presentation and then repeated at least 1 h later. Results:Thirty-three patients with head and neck angioedema from any cause were enrolled (mean age 58, range 23e89 years). The upper lip was the most commonly involved site (58%). On reevaluation, 82% of patients reported subjective improvement in symptoms. Theassociation between subjective improvement and the physical exam, including fiberoptic laryngoscopy findings, was statistically significant (P<0.001). Conclusion:In stable patients with angioedema of any head and neck subsite, self-reported symptoms are associated with clinical stability or improvement as assessed by physical signs and fiberoptic laryngoscopy. Patients’ symptoms may be an appropriate surrogate to monitor clinical status without the need for routine serial physical examinations or fiberoptic laryngos-copy, though further study is needed. Copyright a 2016 Chinese Medical Association. Production and hosting by Elsevier B.V. on behalf of KeAi Communications Co., Ltd. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

Introduction

Since its inception with the invention of the laryngeal mirror and the early work of Horace Green, Chevalier Jackson, Johann Czermak, Morrell McKenzie, and others in the mid-19th Century, the field of laryngology has grown exponentially. With the introduction of suspension laryngoscopy and general anesthesia, surgeons were able to work with both hands. The addition of the operative microscope allowed visualization not previously possible. In the mid-20th Century, the CO2 laser permitted laryngeal surgery to performed with unprecedented precision and hemostasis. The 1970's saw the advent of flexible laryngoscopes and stroboscopy which took our diagnostic capabilities to new levels. The distal chip laryngoscopes which followed along with the fiber-based lasers, allowed procedures to be done in the office setting with superior visualization and exactness. And the story continues……