Post-intubation tracheal stenosis was a late time complication after tracheotomy but the happening of dyspnea was unusual. Diagnosing tracheal stenosis after incubation, and figuring out the location and causes of the stenosis were important. Treatment of post-incubation tracheal stenosis relied on accurate diagnosis of the type of tracheal stenosis. Computed tomography (CT) and laryngoscope could be used for detecting the stenosis but not enough. Two patients who were already under the urgent tracheotomy over 1 year were reported. However apnea was found on these two patients for a long time after traheotomy. Obviously laryngeal obstruction appeared. CT virtual bronchoscope and laryngoscope examination showed that the cannula was obstructed and plenty of granulation tissue blocked the orificium. But the exact location of the cannula and the adjacent relationship of the tissue around the cannula was equivocal. Mimics 10.01 software was used to analyze the data of the CT scan and found that a pseudo cavity was formed by granulation tissue which partly blocked the cannula in 1 case; granulation tissue occupation and scar formation in the trachea were the reason of tracheal stenosis but not the collapse of the cartilage in case 2. The purpose of this report is to discuss the cause of dyspnea after emergency tracheotomy, its diagnostic method and their management. CT virtual bronchoscope and laryngoscope should be used as a regular examination after tracheotomy to clarify the location of cannula and avoid the failure of airway opening caused by the dislocation of cannula and the complication. Trachea tissue should be protected properly during and after the tracheotomy which might decline the rate of the tissue remodeling, tracheal stenosis and dyspnea after surgery. The clinical use of Mimics 10.01 made it possible to observe morphology more directly by invasive examination and provided a significant clue to make the operation plan so that it should be used widely. Meanwhile, the method to put the cannula into its right way under the guidance of rigid endoscope and the excision of granulation tissue by semiconductor laser should become one of the best treatments of this disease. Following the method above, laryngeal obstruction was relieved after the surgery. Postoperative follow-up lasted for 1 year and recurrence was not found.
Dyspnea/etiology* ; Humans ; Laryngoscopes ; Trachea ; Tracheal Stenosis ; Tracheotomy/adverse effects*

OBJECTIVE: To analyze the related factors of difficult laryngeal exposure under retaining laryngoscope. METHOD: We did a retrospective analysis of 287 retaining laryngoscope surgery patients' clinical datas to observe the relationship between difficult glottis exposure and patients' gender, degree of mouth opening, BMI, neck circumference, head and neck flexion, TMD, HMD and SMD. RESULT: By ROC curve analysis, we determine the optimal threshold for TMD was 7.35 cm, HMD was 6.33 cm, SMD was 14.75 cm. Univariate analysis showed that gender, and glottis exposure had no significant correlation with difficult laryngeal exposure under retaining laryngoscope. Degree of mouth opening, BMI, neck circumference, head and neck flexion, TMD, HMD and SMD had correlation with difficult laryngeal exposure. Multivariate analysis showed that neck circumference, head and neck flexion, TMD, SMD were independent factors of difficult laryngeal exposure under retaining laryngoscope. CONCLUSION Measurement of neck circumference, head and neck flexion, TMD, SMD before the operation is important for the prediction of difficult laryngeal exposure under retaining laryngoscope.
Glottis ; Head ; Humans ; Laryngoscopes ; Laryngoscopy ; adverse effects ; methods ; Larynx ; Neck ; Posture ; ROC Curve ; Retrospective Studies

Objective: To investigate the reduction effect of hoding cricoarytenoid joint reduction with visual laryngoscope under intravenous anesthesia. Methods: The therapeutic effects of 40 patients with arytenoid dislocation(AD)treated by closed reduction in the single center from January 2020 to September 2021 were retrospectively analyzed, including 21 males and 19 females, median age 48 years. The etiology, symptoms, preoperative evaluation methods, reduction mode, reduction times, and the recovery of arytenoid cartilage movement and sound after reduction were evaluated and analyzed. Results: All patients had obvious hoarseness and breath sound before treatment. Under stroboscopic laryngoscope or electronic nasopharyngoscope, different degrees of vocal cord movement disorder and poor glottic closure can be seen. There were 28 cases of left dislocation, 9 cases of right dislocation and 3 cases of bilateral dislocation. The etiology of dislocation of cricoarytenoid joint: 25 cases (62.5%) of tracheal intubation under general anesthesia were the most common causes, was as follows by laryngeal trauma, gastroscopy, cough, vomiting and so on. Among them, 28 cases of reduction were initially diagnosed in our department, and 12 cases were diagnosed later after failure of reduction treatment. Of the 40 patients, 6 underwent reduction 24 hours after dislocation; 18 cases from 3 days to 1 month; 7 cases from 1 to 3 months; 6 cases were reset in 3~6 months; Over 6 months in 3 cases. After one reduction, 10 cases (10/40, 25%) recovered normal pronunciation, 14 cases (14/40, 35%) recovered normal pronunciation after two reduction, 10 cases (10/40, 25%) recovered normal pronunciation after three times, 2 cases (2/40, 5%) recovered normal pronunciation after four times, and 1 case (2.5%) recovered normal pronunciation after five times. Thin slice CT scan of larynx and cricoarytenoid joint reconstruction showed the types of AD: subluxation in 37 cases (92.5%) and total dislocation in 3 cases; 28 cases of left dislocation, 9 cases of right dislocation and 3 cases of bilateral dislocation; 29 cases (72.5%) had posterior dislocation and 11 cases (27.5%) had anterior dislocation. All patients were treated by intravenous anesthesia with arytenoid cartilage clamped by cricoarytenoid joint reduction forceps under visual laryngoscope. The curative effect was evaluated by stroboscopic laryngoscope and/or voice analysis at 1-2 weeks after operation. The vocal cord movement returned to normal and the pronunciation was good in 37 cases (92.5%). Conclusions: Hoding cricoarytenoid joint reduction with the vision laryngoscope under intravenous anesthesia is easy to operate and the reduction effect is more stable. It is a effective method for AD.
Anesthesia, Intravenous/adverse effects* ; Arytenoid Cartilage/injuries* ; Female ; Humans ; Intubation, Intratracheal/adverse effects* ; Joint Dislocations/therapy* ; Laryngeal Diseases/etiology* ; Laryngoscopes/adverse effects* ; Male ; Middle Aged ; Retrospective Studies

To assess the curative effects of different reduction techniques on the dislocation of cricoarytenoid joint caused by intubation, indirect laryngoscope (IL) and direct laryngoscope (DL) were utilized for the closed reduction of the displaced arytenoid under local anesthesia. 23 patients who underwent the reduction for dislocated arytenoid under IL or DL from January 1991 to June 2001 were reviewed. The data were collected on the duration of the laryngeal injury, times of receiving reduction, side-effects after the treatment and the period for voice to return to normal. The relationship between the duration of the laryngeal lesion and the period of the voice rehabilitation was examined. 13 patients received the reduction under IL and 10 patients under DL. Except the times of the reduction, which showed significant difference, no differences were found between IL group and DL group in the course and the period of voice rehabilitation, as well as sore throat after the manipulation. The patients' voice recovery was positively related to their course of disease in both IL and DL group. It is concluded that the recovery of normal voice is obviously affected by the duration of arytenoid dislocation. The reduction under IL is as effective as under DL in the treatment of arytenoid dislocation. Reduction by DL is better suit the patients with long time course of disease.
Adult ; Aged ; Arytenoid Cartilage ; injuries ; Female ; Humans ; Intubation, Intratracheal ; Joint Dislocations ; diagnosis ; etiology ; therapy ; Laryngeal Cartilages ; injuries ; Laryngoscopes ; adverse effects ; Laryngoscopy ; adverse effects ; methods ; Male ; Middle Aged

To assess the curative effects of different reduction techniques on the dislocation of cricoarytenoid joint caused by intubation, indirect laryngoscope (IL) and direct laryngoscope (DL) were utilized for the closed reduction of the displaced arytenoid under local anesthesia. 23 patients who underwent the reduction for dislocated arytenoid under IL or DL from January 1991 to June 2001 were reviewed. The data were collected on the duration of the laryngeal injury, times of receiving reduction, side-effects after the treatment and the period for voice to return to normal. The relationship between the duration of the laryngeal lesion and the period of the voice rehabilitation was examined. 13 patients received the reduction under IL and 10 patients under DL. Except the times of the reduction, which showed significant difference, no differences were found between IL group and DL group in the course and the period of voice rehabilitation, as well as sore throat after the manipulation. The patients' voice recovery was positively related to their course of disease in both IL and DL group. It is concluded that the recovery of normal voice is obviously affected by the duration of arytenoid dislocation. The reduction under IL is as effective as under DL in the treatment of arytenoid dislocation. Reduction by DL is better suit the patients with long time course of disease.
Arytenoid Cartilage/*injuries ; Dislocations/diagnosis ; Dislocations/*etiology ; Dislocations/therapy ; Intubation, Intratracheal ; Laryngeal Cartilages/*injuries ; Laryngoscopes/adverse effects ; Laryngoscopy/*adverse effects ; Laryngoscopy/methods

OBJECTIVETo compare the hemodynamic responses to orotracheal intubation via fiberoptic bronchoscope (FOB) with conventional orotracheal intubation via direct laryngoscope (DLS) in children under general anesthesia.

METHODSForty-three American Society of Anesthesiologist grade I-II children undergoing the elective plastic surgery and requiring orotracheal intubation were randomly allocated to either the DLS group (n = 20)or the FOB group (n = 23). After standard intravenous anesthetic induction, orotracheal intubation was performed using a DLS or a FOB. Noninvasive systolic blood pressure (SBP), diastolic blood pressure (DBP), heart rate (HR), and rate-pressure product (RPP) were recorded before and after anesthetic induction, at intubation, and 5 minutes after intubation with 1 minute interval.

RESULTSIn the DLS group, SBP, HR, and RPP at intubation increased significantly compared to their postinduction values (P < 0.05),but blood pressure, HR and RPP at intubation didn't differ from their preinduction values. The maximal values of SBP, HR and RPP during the observation (from the beginning of intravenous anesthetic induction to 5 minutes after intubation) were significantly higher than their preinduction values (P < 0.05). In the FOB group, blood pressure, HR and RPP at intubation increased significantly compared to their preinduction and postinduction values (P < 0.05), and the maximal values of blood pressure, HR and RPP during the observation were significantly higher than their preinduction values (P < 0.05). There were no significant differences in blood pressure and RPP at each time point during the observation between the two groups. The HR at intubation were significantly higher in the FOB group than in the DLS group (P < 0.05), but no significant difference was observed in the HR values at other time points during the observation between the two groups. There were also no significant differences in the maximal values of blood pressure, HR and RPP or the times to reach their maximal values between the two groups.

CONCLUSIONGeneral anesthesia of clinical standard depth can not effectively inhibit the pressor and tachycardiac responses caused by fiberoptic orotracheal intubation in children. As compared with DLS, FOB has no special advantages in preventing the cardiovascular stress responses to orotracheal intubation in children.

Anesthesia, General ; Blood Pressure ; physiology ; Bronchoscopes ; Child, Preschool ; Female ; Heart Rate ; physiology ; Humans ; Infant ; Intubation, Intratracheal ; adverse effects ; instrumentation ; Laryngoscopes ; Male ; Surgery, Plastic

OBJECTIVE: To research the causes of postintubation vocal cord dyskinesia and its contributing factors. METHOD: The causes of vocal cord dyskinesia were confirmed by laryngoscope, three-dimensional spiral CT, stroboscope, and the analysis of therapy. The factors relevant to the causes of vocal cord dyskinesia were analysed based on the following elements: (1) the anatomic or pathological condition of patients or the technical skills of anesthetists. (2) emaciated or obese body and neck. (3) the age of patients. (4) the duration of endotracheal tube retention. (5) the types of operations. (6) anesthesia procedure. RESULT: Among 135 patients, 128 cases (94.81%) manifested arytenoid dislocation, 7 cases (5.19%) vocal cord paralysis. The study showed that the vocal cord dyskinesia associated with anatomic or pathological condition of patients and technical skills of anesthetists (with intubation difficulty) accounted for 76.30%. The patients with relative emaciated body or neck accounted for 90.62% in cases without intubation difficulty. Age had no significant analytical relationship with vocal cord dyskinesia. Prolonged intubation (endotracheal tube retention over 12 hours) was accounted for only 17.64%. The incidence of vocal cord dyskinesia was nearly 0.5% in patients underwent cardio-thoracic surgery, accounting for 59.26% of all the patients. CONCLUSION There are two major causes of vocal cord dyskinesia: arytenoid dislocation and vocal cord paralysis, and the rate of vocal cord dyskinesia could be reduced by the improvement of technical skill of anesthetists and/or sufficient attention to the intubation condition of patients.
Adolescent ; Adult ; Aged ; Aged, 80 and over ; Child ; Child, Preschool ; Female ; Humans ; Infant ; Intubation, Intratracheal ; adverse effects ; Laryngoscopes ; adverse effects ; Male ; Middle Aged ; Vocal Cord Paralysis ; etiology ; physiopathology ; Vocal Cords ; physiopathology ; Young Adult