Claviculotracheopexy for complex airway reconstructions
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Claviculotracheopexy for complex airway reconstructions K. Sandu1 · Pauline Vinckenbosch‑Jaballah1 · L. Duchoud1 Received: 11 April 2020 / Accepted: 23 May 2020 © Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Purpose Revision surgery for correcting benign laryngotracheal stenosis is challenging and it gets complicated in patients with comorbidities. To improve results in such cases, we describe a new technique of stabilizing the trachea by splinting it to the clavicle on both sides. Methods Retrospective case series. Results Three patients received claviculotracheopexy to maintain their tracheal static. The surgery offers an immediate and optimal support to an unstable trachea. Conclusion Claviculotracheopexy can be used as a complementary procedure in complex airway reconstructions. Keywords Tracheomalacia · Laryngotracheal stenosis · Salvage surgery
Introduction Symptomatic tracheomalacia (TM) presents with tracheal lumen collapse of more than 50% during the respiratory cycle [1]. The main etiologies of acquired cervical TM with increased cartilage framework fragility are tracheostomy, previous tracheal surgeries, prolonged endotracheal intubation, and external neck trauma. Tracheostomy-induced damage to the tracheal cartilages and associated chronic perichondritis forms a localized weakened area that subsequently evolves into an A-shape deformity causing dynamic airway collapse. The treatment objective in these cases of deformed and stenotic tracheas is to obtain an optimal airway caliber with adequate dynamic stability. Segmental tracheal resection and end-to-end anastomosis means removal of the diseased tracheal rings followed by tracheo-tracheal or cricotracheal anastomosis and is the treatment of choice for short malacic tracheal stenosis [2]. In patients who had prior cricotracheal or tracheal resection, any additional airway excision is challenging or might not be possible. In addition, airway resection and anastomosis poses a high risk of anastomotic dehiscence in patients after radiotherapy to the head and neck region. In this report, * K. Sandu [email protected] 1
Department of Otolaryngology, Lausanne University Hopsital, CHUV, Lausanne, Switzerland
we describe the technique of claviculotracheopexy (CTP) to stabilize the trachea during surgery for complex laryngotracheal stenoses.
Methods Technical description An institutional review board clearance and appropriate patient’s consent were obtained. Before surgery, an endoscopic assessment under general anesthesia and spontaneous breathing was performed to define the location, type, and length of the tracheomalacic segment. The three cases presented in this report benefited from additional placement of extra luminal biodegradable polydiaxanone (PDS) plates, as has been previously described by our team [3]. The objective of using these splints is to rigidify and stiffen the tracheal exoskeleton. Following a horizontal skin incision, the trachea and larynx were exposed after lateralising the pre
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