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Surgical Management of Supraglottic Stenosis Using Intubationless Optiflow.

Abstract Airway management during endoscopic surgical treatment of supraglottic and pharyngeal stenosis is often challenging and can be accomplished by various means, including tracheostomy, jet ventilation, or direct laryngoscopy. We describe CO2 laser excision of supraglottic-pharyngeal stenosis using intubationless Optiflow high-flow nasal cannula (HFNC).
PMID
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Authors

Mayor MeshTerms

Cannula

Keywords

high flow nasal cannula

laryngeal stenosis

laryngology

laryngotracheal stenosis

miscellaneous

optiflow

otolaryngology

pre-oxygenation

supraglottic stenosis

Journal Title the annals of otology, rhinology, and laryngology
Publication Year Start




PMID- 28766977
OWN - NLM
STAT- MEDLINE
DA  - 20170802
DCOM- 20170821
LR  - 20170821
IS  - 1943-572X (Electronic)
IS  - 0003-4894 (Linking)
VI  - 126
IP  - 9
DP  - 2017 Sep
TI  - Surgical Management of Supraglottic Stenosis Using Intubationless Optiflow.
PG  - 669-672
LID - 10.1177/0003489417720220 [doi]
AB  - OBJECTIVE: Airway management during endoscopic surgical treatment of supraglottic
      and pharyngeal stenosis is often challenging and can be accomplished by various
      means, including tracheostomy, jet ventilation, or direct laryngoscopy. We
      describe CO2 laser excision of supraglottic-pharyngeal stenosis using
      intubationless Optiflow high-flow nasal cannula (HFNC). METHODS: A 55-year-old
      male presented with dyspnea and dysphagia secondary to severe
      supraglottic-pharyngeal stenosis in the setting of previous chemoradiation for a 
      T0N2aM0 squamous cell carcinoma. Laryngoscopy revealed severe
      supraglottic-pharyngeal stenosis with tethering of the epiglottis to the lateral 
      pharyngeal walls. Optiflow HFNC was used to deliver 70 L/min of oxygen. After
      anesthetic induction, CO2 laser microlaryngoscopy was utilized to release scar
      tissue along the lateral epiglottic border, opening up the supraglottic airway
      sufficiently for endotracheal intubation and further laser resection. RESULTS:
      Airway management with Optiflow HFNC allowed initial endoscopic surgical access, 
      partial stenotic release, and intubation. From anesthetic induction to
      intubation, the patient remained apneic for 26 minutes. The patient's stenosis
      was successfully addressed, and 10-month follow-up demonstrated stable patency of
      the airway. CONCLUSION: Optiflow is an important new tool in the management of
      severe supraglottic stenosis. It provides sufficient oxygenation to perform
      extended apneic surgery and improves endoscopic surgical access in a limited
      airway.
FAU - Tam, Kenric
AU  - Tam K
AD  - 1 Stanford University School of Medicine, Stanford, California, USA.
FAU - Jeffery, Caroline
AU  - Jeffery C
AD  - 2 Stanford University School of Medicine, Department of Otolaryngology-Head and
      Neck Surgery, Division of Laryngology, Stanford, California, USA.
FAU - Sung, C Kwang
AU  - Sung CK
AD  - 2 Stanford University School of Medicine, Department of Otolaryngology-Head and
      Neck Surgery, Division of Laryngology, Stanford, California, USA.
LA  - eng
PT  - Case Reports
PT  - Journal Article
DEP - 20170802
PL  - United States
TA  - Ann Otol Rhinol Laryngol
JT  - The Annals of otology, rhinology, and laryngology
JID - 0407300
RN  - Carcinoma, squamous cell of head and neck
SB  - AIM
SB  - IM
MH  - Airway Obstruction/etiology/*surgery
MH  - *Cannula
MH  - Carcinoma, Squamous Cell/therapy
MH  - Chemoradiotherapy/adverse effects
MH  - Constriction, Pathologic/etiology/surgery
MH  - Deglutition Disorders/etiology/*surgery
MH  - Epiglottis/*surgery
MH  - Head and Neck Neoplasms/therapy
MH  - Humans
MH  - Intubation, Intratracheal
MH  - Laryngoscopy/*methods
MH  - Laser Therapy/*methods
MH  - Lasers, Gas/therapeutic use
MH  - Male
MH  - Middle Aged
MH  - Oxygen Inhalation Therapy/*instrumentation/methods
MH  - Pharyngeal Diseases/etiology/*surgery
MH  - Pharyngeal Neoplasms/therapy
OTO - NOTNLM
OT  - high flow nasal cannula
OT  - laryngeal stenosis
OT  - laryngology
OT  - laryngotracheal stenosis
OT  - miscellaneous
OT  - optiflow
OT  - otolaryngology
OT  - pre-oxygenation
OT  - supraglottic stenosis
EDAT- 2017/08/03 06:00
MHDA- 2017/08/22 06:00
CRDT- 2017/08/03 06:00
AID - 10.1177/0003489417720220 [doi]
PST - ppublish
SO  - Ann Otol Rhinol Laryngol. 2017 Sep;126(9):669-672. doi: 10.1177/0003489417720220.
      Epub 2017 Aug 2.