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5 results

  • Anomalous innominate artery complicating tracheal surgical procedures

  • J J E Sargunaraj, R R Paul, S S Mathews, R R A Albert
  • Journal:
    The Journal of Laryngology & Otology / Volume 135 / Issue 2 / February 2021
    Published online by Cambridge University Press:
    25 January 2021, pp. 185-188
    Print publication:
    February 2021
  • Objective

    To highlight the importance of imaging in reducing an accidental injury to the anomalous brachiocephalic trunk and its branches during tracheal surgery.

    Case report

    This paper reports two cases of accidental injury to the great vessels in the neck during tracheal surgery. The first incident occurred during a repeat tracheostomy, when the right common carotid artery was injured. On reviewing the computed tomography images, the bifurcation of the brachiocephalic artery was seen to the left of the midline, and the right common carotid artery was adherent just below the tracheostomy site. The second incident happened during surgery for tracheal stenosis, when there was an inadvertent injury to the main brachiocephalic trunk, which was adherent to the trachea in the lower neck region.

    Conclusion

    For airway surgeons, radiological assessment of vascular structures in relation to the trachea prior to surgery is as important as the endoluminal airway assessment for the best outcome.

  • Aortopexy for the management of paediatric tracheomalacia – the Alder Hey experience

  • S P Williams, P D Losty, R Dhannapuneni, A Lotto, R Guerrero, A J Donne
  • Journal:
    The Journal of Laryngology & Otology / Volume 134 / Issue 2 / February 2020
    Published online by Cambridge University Press:
    23 January 2020, pp. 174-177
    Print publication:
    February 2020
  • Background

    Whilst aortopexy is an accepted and established procedure, there remains considerable heterogeneity within the literature, with inconsistencies in both the approach taken and the technique employed. Furthermore, limited data exist on both patient selection and long-term outcomes. This study aimed to report the experience of managing severe tracheomalacia by way of aortopexy in a large UK paediatric centre.

    Method

    A retrospective case note review was conducted. Mean follow up was five years.

    Results

    Twenty-five patients underwent aortopexy for severe tracheomalacia caused by external vascular compression. Acute life-threatening events precipitated investigation in 72 per cent of cases. Twenty-one patients initially presented to ENT services for investigation, which comprised upper airway endoscopy and imaging with computed tomography angiography. Post-operatively, the majority of patients demonstrated complete resolution of symptoms and were discharged from all associated services. Only four patients required a tracheostomy.

    Conclusion

    Aortopexy offers an effective method of treating severe tracheomalacia due to vascular compression.

  • Tracheoinnominate fistula: surgical management of an iatrogenic disaster

  • R W Ridley, J B Zwischenberger
  • Journal:
    The Journal of Laryngology & Otology / Volume 120 / Issue 8 / August 2006
    Published online by Cambridge University Press:
    19 May 2006, pp. 676-680
    Print publication:
    August 2006

  • Tracheoinnominate fistula (TIF) is a rare condition with significant potential for mortality if surgical intervention is not immediate. We present two cases of successfully managed TIF. Both cases involve ligation and resection of the innominate artery at the TIF followed by a pectoralis major muscle flap. In both cases, success was largely due to a high index of suspicion and immediate control of the bleeding with transport to the operating room for surgical repair. The history, aetiology, and pathogenesis of TIF are reviewed, yielding an algorithm for recommended management of TIF.

  • Tracheo-innominate artery fistula: a rare complication in a laryngectomized patient

  • Produl Hazarika, Ganesh Kamath, R. Balakrishnan, Raj Girish, Kundaje Harish G.
  • Journal:
    The Journal of Laryngology & Otology / Volume 116 / Issue 7 / July 2002
    Published online by Cambridge University Press:
    08 March 2006, pp. 562-564
    Print publication:
    July 2002

  • A tracheo-innominate artery fistula is an uncommon but frequently fatal complication of tracheostomy. Rarely, it can also occur in laryngectomized patients. We report a post-laryngectomy, post-radiotherapy patient using a metal tracheostomy tube, who developed a tracheo-innominate artery fistula about two months after radiotherapy. To our knowledge this is only the second reported case in a laryngectomized patient. The computed tomography (CT) angiography findings helped confirm the diagnosis and the patient was successfully managed by surgical exploration and ligation of the innominate artery. Coagulase negative Staphylococcus aureus was cultured from a tracheal swab. The clinical features, CT angiography findings, management protocols and possible aetiological factors are discussed.