Hermes C. Grillo, MD, Cameron D. Wright, MD

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Presentation transcript:

Airway Obstruction Owing to Tracheopathia Osteoplastica: Treatment by Linear Tracheoplasty Hermes C. Grillo, MD, Cameron D. Wright, MD The Annals of Thoracic Surgery Volume 79, Issue 5, Pages 1676-1681 (May 2005) DOI: 10.1016/j.athoracsur.2004.10.008 Copyright © 2005 The Society of Thoracic Surgeons Terms and Conditions

Fig 1 Preoperative bronchoscopic observations. (A) Patient 1. Note narrowing as a result of tracheopathia osteoplastica nodules and saber sheath deformity. The membranous wall is unaffected. (B) Patient 3. Large and small nodules, distorted lumen. The Annals of Thoracic Surgery 2005 79, 1676-1681DOI: (10.1016/j.athoracsur.2004.10.008) Copyright © 2005 The Society of Thoracic Surgeons Terms and Conditions

Fig 2 Tracheopathia osteoplastica. (A) Patient 1. Preoperative posteroanterior chest roentgenogram. Note marked narrowing of the trachea. Clips and sutures are from previous coronary artery surgery. (B) Patient 3. Three-dimensional computed tomographic reconstruction of the trachea, showing extreme deformity. (C) Patient 3. Computed tomographic scan of trachea. The nodularity, calcification, extreme saber sheath deformity, and narrowed lumen are diagnostic of tracheopathia osteoplastica. The Annals of Thoracic Surgery 2005 79, 1676-1681DOI: (10.1016/j.athoracsur.2004.10.008) Copyright © 2005 The Society of Thoracic Surgeons Terms and Conditions

Fig 3 Operative correction of obstructive tracheopathia osteoplastica. (A) The trachea is opened from the cricoid to the carina (dashed line), or also over the main bronchi (dotted line) if required. Exposure is described in text. (B) A previously prepared T or T-Y silicone rubber tube is placed in the lumen of the airway, and the tracheotomy (and any bronchotomies) are sutured closed. (C) The tracheal incisions are buttressed with pedicled sternohyoid muscles below the T sidearm and with sutured sternothyroid muscles above. The Annals of Thoracic Surgery 2005 79, 1676-1681DOI: (10.1016/j.athoracsur.2004.10.008) Copyright © 2005 The Society of Thoracic Surgeons Terms and Conditions

Fig 4 Cross-sectional diagrams of the correction. (A) The initial configuration of the lumen. Dashed line indicates location of longitudinal tracheal incision. (B) Anterior incision allows the side walls to hinge open on the uninvolved membranous tracheal wall. (C) The rigid walls are sutured together anteriorly, stretching the membranous wall posteriorly, over the T tube. (D) After firm healing the T tube is removed, leaving a permanently enlarged lumen. The Annals of Thoracic Surgery 2005 79, 1676-1681DOI: (10.1016/j.athoracsur.2004.10.008) Copyright © 2005 The Society of Thoracic Surgeons Terms and Conditions

Fig 5 Postoperative bronchoscopic view, patient 1. Nodular walls persist but are widely separated. Compare with Figure 1A. The Annals of Thoracic Surgery 2005 79, 1676-1681DOI: (10.1016/j.athoracsur.2004.10.008) Copyright © 2005 The Society of Thoracic Surgeons Terms and Conditions

Fig 6 Flow–volume curves, preoperative (dotted lines) and postoperative (solid lines) in patient 3 (A) and patient 4 (B). Inspiratory loops were not determined satisfactorily in patient 4. The Annals of Thoracic Surgery 2005 79, 1676-1681DOI: (10.1016/j.athoracsur.2004.10.008) Copyright © 2005 The Society of Thoracic Surgeons Terms and Conditions

Fig 7 Postoperative computed tomographic scan, patient 3. The lumen is significantly enlarged. Compare with Figure 2C. The Annals of Thoracic Surgery 2005 79, 1676-1681DOI: (10.1016/j.athoracsur.2004.10.008) Copyright © 2005 The Society of Thoracic Surgeons Terms and Conditions