For airway reconstruction, if you have a particularly long suprastomal stent, patients will often gag and wretch because of some of the disruption of the sensation in the hypopharynx and oropharynx as a result of these caustic injuries, these. Patients sometimes tolerate this a little bit better.
You can see that there's really extensive scarring in the hypopharynx. There's no discernible esophageal inlet. There's also no discernible laryngeal structures as we retract the laryngoscope, you can see that the base of the tongue is essentially scarred to the hypopharyngeal wall.
QUAD #5 Pharyngeal Scar Management with Dr. Doug von Allmen
▶Ep 21 · 0:52
quoteThe challenge that we face when we deal with pharyngeal stenosis as it relates to caustic congestion is we not only have to deal with the physical obstruction, but we also have to deal with the altered sensation and altered motor function as well.↗
▶Ep 21 · 0:52
clinicalIn pharyngeal stenosis related to caustic ingestion, clinicians must address not only physical obstruction but also altered sensation and altered motor function↗
▶Ep 21 · 1:48
quoteYou can see that there's really extensive scarring in the hypopharynx. There's no discernible esophageal inlet. There's also no discernible laryngeal structures as we retract the laryngoscope, you can see that the base of the tongue is essentially scarred to the hypopharyngeal wall.↗
▶Ep 21 · 1:48
clinicalThe presented patient had extensive scarring in the hypopharynx with no discernible esophageal inlet and no discernible laryngeal structures, with base of tongue scarred to hypopharyngeal wall↗
▶Ep 21 · 2:10
clinicalAfter scar tissue removal, the large raw surface area poses a risk of re-scarring↗
▶Ep 21 · 2:10
quoteAfter removal of the scar tissue, we have this big raw surface area. And so the question is how do we prevent this from re-scarring?↗
▶Ep 21 · 2:19
clinicalSome surgeons have used free mucosal grafts to prevent re-scarring after scar tissue removal↗
▶Ep 21 · 2:22
clinicalA modified suprastomal stent can be placed through the glottis and secured with suture, then wrapped with silastic sheeting to increase the stent diameter in the pharynx↗
▶Ep 21 · 3:09
clinicalPatients with caustic injuries sometimes tolerate suprastomal stents better than airway reconstruction patients because disrupted sensation in the hypopharynx and oropharynx reduces gagging and retching↗
▶Ep 21 · 3:09
quoteFor airway reconstruction, if you have a particularly long suprastomal stent, patients will often gag and wretch because of some of the disruption of the sensation in the hypopharynx and oropharynx as a result of these caustic injuries, these. Patients sometimes tolerate this a little bit better.↗
▶Ep 21 · 3:36
clinicalAt one-year follow-up, the presented patient maintained a fairly decent opening to the glottis but remains tracheostomy and G-tube dependent↗
▶Ep 21 · 3:53
quoteWe did undergo a colon interposition and it was able to get PO taste and certainly has improved management of the secretions, but these can be difficult cases in terms of their long-term outcomes and swallowing dysfunction.↗
▶Ep 21 · 3:53
clinicalThe patient underwent colon interposition and was able to get PO taste with improved secretion management, but continues to have swallowing dysfunction↗
▶Ep 21 · 4:15
clinicalIn the oropharynx and hypopharynx, a larger caliber balloon is needed for dilation↗
▶Ep 21 · 4:46
clinicalRotational flaps and free flaps can be used to help break up scarring in pharyngeal stenosis↗
▶Ep 21 · 5:04
clinicalZ-plasty technique can be used to break up scar orientation by rotating mucosal flaps↗
▶Ep 21 · 5:13
clinicalStaged procedures are helpful to avoid creating circumferential scarring again↗
▶Ep 21 · 5:13
quoteIt's helpful to do this in a staged fashion so that you're not creating circumferential scarring again.↗
▶Ep 21 · 5:35
clinicalMany pharyngeal stenosis patients require tracheostomy, often due to extensive supraglottic scarring↗
▶Ep 21 · 6:03
clinicalInvolvement of speech language pathologists and pulmonary colleagues is important to help manage the sequelae of aspiration↗
▶Ep 21 · 6:11
clinicalPharyngeal stenosis patients warrant long-term surveillance as there is suggestion they may be at increased risk for malignancy, and surveillance for neoplasm development is helpful↗
▶Ep 21 · 6:15
quoteThere is some suggestion that these patients can be at increased risk for malignancy down the road and surveillance for neoplasm development is helpful.↗
