10:13pm Thursday 19 October 2017

U-M surgeons pioneer procedure to close tracheotomies in children

ANN ARBOR, Mich. – Surgeons at the University of Michigan have pioneered a way to close tracheotomies in children with a new procedure that has, so far, been 100 percent successful.

A paper outlining the results of a study that looked at cases involving this procedure – a reconstruction of the damaged airway – is in today’s Archives of Otolaryngology, Head and Neck Surgery.

“We’ve pioneered a way to get the tracheotomy tube out and free children of the care that would have been required over their lifetime, with the added benefit of enabling them to talk,” said Glenn E. Green, M.D. , pediatric otolaryngologist in the Department of Otolaryngology at the University of Michigan Health System and lead author of the paper. “For these children and their families, this is life-changing.”

Children who need tracheotomy tubes to breathe typically live with significant limitations. They have difficulty speaking or are unable to speak at all. They can’t swim or engage in water activities. Caring for a tracheotomy is also difficult. Children need frequent suctioning and the tracheotomy tube needs to be cleaned out and changed. Heavy scarring also can occur along the trachea over time, which can lead to other medical complications.

A tracheotomy is used to bypass damaged airways that are the result of motor vehicle accidents, or as a result of premature birth – where kids are sometimes born unable to breathe on their own and need to be on a vent or intubated. About one percent of premature babies receive tracheotomies in order to breathe. A tracheotomy tube is inserted in a child when the airway is too damaged and the child is unable to breathe through the mouth. An opening is made through the neck in order to allow breathing.

Green first tried the procedure on a pregnant woman who had a very damaged airway and who he was trying to keep alive until her baby was born. The procedure worked. She and the baby both survived and have gone on to live normal lives.

The procedure or reconstruction of the airway is two-pronged and involves a cricotracheal resection and a hilar (pronounced high-lar) release. A cricotracheal resection is a surgery in which the narrowed, stenotic, or damaged part of the airway below the voice box is removed and the voice box and wind pipe (or trachea) are sewn back together.

The hilar release essentially makes additional incisions within the chest to allow doctors to elevate the lower windpipe from the chest up into the neck.

“We’re doing about ten major reconstructions a year,” says Green about the new procedure. “We would like to let others know what we’ve learned so that it can be offered to more children.”

“So far we have been extremely successful and have the highest success rate that’s been reported for the most difficult problem:  long-segment, complete stenosis,” Green says.

In this study, doctors looked at 16 child patients who had undergone a cricotracheal resection and a hilar release in patients with a high level of narrowing or obstruction in the trachea between January 2004 and December 2008.

Doctors looked at decannulation (removal of a tracheotomy tube) and rupture rates to determine the best course of treatment to repair a narrowed or obstructed airway.

In all but one case, all children had a successful removal of the tracheotomy tube. The exception was a quadriplegic child who remains on a ventilator and for whom speech was restored.

Ramona Russell’s six-year-old daughter Ayonna Green, of Troy, Mich., was one of the young patients who Green was able to free of her tracheotomy tube and whose case was included in this study. Born premature and with a very damaged airway, Russell was told by doctors they would be unable to do more for Ayonna and that she would more than likely not survive, even with a tracheotomy.

Russell sought the help of U-M and Dr. Green took her case, operating on her five years ago. She has since been able to breathe tracheotomy-free and do most things that a typical child her age can do.

“She is in kindergarten, she can swim, she’s talking and taking voice lessons to get some volume,” Russell says. “I am so grateful.”

Joseph Taylor, M.D., Ryan M. Collar, M.D., Kevin F. Wilson, M.D., Richard G. Ohye, M.D., were co-authors in the paper

Journal reference: DOI:10.1001/archoto.2010.12

Media contact: Margarita Bauza
E-mail: mbauza@med.umich.edu
Phone: 734-764-2220


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