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Dynamic Tissue Expansion of the Larynx in a Canine Model
Ron Eliashar, MD;
Isaac Eliachar, MD;
Terry Gramlich, MD;
William Davros, PhD;
Kaven Moffett;
Marshall Strome, MD
Arch Otolaryngol Head Neck Surg. 2001;127:309-315.
Objectives To test whether staged, progressive, monitored, dynamic tissue expansion
is possible in the larynx and to evaluate its effectiveness in dilating and
augmenting constricting cicatricial lesions.
Design Animal study.
Setting Research facility, tertiary care medical center.
Subjects Thirteen dogs, 3 with laryngotracheal stenosis.
Interventions Dogs underwent laryngeal splits, tracheostomy, and insertion of inflatable
stents. In 7 normal dogs, stents were progressively inflated by air in predetermined
increments during 11 days. In 3 normal dogs and 3 with laryngotracheal stenosis,
stents were gradually expanded by water. Stents were kept in place for 21
days. After removal, dogs were observed for 25 days. Five died of complications
of tracheostomy.
Main Outcome Measures Airway diameter measured by endoscopy before the induction of stenosis,
before the laryngeal splitting procedure, after stent removal, and before
euthanasia.
Results The lumen increased, then shrank somewhat after stent removal. In 2
surviving dogs with laryngotracheal stenosis and water-expanded stents, the
lumen was 82.5% larger than baseline at stent removal and 71.0% larger at
euthanasia. In 2 surviving normal dogs with water-expanded stents, lumen size
increased by 50.0% at stent removal, and in 1 dog surviving to day 46, it
was 17.0% larger. In 5 surviving dogs with air-inflated stents, lumen size
was 39.0% larger at stent removal and 8.0% larger at day 46. Histologically,
fibrous tissue developed in the gaps between the splayed margins of the laryngeal
cartilages.
Conclusions The larynx may be dynamically expanded. Although the maximal diameter
is not maintained, final cross-sectional areas are larger.
From the Department of Otolaryngology/Head & Neck Surgery, Hadassah
University Hospital, Jerusalem, Israel (Dr Eliashar); and Departments of Otolaryngology
and Communicative Disorders (Drs Eliachar and Strome), Anatomic Pathology
(Dr Gramlich), and Radiology (Dr Davros and Ms Moffett), The Cleveland Clinic
Foundation, Cleveland, Ohio. From 1997 to 1998 Dr Eliashar was a research
fellow in The Cleveland Clinic Foundation. Dr Eliachar receives royalties
from Hood Laboratories Inc Pembroke, Mass.
Corresponding author: Isaac Eliachar, MD, Department of Otolaryngology
and Communicative Disorders (A71), The Cleveland Clinic Foundation, 9500 Euclid
Ave, Cleveland, OH 44195 (e-mail: eliachi{at}ccf.org).
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