 |
|
Simulated Reflux and Laryngotracheal Reconstruction
A Rabbit Model
Jeffrey D. Carron, MD;
John H. Greinwald, MD;
James P. Oberman, MD;
Alice L. Werner, MD;
Craig S. Derkay, MD
Arch Otolaryngol Head Neck Surg. 2001;127:576-580.
Objectives (1) To test the feasibility of a rabbit model using a pharyngostomy
tube to simulate gastroesophageal reflux and (2) to study the effects of gastroesophageal
reflux on laryngotracheal reconstruction using a new rabbit model.
Design Prospective randomized trial.
Subjects Thirty-three New Zealand white rabbits.
Interventions Anterior cartilage laryngotracheoplasty and pharyngostomy tube placement
into the pyriform sinus were performed in 33 rabbits, 22 of which are included
in this analysis. Beginning postoperative day 1, hydrochloric acid at a pH
of 1.5 with pepsin (n = 7) or at a pH of 4.0 with pepsin (n = 8) was irrigated
twice daily through the pharyngostomy tube to simulate gastroesophageal reflux,
and a control group received twice-daily isotonic sodium chloride solution
irrigations (n = 7).
Main Outcome Measures Specimens were scored by a pathologist masked to individual groups using
a newly modified inflammation scoring system. In addition, cross-sectional
areas of the cartilage grafts and subglottic airway lumina were compared.
Results Inflammation scores were significantly higher in rabbits receiving hydrochloric
acid and pepsin irrigations at a pH of 4.0 (P = .04)
but not in those in the pH 1.5 group. Cartilage necrosis was prominent in
all groups, and airway sizes and cross-sectional areas of the grafts were
not significantly different among the 3 groups.
Conclusions Cartilage necrosis is prominent during the early stages after laryngotracheoplasty.
Inflammation can be increased using hydrochloric acid and pepsin irrigations
but is difficult to predict based on this study. Although we confirmed the
feasibility of this model, further modifications of this study are proposed
to improve animal survival and data collection.
From the Department of Otolaryngology–Head and Neck Surgery,
Eastern Virginia Medical School, Norfolk (Drs Carron and Derkay); the Department
of Otolaryngology–Head and Neck Surgery, Naval Medical Center–Portsmouth,
Portsmouth, Va (Drs Greinwald and Oberman); and Anatomic and Laboratory Pathology,
Children's Hospital of the King's Daughters, Norfolk (Dr Werner). Dr Greinwald
is now with the Department of Pediatric Otolaryngology, Children's Hospital
of Cincinnati, Cincinnati, Ohio.
Corresponding author: Jeffrey D. Carron, MD, Department of Otolaryngology–Head
and Neck Surgery, Eastern Virginia Medical School, 825 Fairfax Ave, Norfolk,
VA 23507 (e-mail: jdcarron{at}yahoo.com).
 CiteULike  Connotea  Del.icio.us  Digg  Reddit  Technorati  Twitter
What's this?
RELATED ARTICLE
Archives of Otolaryngology–Head & Neck Surgery Reader's Choice: Continuing Medical Education
Arch Otolaryngol Head Neck Surg. 2001;127(5):606-608.
FULL TEXT
THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES
Effect of Acid and pepsin on glottic wound healing: a simulated reflux model.
Roh and Yoon
Arch Otolaryngol Head Neck Surg 2006;132:995-1000.
ABSTRACT
| FULL TEXT
|
