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figure 15-3 (continued) C, Inspiratory-expiratory computed tomography (CT) scans demonstrate the degree of narrowing of the affected intrathoracic trachea. Inspiratory view. D, Expiration at the same level. E, Virtual bronchoscopy from a CT scan, showing the supra-carinal trachea in inspiration in the same patient. F, View at the same level in expiration. G, Three-dimensional CT reconstructions of the trachea and main bronchi in another patient, a 57-year-old man with severely symptomatic obstructive malacia. Anterior view. Note the transition from a circular cervical configuration through a triangular shape to flattened cartilages distally. H, Oblique view showing ridging of the membranous wall. Corresponding bronchoscopic views are seen in Figures 15-4C and 15-4D.

figure 15-4 Pre- and postoperative bronchoscopic observations. A, In a 79-year-old male with chronic obstructive pulmonary disease, bronchiectasis, and worsening dyspnea. Changes are evident in the lower trachea with characteristic splaying ofmalacic cartilages. B, Postoperative view at the same level demonstrates restoration of a D-shaped trachea. The carina is clearly visible. The membranous wall is puckered by posterior scar and sutures. C, Inspiratory view in a 57-year-old male, just above the carina. The right main bronchus remains nearly occluded. D, Expiration occludes the trachea and bronchi. E, Following posterior splinting procedure, a stable and open airway results. An open carina is below. The posterior wall is fixed to the Marlex backing.

Table 15-1 Functional Results* of Membranous Wall Tracheoplasty for Malacia

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