Case Study
A Novel Laryngeal Stent in the Treatment of Subglottic Stenosis in Children
Nuevo stent laríngeo en el tratamiento de la estenosis subglótica en niños
Adrián Zanetta, Giselle Cuestas
, Hugo Rodríguez, Carlos Tiscornia
Corresponding author
Servicio de Endoscopia Respiratoria, Hospital de Pediatría Prof. Dr. Juan P. Garrahan, Pichincha, Buenos Aires, Argentina
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Garrahan, Pichincha, Buenos Aires, Argentina" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Nuevo <span class="elsevierStyleItalic">stent</span> laríngeo en el tratamiento de la estenosis subglótica en niños" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1106 "Ancho" => 1447 "Tamanyo" => 182266 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">(A) Cervical radiograph showing a suprastomal stent. (B) Stent with silicone seals in its ends.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Case Report</span><p id="par0005" class="elsevierStylePara elsevierViewall">We present a 3-year-old, preterm, male patient, who suffered bronchopulmonary dysplasia and was tracheostomised, giving rise to Cotton grade III subglottic stenosis (SS) secondary to prolonged intubation, which was subsequently treated by laryngotracheofissure with a posterior cricoid split and interposition of anterior costal cartilage and placement of a new suprastomal stent (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0010" class="elsevierStylePara elsevierViewall">The laryngeal stent employed was created from a number 8 T-shaped tube. After measuring the distance from the anterior commissure to the superior margin of the tracheal stoma, we cut the internal branch to the correct length, separating it from the rest of the T tube. The proximal and distal ends were covered with rounded silicone seals. The stent was placed in a suprastomal position by the laryngofissure and fixed by a double transfixing point at the level of the cricoid cartilage with a support of silicone buttons in the subcutaneous tissue of the neck. The correct position was confirmed by observation through the tracheal stoma and also orally (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>).</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">Next, we placed the anterior costal graft. This was closed by planes, leaving a number 5 Rusch tracheostomy tube.</p><p id="par0020" class="elsevierStylePara elsevierViewall">The patient was admitted at the intermediate care unit for 5 days. We indicated antibiotic (amoxicillin), analgesic (ibuprofen) and antireflux (lansoprazole) treatment, as well as feeding through a nasogastric tube.</p><p id="par0025" class="elsevierStylePara elsevierViewall">The stent was removed under general anaesthesia after 34 months. After removing the buttons through a small cervical incision, the stent was extracted transorally during the laryngoscopy. We carried out weekly endoscopies (for the first 3 weeks) to assess the location of the graft, calibre of the airway and formation of granulation tissue.</p><p id="par0030" class="elsevierStylePara elsevierViewall">The prosthesis was well tolerated. Oral feeding was reintroduced 48<span class="elsevierStyleHsp" style=""></span>h after surgery. Aspiration was not reported. Decannulation took place 4 months after surgery.</p><p id="par0035" class="elsevierStylePara elsevierViewall">The patient presented adequate ventilation, mild dysphonia and normal deglutition at 12 months after decannulation.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Discussion</span><p id="par0040" class="elsevierStylePara elsevierViewall">Laryngeal stents are mainly used to maintain the airway expanded after its surgical reconstruction in cases of severe laryngeal stenosis.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> In the expansion technique through insertion of a cartilage graft they help to structurally support the graft in the correct position.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1–3</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">The decision to use an endoluminal prosthesis, as well as the type, length and permanence thereof, must be individualised in each patient, depending on the severity and location of the stenosis.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a></p><p id="par0050" class="elsevierStylePara elsevierViewall">There is no ideal stent for the treatment of SS in children.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> The stent can act as a foreign body in the reconstructed airway and cause damage in the mucosa, ulcers, formation of granulation tissue and restenosis. Furthermore, it can cause difficulties for feeding and in voice production.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a></p><p id="par0055" class="elsevierStylePara elsevierViewall">The characteristics of an ideal stent would include<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,2,4</span></a>:<ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">1.</span><p id="par0060" class="elsevierStylePara elsevierViewall">Availability in various sizes and shapes.</p></li><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">2.</span><p id="par0065" class="elsevierStylePara elsevierViewall">Sufficient rigidity to support the reconstructed area.</p></li><li class="elsevierStyleListItem" id="lsti0015"><span class="elsevierStyleLabel">3.</span><p id="par0070" class="elsevierStylePara elsevierViewall">Resistance to compression, without causing pressure necrosis.</p></li><li class="elsevierStyleListItem" id="lsti0020"><span class="elsevierStyleLabel">4.</span><p id="par0075" class="elsevierStylePara elsevierViewall">Biocompatibility.</p></li><li class="elsevierStyleListItem" id="lsti0025"><span class="elsevierStyleLabel">5.</span><p id="par0080" class="elsevierStylePara elsevierViewall">Allowing vocalisation.</p></li><li class="elsevierStyleListItem" id="lsti0030"><span class="elsevierStyleLabel">6.</span><p id="par0085" class="elsevierStylePara elsevierViewall">Allowing feeding easily, without risk of aspiration.</p></li><li class="elsevierStyleListItem" id="lsti0035"><span class="elsevierStyleLabel">7.</span><p id="par0090" class="elsevierStylePara elsevierViewall">Stable placement.</p></li><li class="elsevierStyleListItem" id="lsti0040"><span class="elsevierStyleLabel">8.</span><p id="par0095" class="elsevierStylePara elsevierViewall">Simple to examine and remove.</p></li></ul></p><p id="par0100" class="elsevierStylePara elsevierViewall">The most widely used endoluminal prostheses are made of silicone, with T-shaped tubes being the best known.<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">5,6</span></a> However, T-shaped tubes entail a risk of obstruction, especially when the inner diameter is small.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> Moreover, in children the upper end must be positioned over the false vocal cords, creating a risk of aspiration and dysphonia.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a></p><p id="par0105" class="elsevierStylePara elsevierViewall">Short suprastomal stents can be used when the stenosis does not affect the trachea. Its advantages include: enabling a change of tracheostomy tube when necessary and the absence of risk of trauma caused by the stent on the distal trachea.</p><p id="par0110" class="elsevierStylePara elsevierViewall">In this patient we placed a short suprastomal stent which was created using the vertical portion of a T-shaped tube (Montgomery tube). It was made of silicone and was smooth and flexible. The ends were covered with solid and soft silicone seals, with rounded edges to prevent scraping neighbouring structures. It was easy to place during the open surgery procedure. It could also be inserted into the airway after the endoscopic treatment of SS. It was easy to remove orally.</p><p id="par0115" class="elsevierStylePara elsevierViewall">The stent was smooth in order to avoid pressure necrosis in the medial side of the arytenoids, and its rounded edges prevented the formation of granulation tissue. Furthermore, the seal covering the proximal end of the tube prevented aspiration. The rounded silicone cover of the distal edge prevented the possible formation of granulomas in the superior edge of the stoma and reinforced the strength of the stent at this level, thus preventing suprastomal collapse.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> This allows the stent to be left for more than 6 months in cases which require it, without a risk of damaging the reconstructed airway.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,9</span></a></p><p id="par0120" class="elsevierStylePara elsevierViewall">A stitch or silicone glue can be used to avoid the risk of losing the distal cover. Fixation with a non-resorbable stitch is required in order to prevent extrusion of the prosthesis.<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">9,10</span></a> In our patient, the silicone buttons which supported the stent were located in the subcutaneous tissue of the neck, but these can also be placed on the skin, in order to avoid another incision to extract them, washing the skin daily.</p><p id="par0125" class="elsevierStylePara elsevierViewall">Among the advantages of this new stent we noted an absence of formation of granulation tissue, a short decannulation time and early reintroduction of oral feeding with no risk of aspiration. Another advantage was its accessibility, since T-shaped tubes are available in various sizes and can be cut to the required dimensions. Its main disadvantage was that it did not allow vocalisation. Often, patients with SS present aphonia, so a delay of some months until successful decannulation and voice production is acceptable.</p><p id="par0130" class="elsevierStylePara elsevierViewall">We designed a short suprastomal stent made from the vertical portion of a T-shaped tube with the ends covered by silicone seals for the treatment of SS in a child. Although further experience in the treatment of SS using this stent is required, the results were promising. The treatment was successful, the resolution time was short and it enabled an early reintroduction of oral feeding. The smoothness and evenness of the prosthesis, with a rounded configuration of both ends, helped to prevent the formation of granulation tissue in the airway. We found this design quite safe and effective for the surgical repair of SS in children.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Case Report" ] 1 => array:2 [ "identificador" => "sec0010" "titulo" => "Discussion" ] 2 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2012-03-29" "fechaAceptado" => "2012-05-20" "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Zanetta A, Cuestas G, Rodríguez H, Tiscornia C. Nuevo <span class="elsevierStyleItalic">stent</span> laríngeo en el tratamiento de la estenosis subglótica en niños. Acta Otorrinolaringol Esp. 2014;65:120–122.</p>" ] ] "multimedia" => array:2 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1106 "Ancho" => 1447 "Tamanyo" => 182266 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">(A) Cervical radiograph showing a suprastomal stent. (B) Stent with silicone seals in its ends.</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 824 "Ancho" => 1447 "Tamanyo" => 142714 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">(A) Sutured stent in its correct position, supported by silastic buttons. (B) Endoscopic image of the stent.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:10 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Airway stenting with the LT-Mold: experience in 30 pediatric cases" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "P. Monnier" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Int J Pediatric Otorhinolaryngol" "fecha" => "2007" "volumen" => "71" "paginaInicial" => "1351" "paginaFinal" => "1359" ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "A novel stent for treatment of combined anterior glottis web-subglottic stenosis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "D. Tunkel" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Int J Pediatric Otorhinolaryngol" "fecha" => "2005" "volumen" => "69" "paginaInicial" => "893" "paginaFinal" => "896" ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0015" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Laryngeal and tracheal stents in children" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "D. Preciado" 1 => "G. Zalzal" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/MOO.0b013e3282f433f4" "Revista" => array:6 [ "tituloSerie" => "Curr Opin Otolaryngol Head Neck Surg" "fecha" => "2008" "volumen" => "16" "paginaInicial" => "83" "paginaFinal" => "85" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18197028" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0020" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Pitfalls in laryngotracheal reconstruction" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "S.S. Choi" 1 => "G.H. Zalzal" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Arch Otolaryngol Head Neck Surg" "fecha" => "1999" "volumen" => "125" "paginaInicial" => "650" "paginaFinal" => "653" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10367921" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0025" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Airway stents in children" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "T. Nicolai" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1002/ppul.20790" "Revista" => array:6 [ "tituloSerie" => "Pediatr Pulmonol" "fecha" => "2008" "volumen" => "43" "paginaInicial" => "330" "paginaFinal" => "344" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18286550" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0030" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Larynx: implants and stents" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "C. Sittel" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Laryngo-Rhino-Otol" "fecha" => "2009" "volumen" => "88" "paginaInicial" => "119" "paginaFinal" => "124" ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0035" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The use of the Montgomery T-tube in difficult paediatric airways" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "P.S. Phillips" 1 => "H. Kubba" 2 => "B.E. Hartley" 3 => "D.M. Albert" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.ijporl.2005.05.008" "Revista" => array:6 [ "tituloSerie" => "Int J Pediatr Otorhinolaryngol" "fecha" => "2006" "volumen" => "70" "paginaInicial" => "39" "paginaFinal" => "44" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15978676" "web" => "Medline" ] ] ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0040" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Resolución quirúrgica de las estenosis laringotraqueales en pediatría" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "A. Zanetta" 1 => "C. Tiscornia" 2 => "H. Rodríguez" 3 => "H. Botto" 4 => "M. Nieto" 5 => "G. Cuestas" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Rev FASO" "fecha" => "2011" "volumen" => "4" "paginaInicial" => "64" "paginaFinal" => "71" ] ] ] ] ] ] 8 => array:3 [ "identificador" => "bib0045" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Applied surgical anatomy of the larynx and trachea" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "P. Monnier" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Libro" => array:6 [ "titulo" => "Pediatric airway surgery. Management of laryngotracheal stenosis in infants and children" "fecha" => "2011" "paginaInicial" => "7" "paginaFinal" => "29" "editorial" => "Springer" "editorialLocalizacion" => "Switzerland" ] ] ] ] ] ] 9 => array:3 [ "identificador" => "bib0050" "etiqueta" => "10" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "A new stent for the management of adult and pediatric laryngotracheal stenosis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "P. Monnier" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/00005537-200308000-00029" "Revista" => array:6 [ "tituloSerie" => "Laryngoscope" "fecha" => "2003" "volumen" => "113" "paginaInicial" => "1418" "paginaFinal" => "1422" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12897569" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/21735735/0000006500000002/v1_201404170146/S2173573514000374/v1_201404170146/en/main.assets" "Apartado" => array:4 [ "identificador" => "5873" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Case study" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/21735735/0000006500000002/v1_201404170146/S2173573514000374/v1_201404170146/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173573514000374?idApp=UINPBA00004N" ]
| Year/Month | Html | Total | |
|---|---|---|---|
| 2023 March | 1 | 0 | 1 |
| 2021 February | 0 | 3 | 3 |
| 2021 January | 0 | 2 | 2 |
| 2020 November | 0 | 1 | 1 |
| 2020 October | 0 | 1 | 1 |
| 2020 June | 0 | 1 | 1 |
| 2020 May | 0 | 1 | 1 |
| 2020 March | 155 | 7 | 162 |
| 2020 February | 1049 | 16 | 1065 |
| 2020 January | 34 | 10 | 44 |
| 2019 December | 42 | 10 | 52 |
| 2019 November | 30 | 16 | 46 |
| 2019 October | 35 | 4 | 39 |
| 2019 September | 27 | 3 | 30 |
| 2019 August | 21 | 5 | 26 |
| 2019 July | 35 | 21 | 56 |
| 2019 June | 43 | 20 | 63 |
| 2019 May | 146 | 29 | 175 |
| 2019 April | 69 | 22 | 91 |
| 2019 March | 16 | 6 | 22 |
| 2019 February | 20 | 9 | 29 |
| 2019 January | 17 | 2 | 19 |
| 2018 December | 23 | 13 | 36 |
| 2018 November | 15 | 14 | 29 |
| 2018 October | 22 | 3 | 25 |
| 2018 May | 2 | 0 | 2 |
| 2018 April | 10 | 3 | 13 |
| 2018 March | 12 | 4 | 16 |
| 2018 February | 9 | 4 | 13 |
| 2018 January | 13 | 0 | 13 |
| 2017 December | 18 | 5 | 23 |
| 2017 November | 17 | 7 | 24 |
| 2017 October | 19 | 8 | 27 |
| 2017 September | 24 | 3 | 27 |
| 2017 August | 20 | 3 | 23 |
| 2017 July | 19 | 5 | 24 |
| 2017 June | 36 | 1 | 37 |
| 2017 May | 28 | 6 | 34 |
| 2017 April | 27 | 34 | 61 |
| 2017 March | 34 | 41 | 75 |
| 2017 February | 45 | 9 | 54 |
| 2017 January | 23 | 4 | 27 |
| 2016 December | 23 | 11 | 34 |
| 2016 November | 39 | 18 | 57 |
| 2016 October | 42 | 21 | 63 |
| 2016 September | 45 | 14 | 59 |
| 2016 August | 33 | 18 | 51 |
| 2016 July | 19 | 3 | 22 |
| 2016 June | 36 | 11 | 47 |
| 2016 May | 32 | 31 | 63 |
| 2016 April | 30 | 26 | 56 |
| 2016 March | 35 | 17 | 52 |
| 2016 February | 37 | 19 | 56 |
| 2016 January | 34 | 22 | 56 |
| 2015 December | 30 | 15 | 45 |
| 2015 November | 28 | 15 | 43 |
| 2015 October | 31 | 19 | 50 |
| 2015 September | 32 | 10 | 42 |
| 2015 August | 44 | 5 | 49 |
| 2015 July | 67 | 6 | 73 |
| 2015 June | 17 | 1 | 18 |
| 2015 May | 37 | 3 | 40 |
| 2015 April | 26 | 6 | 32 |
| 2015 March | 32 | 7 | 39 |
| 2015 February | 9 | 2 | 11 |
| 2015 January | 19 | 4 | 23 |
| 2014 December | 18 | 7 | 25 |
| 2014 November | 9 | 5 | 14 |
| 2014 October | 25 | 5 | 30 |
| 2014 September | 16 | 5 | 21 |
| 2014 August | 24 | 7 | 31 |
| 2014 July | 27 | 13 | 40 |
| 2014 June | 28 | 8 | 36 |
| 2014 May | 34 | 12 | 46 |
| 2014 April | 13 | 6 | 19 |
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