Idiopathic laryngotracheal stenosis: Effective definitive treatment with laryngotracheal resection (original) (raw)

2004, The Journal of Thoracic and Cardiovascular Surgery

See related editorial on page 10. Objective: Little was known about idiopathic laryngotracheal stenosis when it was first described. We have operated on 73 patients with idiopathic laryngotracheal stenosis, have confirmed its mode of presentation and response to surgical therapy, and have established long-term follow-up. Methods: Charts of 73 patients treated surgically for idiopathic laryngotracheal stenosis between 1971 and 2002 were retrospectively reviewed. Results: All patients were treated with a single-staged laryngotracheal resection, with (36/73) and without (37/73) a posterior membranous tracheal wall flap. Nearly all were women (71/73), with a mean age of 46 years (range, 13-74 years). Twenty-eight (38%) of 73 had undergone a previous procedure with laser, dilation, tracheostomy, T-tube, or laryngotracheal operations. After laryngotracheal resection, the majority of patients (67/73) were extubated in the operating room, and 7 required temporary tracheostomies, only 1 of whom was among the last 30 patients. All were successfully decannulated. There was no perioperative mortality. Principal morbidity was alteration of voice quality, which was mild and tended to improve with time. Sixty-seven (91%) of 73 patients had good to excellent long-term results with voice and breathing quality and do not require further intervention for their idiopathic laryngotracheal stenosis. Conclusion: Idiopathic laryngotracheal stenosis is an entity that occurs almost exclusively in women and is without a known cause. It is not a progressive process, but the timing of the operation is crucial. Single-staged laryngotracheal resection is successful in restoring the airway while preserving voice quality in more than 90% of patients. Protective tracheostomy is now rarely required (1/30). Long-term follow-up shows a stable airway and improvement in voice quality. I diopathic laryngotracheal stenosis (ILTS) is a rare disease characterized by an inflammatory cicatricial stenosis at the level of the cricoid and upper trachea. Patients experience dyspnea on exertion that progresses to dyspnea at rest, noisy breathing, stridor, or a combination of these symptoms. Symptoms develop over the course of months to years, with patients often given erroneous diagnoses and treated for asthma. It occurs almost exclusively in women in their third, fourth, and fifth decades who have no identifiable cause of airway stenosis. Its cause remains unknown. 1 Patients are considered to have ILTS if they have an inflammatory cicatricial stenosis of the subglottis, upper trachea, or both and known causes are excluded. Known causes of subglottic stenosis include post-intubation injury; airway trauma, including external injury; inhalational burns and irradiation; specific and nonspecific