Laryngotracheal Stenosis –Etiology And Management (original) (raw)
Related papers
Laryngotracheal Stenosis: Our Experience in a Tertiary Care Hospital
Indian journal of otorhinolaryngology and head and neck surgery(Springer), 2022
Laryngotracheal stenosis is a recalcitrant disease with high morbidity. Laryngotracheal stenosis can be defined as a partial or circumferential narrowing of the airway and may be congenital or acquired. Sites involved are supraglottis, glottis, or sub glottis. The goal of treating the patient with laryngotracheal stenosis is to reconstruct an adequate airway while preserving phonation and airway protection. Furthermore, there is no fixed treatment for laryngotracheal stenosis, the choice of surgical procedure is determined by the individual anatomy, involved site, length and luminal narrowing of stenotic segment and function of the larynx and trachea, together with patient factors and available facilities. To determine the most common aetiology of laryngotracheal stenosis and to study outcome of various treatment modalities and their efficacies according to the site of stenosis and time of presentation. We have prospectively studied 25 cases of laryngotracheal stenosis who presented in Department of ENT, Civil Hospital, Ahmedabad from May 2019 to December 2021. All patients with clinical suspicion of laryngotracheal stenosis underwent CECT Neck and Thorax with virtual bronchoscopy, flexible bronchoscopy and graded according to myer cotton classification and then included in study. In our study of 25 patients 19 patients had history of intubation. Out of 25 patients, 5 Powered by Editorial Manager® and ProduXion Manager® from Aries Systems Corporation patients had supraglottic stenosis, 14 had subglottic stenosis and 6 patients had tracheal stenosis. 20 patients were tracheostomised. Bilateral vocal cord mobility is pre requisite for any surgical intervention and
Laryngotracheal Stenosis: Clinical Aspects and Management Challenges
International Journal of Recent Surgical and Medical Sciences
Laryngotracheal stenosis (LTS) is a severe condition with a high morbidity rate, described as the narrowing of the upper airway diameter. The etiology of acquired LTS is dominated by prolonged tracheal intubation. The diagnosis is based on endoscopic examination and computed tomography scan imaging providing an exact analysis of the lesion, with precise measurements.We report a descriptive retrospective review based on the analysis of the medical records of a cohort of 18 patients, treated between January 2015 and January 2018 for an acquired LTS.The results showed predominance in young males. The majority (73%) was hospitalized in a reanimation unit under tracheal intubation while the others (27%) underwent a tracheostomy. The location of the stenosis was tracheal in 69% of the patients, laryngeal in 23%, and laryngotracheal in 8%, and the degree of obstruction exceeded 70% in 11.2%. The endoscopic treatment was based on dilatation and endoluminal calibration by the Montgomery T-tu...
Idiopathic laryngotracheal stenosis: Effective definitive treatment with laryngotracheal resection
The Journal of Thoracic and Cardiovascular Surgery, 2004
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
Management of Laryngotracheal Stenosis: A 10-Year Study on the Role of Stents
Annals of the National Academy of Medical Sciences (India), 2019
Introduction Laryngotracheal stenosis (LTS) is mostly due to road traffic accidents, prolonged intubation, and tracheostomy. Objectives This study focused on a 10-year experience on the role of stents in the management of LTS in a tertiary referral hospital. The aims of this study were to study the internal dimensions of the subglottis and upper trachea in the Indian adult population; to study the mucosal response to injury to the subglottis and the trachea; and to develop an ideal stent for use in LTS in a rabbit model. Materials and Methods The authors have been treating patients with LTS since 2000. The present study deals with the experience of 82 cases of LTS treated over the past 10 years using stents as well as surgical procedures such as Shiann Yann Lee tracheoplasty and tracheal resection and anastomosis. The work also involved a focused research on LTS using rabbits by inducing injury to the mucosa of the upper trachea and subglottis and histological study of the response ...
Management of laryngotracheal stenosis - our experience
Indian journal of otolaryngology and head and neck surgery : official publication of the Association of Otolaryngologists of India, 2009
To describe our experience in the management of laryngotracheal stenosis (LTS). Prospective study. This study was carried out from 2001 to 2004 on 30 cases. All cases were investigated by spiral computerized tomography and endoscopic examination. There were 21 males and 9 females treated for LTS resulting from trauma (19), intubation (9) and congenital (2). Patients were divided into four groups based on surgical procedures they underwent: group I, endoscopy dilatation group (7 cases); group II, laryngotracheoplasty with Montgomery tube insertion (12 cases); group III, laryngotracheoplasty with Montgomery laryngeal stent insertion (5 cases) and group IV, cricotracheal resection with M-tube insertion (6 cases); The number of patients decannulated in group I, group II, group III and group IV were 4, 10, 0 and 5, respectively. We found statistically significant difference between decannulated and nondecannulated group for site and length of stenosis. Patients undergoing dilatation for ...
Surgical management of laryngotracheal stenosis in adults
European Archives of Oto-Rhino-Laryngology, 2005
The purpose was to evaluate the outcome following the surgical management of a consecutive series of 26 adult patients with laryngotracheal stenosis of varied etiologies in a tertiary care center. Of the 83 patients who underwent surgery for laryngotracheal stenosis in the Department of Otorhinolaryngology and Head and Neck Surgery, University Hospital of Lausanne, Switzerland, between 1995 and 2003, 26 patients were adults ( ‡16 years) and formed the group that was the focus of this study. The stenosis involved the trachea (20), subglottis (1), subglottis and trachea (2), glottis and subglottis (1) and glottis, subglottis and trachea (2). The etiology of the stenosis was post-intubation injury (n =20), infiltration of the trachea by thyroid tumor (n =3), seeding from a laryngeal tumor at the site of the tracheostoma (n =1), idiopathic progressive subglottic stenosis (n =1) and external laryngeal trauma (n =1). Of the patients, 20 underwent tracheal resection and end-to-end anastomosis, and 5 patients had partial cricotracheal resection and thyrotracheal anastomosis. The length of resection varied from 1.5 to 6 cm, with a median length of 3.4 cm. Eighteen patients were extubated in the operating room, and six patients were extubated during a period of 12 to 72 h after surgery. Two patients were decannulated at 12 and 18 months, respectively. One patient, who developed anastomotic dehiscence 10 days after surgery, underwent revision surgery with a good outcome. On long-term outcome assessment, 15 patients achieved excellent results, 7 patients had a good result and 4 patients died of causes unrelated to surgery (mean follow-up period of 3.6 years). No patient showed evidence of restenosis. The excellent functional results of cricotracheal/tracheal resection and primary anastomosis in this series confirm the efficacy and reliability of this approach towards the management of laryngotracheal stenosis of varied etiologies. Similar to data in the literature, post-intubation injury was the leading cause of stenosis in our series. A resection length of up to 6 cm with laryngeal release procedures (when necessary) was found to be technically feasible.
Multimodality Surgical Approach in Management of Laryngotracheal Stenosis
Case reports in otolaryngology, 2018
Postintubation laryngotracheal stenosis requires a precise diagnosis and an experienced operator in both endoscopic and surgical treatment. This report presents surgically treated cases of laryngotracheal stenosis secondary to long-term intubation/tracheostomy with review of the literature. In this retrospective study, we present 5 cases (a 23-year-old male, 13-year-old male, 22-year-old male, 19-year-old male, and 33-year-old female) of postintubation/tracheostomy laryngotracheal (glottic/subglottic) stenosis in the years 2016 and 2017. Each patient was managed differently. Intubation characteristics, localization of stenosis, surgical technique and material, postoperative complications, and survival of patients were recorded. The site of stenosis was in the subglottis in 4 patients and glottis in 1 patient. The mean length of the stenosis was greater in the postintubation group. Postintubation stenosis had a mean duration of intubation of 6.8 days, compared to 206.25 days of cannu...
Acta otorhinolaryngologica Italica : organo ufficiale della Società italiana di otorinolaringologia e chirurgia cervico-facciale, 2012
Laryngotracheal stenosis is a complex condition that usually requires multiple procedures to restore physiological respiration. The aim of this study was to evaluate the percentage of decannulation compared to different or multiple surgical treatments. We retrospectively reviewed the charts of 70 patients treated between 1990 and 2005 for laryngotracheal stenosis of various aetiology: iatrogenic stenosis (n = 55), post-traumatic stenosis (n = 11) or other causes (autoimmune disease, n = 3; diphtheria, n = 1). In order to maintain laryngotracheal patency, a Montgomery Safe-T tube was used in all patients as a single dilation treatment or associated with endoscopic and/or open-neck surgery. Fifty-four of the 70 patients (77.1%) were eventually decannulated; 39 of these (72.2%) underwent 3 or fewer surgical procedures, showing a significant difference compared to patients who underwent more than 3 surgeries (p = 0.00002). A total of 257 surgeries were performed. Only seven of 54 patien...
A clinical study of Laryngo- tracheal stenosis
Abstract: Introduction: Laryngo-tracheal Stenosis is a common, complex problem resulting most often from intubation, direct trauma or autoimmune disease. Recently airway trauma has increased considerably owing to increased ventilator care in many emergencies. Objective of the Study: The aim of the present clinical study is to review the Aetiology, clinical features and indications of emergency tracheostomy to save life in patients who develop stenosis of the upper airway. The study also reviews the planned repair of the stenosed segment. The upper trachea and Sub-glottis are approached through a midline neck incision and stenosed segment is repaired with Montgomery ‘T’ tube stenting. Material and Methods: Twenty five patients attending Government General Hospital; Kurnool; India, presenting with airway obstruction following discharge after being treated in Emergency care ward were included in this study. A Montgomery ‘T’ tube was used in 23 patients, resection anastomoses in 1 patient and medical management in 1 patient was undertaken. All the patients were followed for 24 - 36 months with regular follow up. Post extubation radiological improvement. Results: The ‘T’ tube stenting was found to be ideal as it was cost effective, easy to perform under local anesthesia. There was no recurrence in any of the patients till the time of reporting