Idiopathic laryngotracheal stenosis and its management

Grillo, Hermes C.; Mark, Eugene J.; Mathisen, Douglas J.; WAIN, J

doi:10.1016/0003-4975(93)90406-8

Cited by 145 publications

(129 citation statements)

References 14 publications

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“…Major series of laryngotracheal resections published in literature [3][4][5][6][7][8][9][10][11] report good results rates ranging between 87% and 100%, and almost no mortality (generally under 1%), thus affirming the role of surgery as the treatment of choice.…”

Section: Discussionmentioning

confidence: 99%

Long-term results of laryngotracheal resection for benign stenosis☆

D’Andrilli¹,

Ciccone²,

Venuta

et al. 2008

European Journal of Cardio-Thoracic Surgery

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Objective: We report the long-term results of our 16-year experience with laryngotracheal resection for benign stenosis. Methods: Between 1991 and 2006, 35 consecutive patients (19 males, 16 females) underwent laryngotracheal resection for subglottic postintubation (32) or idiopathic (3) stenosis. Mean age was 43 years (range 14-71). At the time of surgery 13 patients presented with tracheostomy and 7 with a Dumon stent. The upper limit of the stenosis was from 0.6 to 1.5 cm below the vocal cords. The length of airway resection ranged between 1.5 and 6 cm. Suprahyoid release was performed in two patients and pericardial release in one. Nine patients had psychiatric and/or neurological post-coma disorders. Mean follow-up is over 5 years (61 months; range 3-194). Results: There was no perioperative mortality. Thirty patients (85.7%) had excellent or good anatomic and functional results. Four patients (11.4%) presented restenosis at a distance of 25-110 days from the operation. Restenosis was successfully treated by endoscopic procedures in all four patients. One patient (2.9%) presented anastomotic dehiscence that required temporary tracheostomy closed after 1 year with no sequelae. Three patients (8.4%) had wound infection. Long-term follow-up was uneventful also in patients who had early complications. Conclusions: Long-term follow-up confirms that laryngotracheal resection is the definitive curative treatment for benign subglottic stenosis. Surgical complications can be successfully managed by non-operative procedures. Despite the occurrence of early complications, excellent and stable results can still be obtained at long term. #

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Section: Discussionmentioning

confidence: 99%

Long-term results of laryngotracheal resection for benign stenosis☆

D’Andrilli¹,

Ciccone²,

Venuta

et al. 2008

European Journal of Cardio-Thoracic Surgery

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“…worse with each advancing stage. GRILLO et al [4] reviewed their experiences with LTS confined to the upper trachea and subglottic larynx. The stenoses were descriptively characterised and three types were identified.…”

Section: Earlier Systemsmentioning

confidence: 99%

“…The major focus of these previous studies [1][2][3][4][5][6] has been a retrospective attempt to discern outcome of various surgical procedures for the treatment of LTS. All attempts at classifications have concentrated on the upper airway with none extending beyond the trachea.…”

Section: Earlier Systemsmentioning

confidence: 99%

A proposed classification system of central airway stenosis

Freitag¹,

Ernst

Unger³

et al. 2007

Eur Respir J

212

105

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Tracheobronchial stenosis, a serious problem in adults and children, has multiple causes and has been treated in many ways. While developing an international multicentre study to evaluate efficacy of airway stents, it was realised that no adequate description of central airway stenosis regarding type, location and degree has been published. Thus, comparing results of different treatment modalities in different centres has been difficult due to a lack of uniformity of classification. Reports are typically descriptive and precise classification schemes have not adequately addressed either for the trachea or the main bronchi.A standardised classification scheme was proposed with descriptive images and diagrams for rapid and uniform classification of central airway stenosis. The present authors' system divides stenosis into structural and dynamic types and further classifies the disease by degree of stenosis, location and transition zone.Multiple sites can be described and each is transformed into a simple numerical scoring system prompted by a diagram, which can be easily captured for subsequent uniform analysis across sites.A pilot validation of the system, with 18 pulmonologists of varying training background, showed strong precision and agreement between observers. Such a system will enhance the ability to study the effectiveness of treatment modalities for central airway stenosis.

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“…Idiopathic disease characteristically is comprised of circumferential lesions of varying length from 1-3 cm, the majority of which demonstrate maximal stenosis at the level of the cricoid (3). On pathologic examination, affected tissue demonstrates replacement of the tracheal lamina propria with dense keloidal, collagenous fibrosis which characterizes the stenotic segment (4). This disease entity is termed idiopathic given the etiology of pathologic transformation remains elusive.…”

Section: Pathophysiologymentioning

confidence: 99%