Laryngotracheal Stenosis: A Retrospective Analysis of Their Aetiology, Diagnose and Treatment

Abstract

BACKGROUND: Laryngotracheal stenosis created as a result of a long-term consequence of prolonged endotracheal intubation is a state of narrowing of the airway, which, depending on the degree of narrowing, can be from an asymptomatic to a potentially life-threatening condition.
 AIM: To understand the severity of postintubation laryngeal stenoses, their diagnosis, endoscopic evaluation, endoscopic and surgical treatment and their success in a multi-year period realised in the University Clinic for Ear, Nose and Throat in Skopje, Macedonia.
 MATERIAL AND METHODS: Through a proper history, physical examination, endoscopic and imaging evaluation of the ear, nose and throat in the Clinic, in the period of 8 years, that is, from 2010 to 2017, laryngotracheal stenosis was diagnosed in a total of 36 patients. During this period, 24 male or 66.7% were diagnosed, as were 12 female subjects or 33.3% of diagnosed patients. Of the analysed total of 36 patients, by Mayers cotton classification, 14 or 38% are patients with grade 1 stenosis, 5 or 13% are grade 2, and 10 or 27% are grade 3, while 7 or 19% are grade 4 stenosis
 RESULTS: It is essential for all laryngotracheal stenoses to exist or to provide a breathing path that depends on the degree of stenosis. Further course of treatment also depends on the characteristics of the stenotic zone that is visualised endoscopically. At the Clinic for ear nose and throat in Skopje, endoscopic treatment was performed through a series of dilatations within 21 patients, or 58 % of the examinee, as well as the administration of mitomycin and corticoderates in 21 patients or 52% of the examinee. The applied actions and procedures had shown 100% outcome on stenoses not longer than 2 cm, who have a fibro-inflammatory scar and by Myer cotton classification 1 and second stadium. Patients that have failed endoscopic treatment, surgical treatment are a method of choice. Surgical treatments have been performed in 4 patients with realised end of the anastomosis, and 3 crycotracheal reconstructions, which is decannulated. After an extensive follow-up of these patients, depending on their condition, multiple endoscopic evaluations have been decannulated to 21 patients or 58%, and after a series of multiple unsuccessful endoscopic treatments, a condition with tracheal stoma occurs in 8 patients or 22% of the examinee.
 CONCLUSION: The observations indicate that the methods used, which are explained previously, have good effects in terms of the achieved outcomes. Due to limited resources, it is necessary to improve new methods and approaches in the treatment of stenoses, depending on their type and severity, thereby improving patient outcomes. Also, to reduce laryngotracheal stenoses, appropriate tubes and low pressure of the caffeine in the endotracheal tubules should be used.

Long-term intubation and high rate of tracheostomy in COVID-19 patients might determine an unprecedented increase of airway stenoses: a call to action from the European Laryngological Society

“…This is clearly far from the usual pre-pandemic standards and a strong effort should be prospectively made to demonstrate that a potential increase in the incidence and severity of laryngotracheal injuries in a given patient is counterbalanced by the potential benefits for him (in terms of reduced risk of accidental decannulation) and to other patients and HCPs (in terms of reduced risk of cross-infections). In the meantime, however, as a consequence of the combination of an increased number of long-term intubated, critically ill patients, and delayed tracheostomy, it is probable that, in the near future, an unprecedented rise of iatrogenic sequelae ranging from granulomas, webs, and laryngotracheal stenosis (LTS), to tracheomalacia, tracheal necrosis, tracheo-esophageal, and tracheo-innominate fistulae may come to arise [16,17].…”

COVID-19 Patients Presenting with Post-Intubation Upper Airway Complications: A Parallel Epidemic?

“…In several laryngological reports [ 10 , 11 ] and in a recent position paper of the European Laryngological Society [ 12 ], it has been postulated that an unprecedented rise of iatrogenic laryngotracheal sequelae may develop in COVID-19 patients requiring intubation and MV. This is anticipated given the tremendous increase in the numbers of patients undergoing intubation and MV, and more so, since in these patients, the tracheostomy is often delayed for more than 2 weeks either due to concerns for high patient mortality, precaution against virus aerosolization, or the prolonged need for prone position MV [ 2 , 13 ].…”

An Experimental Study on Timing in Tracheal Stenosis Surgery

“…Local ischemia generated by the cuff during postintubation tracheal stenosis formation facilitates and stimulates fibrinolytic activity after which the proliferative phase starts which is characterized by angiogenesis, collagen accumulation, and granulation tissue formation. 24 Various trials have been made for the treatment of tracheal stenosis by using agents that suppress proliferation and inflammation. 21,[25][26][27] However, surgical studies have focused mostly on anastomosis tension and do not present data on the timing of tracheal surgery.…”