Laryngotracheal Stenosis: Clinical Aspects and Management Challenges

Abstract

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-tube in 77.7% of our patients, circumferential resection by CO2 laser in 11.1%, and endoscopic posterior cordectomy in 11.1% of the cases. The surgical treatment relied on the resection of the stenosis followed by T-tube calibration in 61.1% of our patients, the resection with a termino-terminal anastomosis in 11%, and supraglottic partial laryngectomy in one patient. The follow-up showed major improvement in the clinical symptomatology, but the biggest challenge in LTS remains the occurrence of restenosis.LTS is a severe condition and needs to be always considered in patients with inspiratory dyspnea and a medical history of tracheal intubation. It requires exhaustive endoscopic and imaging exploration with multidisciplinary management and long-term follow-up to prevent and detect the early signs of an eventual recurrence.