Management of Congenital Tracheal Stenosis

Abstract

Congenital tracheal stenosis (CTS) is a serious and rare condition. In most cases, stenotic lesions are composed of complete tracheal rings of cartilage. The severity of symptoms correlates with the length of affected trachea, the presence of concomitant respiratory conditions, degree of luminal narrowing, and any bronchial involvement. Critically, CTS is a disorder that can lead to life-threatening respiratory insufficiency in children. Thus, it is a clinical entity that demands timely diagnosis and treatment. This review will firstly discuss the anatomy and pathophysiology of CTS and outline the various clinical presentations associated with the disorder. In addition, methods of diagnosis and treatment strategies will be reviewed, with a focus on contemporary surgical techniques. Finally, postoperative care of patients with CTS will be reviewed, and a contemporary multidisciplinary management approach will be presented.

Neonatal airway: challenging endotracheal intubation in infants with tracheal malformations at birth

“…Virtual endoscopy using high-resolution, multirow detector CT is used to evaluate the distal airway in CTS 7 11. MRI is useful in delineating associated cardiovascular anomalies 11. In TA, using the oesophagus as an air conduit and inflating the chest strongly suggests TA in the presence of a fistulous communication between oesophagus and airway.…”

“…Cardiovascular anomalies occur in up to 70% cases of CTS, including pulmonary artery sling, Fallot’s tetralogy, double aortic arch and transposition of the great arteries 11. In case 1, CTS was an isolated anomaly.…”

“…A subset of patients with CTS outgrows the stenosis by 7–9 years of age 11. ET stents have been successfully used in few patients recently.…”

Operative or non-operative treatment of congenital tracheal stenosis: is there something new?

“…period or later on, near the end of the first year of life when physical activity increases, should be operated. Associated cardiovascular anomalies, most frequently left PAS, should be repaired during the same procedure (2,7,8). Of course, tracheal diameter and other bronchoscopic findings such as: length of the stenotic segment, presence of a tracheal bronchus, or diverse anatomical variants, may play a role too in the management strategy of CTS.…”

“…In most cases, stents are used as a life-saving procedure in extremely sick children. In CTS stents are generally used as a temporary measure after surgical reconstruction or in the management of postsurgical complications (7,18). Although some authors describe initial treatment of CTS with metallic stents (19,20), this approach is not shared by most tracheal teams (5,7,10,11).…”