Management of Post-traumatic Laryngotracheal Stenosis: Our Experience

Abstract

To describe our experience in management of post-traumatic laryngo-tracheal stenosis by study of various surgical methods. To compare our results with different studies. To find out best surgical procedure. Retrospective study. 13 patients of LTS were analyzed within the period of 2009-2013 highlighting the important causes of stenosis, management based on type and severity of stenosis and outcome following the treatment given. Cases were diagnosed in detail with help of flexible laryngoscopy. Finer details of stenosis like site, length, associated injuries were studied with help of CT scan. Various modalities of treatment were used and outcome was assessed. There were 13 patients 9 males and 4 females. Of these 54 % had iatrogenic stenosis and 46 % had traumatic stenosis. 46 % had true stenosis, remaining cases suffered from either soft stenosis or had associated injuries rendering the stenosis as a complex one. The patients underwent a combined surgical approach which included treatment modalities like T-tube insertion, endoscopic dilatation, laser, and open surgical intervention (tracheal resection and anastomosis). Of all the patient treated 69.2 % were successfully decannulated and recovered well with a satisfactory airway outcome, (23.07 %) cases remained T-tube dependent, 8 % case died due to septicemia. It was evident that prolonged intubation remained most common cause of tracheal stenosis and the management varied depending on the type of stenosis. Simple soft stenosis could be managed well by endoscopic dilatation and laser while complete, complex stenosis required surgical intervention in form of T-tube stenting or open surgical intervention. Tracheal stenosis is a life threatening complication and difficult to manage. It requires multiple approaches and the successful outcome is assessed by patent airway and voice quality.

Endoscopic Management of Idiopathic Subglottic Stenosis

“…Laryngotracheal stenosis (LTS) is a life-threatening condition that describes narrowing of the airway at different sites such as the larynx, subglottis, trachea, and carina. 1,2 It can often affect more than 1 site, with the subglottis being the most common, involving approximately 50% of cases. 3 Etiologies of subglottic stenosis include traumatic/prolonged intubation, external trauma, granulomatosis with polyangiitis (Wegener’s disease), and idiopathic.…”

“…5 The incidence of ISS is not well known. Some refer to it as the second most common cause of subglottic stenosis 1 while others believe that it only accounts for 20% of cases. 7 Diagnostic delay is common in this population as patients present with nonspecific symptoms such as wheezing, progressive exertional dyspnea, stridor, or dysphonia.…”

Traumatic laryngotracheal stenosis treated by hyoid–sternohyoid osseomuscular flap combined with xenogenic acellular dermal matrix: A case report and literature review

“…Laryngotracheal stenosis mainly occurs after intubation, 1 tracheostomy, 2 or trauma. 3 , 4 The treatment of laryngotracheal stenosis is a major therapeutic challenge.…”

“…Various treatments include observation, medical management, and surgical management. 1 The most effective surgical management is resection and reconstruction. 2 Laryngeal stents are used to maintain the laryngotracheal lumen following surgical resection or reconstruction.…”

“… 2 Laryngeal stents are used to maintain the laryngotracheal lumen following surgical resection or reconstruction. 1 A T-tube is commonly used both as a stent and for tracheostomy. 5 - 7 A straight silicone tube is also used for endoscopic treatment of laryngotracheal stenosis because it can be easily removed.…”