Modern Management of Laryngotracheal Stenosis

Herrington, Heather; Weber, Samuël; Andersen, Peter E.

doi:10.1097/01.mlg.0000228006.21941.12

Cited by 132 publications

(157 citation statements)

References 20 publications

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“…Furthermore, (laryngo)tracheal surgery appears safe, with a mortality of 0.8% in our series, which is in accordance with a surgical mortality of 0% to 2% as reported in the literature (5,(14)(15)(16)(17)(18)(19).…”

Section: Discussionsupporting

confidence: 78%

“…From our point of view, voice function seems to be an overlooked aspect after tracheal surgery. Just five medium-sized to large case-series (including more than 50 patients) mentioned abnormal voice outcome without RLN palsy after tracheal surgery (15)(16)(17)(18)26). Only one study with 32 patients quantified voice outcome from good to poor (25).…”

Section: Discussionmentioning

confidence: 99%

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Functional outcome after (laryngo)tracheal resection and reconstruction for acquired benign (laryngo)tracheal stenosis

Timman¹,

Schoemaker²,

Li³

et al. 2018

Ann. Cardiothorac. Surg.

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Background: In this study we focus on functional outcomes after (laryngo)tracheal resection and reconstruction for acquired benign (laryngo)tracheal stenosis, with a specific interest in the impact of laryngeal involvement on postoperative outcome.Methods: All patients who underwent (laryngo)tracheal surgery for benign pathology between 1996 and 2017 in our centre were included in this retrospective study. Surgical outcomes were procedural success rate, and airway-and voice-related complications. Functional results were assessed using (standardized) questionnaires for quality of life, sensation of dyspnea, swallowing function, and voice perception.Results: Of 119 consecutive patients, 47 underwent laryngotracheal resection and reconstruction and 72 underwent segmental tracheal surgery (78% with an end-to-end tracheal anastomosis and 22% with a cricotracheal anastomosis). Overall success rate was 92% and was similar for all groups, with an overall significant improvement in quality of life when compared to the preoperative situation. However, after laryngotracheal surgery, airway-related complications were more common when compared to segmental resections with an end-to-end tracheal anastomosis (30% versus 7%, P=0.003). Additionally, early voice alterations without recurrent nerve palsy were reported twice as often (34% versus 16%, P=0.034) and voice quality experienced during follow-up was significantly worse when compared to segmental resections.Overall response rate to the questionnaires on functional outcome was 63%.Conclusions: (Laryngo)tracheal surgery is safe and beneficial, with significant functional improvement during mid-and long-term follow-up. However, laryngeal involvement is a predictor for increased surgical airway-related complications. Additionally, voice alterations without recurrent nerve palsy are far more common after laryngotracheal resection and are a serious handicap. This aspect is underexposed in current literature and deserves further attention during preoperative counseling and patient follow-up. However, the results on functional outcome of this current study should be interpreted with caution due to the somewhat low response rate of the questionnaires.

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Section: Discussionsupporting

confidence: 78%

Section: Discussionmentioning

confidence: 99%

Functional outcome after (laryngo)tracheal resection and reconstruction for acquired benign (laryngo)tracheal stenosis

Timman¹,

Schoemaker²,

Li³

et al. 2018

Ann. Cardiothorac. Surg.

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“…Endoscopic treatment includes laryngeal microsurgery, laser-assisted excision, traditional dilation and endoscopic stent insertion, while external surgical treatment comprises a wide range of techniques such as tracheal resection and anastomosis or laryngotracheal reconstruction. In order to maintain laryngotracheal patency, a Montgomery Safe T-tube may be used as a single dilation treatment or in association with endoscopic and/or open-neck surgery [3].…”

Section: Introductionmentioning

confidence: 99%

Results of Montgomery T-Tube in Primary Treatment of Laryngotracheal Stenosis

Aslan¹,

Öztürkcan²,

Eren³

et al. 2013

IJOHNS

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“…Its etiologies are multiple; nowadays, the most common ones are postintubation or posttracheostomy stenoses [1]. Algorithms proposed for endoscopic management or surgical treatment are based on single-center experience and are limited by the number of patients, length of follow-up period or the absence of comparison between different treatment modalities [2,3,4,5]. …”

Section: Introductionmentioning

confidence: 99%

Management of Postintubation Tracheal Stenosis: Appropriate Indications Make Outcome Differences

Melkane¹,

Matar²,

Haddad³

et al. 2010

Respiration

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Background: Laryngotracheal stenosis is difficult to treat and its etiologies are multiple; nowadays, the most common ones are postintubation or posttracheostomy stenoses. Objective: To provide an algorithm for the management of postintubation laryngotracheal stenoses (PILTS) based on the experience of a tertiary care referral center. Methods: A retrospective study was conducted on all patients treated for PILTS over a 10-year period. Patients were divided into a surgically and an endoscopically treated group according to predefined criteria. The characteristics of the two groups were analyzed and the outcomes compared. Results: Thirty-three consecutive patients were included in the study: 14 in the surgically treated group and 19 in the endoscopically treated group. Our candidates for airway surgery were healthy patients presenting with complex tracheal stenoses, subglottic involvement or associated tracheomalacia. The endoscopic candidates were chronically ill patients presenting with simple, strictly tracheal stenoses not exceeding 4 cm in length. Stents were placed if the stenosis was associated with tracheomalacia or exceeded 2 cm in total length. In the surgically treated group, 2/14 patients needed more than one procedure versus 8/19 patients in the endoscopically treated group. At the end of the intervention, 50% of the patients were decannulated in the surgically treated group versus 84.2% in the endoscopically treated group (p = 0.03). However, the decannulation rates at 6 months and the symptomatology at rest and on exertion on the last follow-up visit were comparable in the two groups. Conclusion: Our experience in the management of PILTS demonstrates that both surgery and endoscopy yield excellent functional outcomes if the treatment strategy is based on clear, predefined objective criteria.

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Modern Management of Laryngotracheal Stenosis

Abstract: Patients undergoing dilation for laryngotracheal stenosis require multiple procedures. However, major reconstructive procedures are well tolerated and currently represent a viable primary treatment for laryngotracheal stenosis.

Cited by 132 publications

References 20 publications

Functional outcome after (laryngo)tracheal resection and reconstruction for acquired benign (laryngo)tracheal stenosis

Functional outcome after (laryngo)tracheal resection and reconstruction for acquired benign (laryngo)tracheal stenosis

Results of Montgomery T-Tube in Primary Treatment of Laryngotracheal Stenosis

Management of Postintubation Tracheal Stenosis: Appropriate Indications Make Outcome Differences

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