Postintubation tracheal stenosis

Abstract

A total of 503 patients underwent 521 tracheal resections and reconstructions for postintubation stenosis from 1965 through 1992. Fifty-three had had prior attempts at surgical resection, 51 others had undergone various forms of tracheal or laryngeal repair, and 45 had had laser treatment. There were 251 cuff lesions, 178 stomal lesions, 38 at both levels, and 36 of indeterminate origin. Sixty-two patients with major laryngeal injuries required complete resection of anterior cricoid cartilage and anastomosis of trachea to thyroid cartilage, and 117 had tracheal anastomosis to the cricoid. A cervical approach was used in 350, cervicomediastinal in 145, and transthoracic in 8. Length of resection was 1.0 to 7.5 cm. Forty-nine had laryngeal release to reduce anastomotic tension. A total of 471 patients (93.7%) had good (87.5%) or satisfactory (6.2%) results. Eighteen of 37 whose operation failed underwent a second reconstruction. Eighteen required postoperative tracheostomy or T-tube insertion for extensive or multilevel disease. Twelve died (2.4%). The most common complication, suture line granulations (9.7%), has almost vanished with the use of absorbable sutures. Wound infection occurred in 15 (3%) and glottic dysfunction in 11 (2.2%). Five had postoperative innominate artery hemorrhage. Resection and reconstruction offer optimal treatment for postintubation tracheal stenosis.

Management of Post-traumatic Laryngotracheal Stenosis: Our Experience

“…It is indicated in cases with complex stenosis, restenosis after multiple other techniques and in conjunction with associated conditions like TEO fistula closure. This technique has 90 % success rate as described in literature [5,16,18]. In our study only one patient underwent this procedure and was successfully decannulated.…”

“…According to Grillo, Mathesien, Wain study the two most common causes are post intubation and post tracheostomy [5]. Trauma was the most common cause of stenosis was proved in study reported by Bent III [6] and Cohen and Larsen [7].…”

“…Post intubation: commonest site is site of endotracheal tube [5,8] and stenosis is longer and uniform.…”

“…Treatment The most common treatment options for tracheal stenosis include [5,[16][17][18]. Rigid bronchoscopy and dilatation or excision is useful for treatment of true web like stenosis [19].…”

Tracheal surgery

“…The major series of laryngo-tracheal resection published in the international literature report a high rate of good or excellent results, with low mortality (generally under 1-2%), supporting the role of surgery as the treatment of choice [10,[12][13][14][15][16][17].…”