Surgical treatment of nontumoral stenoses of the upper airway

doi:10.1016/0003-4975(95)00464-V

The Annals of Thoracic Surgery

Volume 60, Issue 2, August 1995, Pages 250-260

https://doi.org/10.1016/0003-4975(95)00464-V Get rights and content

Background.

After 1970, the widespread use of nasotracheal intubation, avoiding tracheostomy and its pitfalls, resulted in more frequent laryngeal or laryngotracheal stenoses, which required more complex and sometimes multistaged procedures.

Methods.

A series of 217 nontumoral stenoses of the upper airway were treated following the same therapeutic principles in the period 1978 to 1992. Two hundred one of them were iatrogenic postintubation strictures (92%); the others were posttraumatic (7), idiopathic (5), and various (4).

Results.

One hundred twenty (55%) were tracheal stenoses and treated by resection and primary end-to-end anastomosis with 117 excellent or good results and three deaths. Length of the stenosis, old age, neuropsychological sequelae, and overall poor respiratory status of the patients made up the remaining difficulties in the treatment. Ninety-seven (45%) were laryngotracheal stenoses with much more complex surgical indications: 57 patients underwent tracheal and subglottic resection and anastomosis with 56 successes and one death, 7 had laryngotracheal resection and anastomosis with total cricoidectomy and consequently laryngeal stenting for 3 to 6 months (six successes, one death), 3 had supraglottic resection and anastomosis (three successes), 12 patients with glottic opening difficulties and short laryngeal stenosis underwent a laryngeal enlargement over a T tube without resection (11 successes, one death), and 18 were subjected to a complex combination of resection and modeling with 16 successes, 2 failures, and 1 death. Final results were successful in 208 cases (96%) with seven deaths and two failures. Mild phonetic sequelae were observed after laryngeal modeling. A minimal follow-up of 1 year has shown long-term stability of most repairs.

Conclusions.

Despite acceptable results, the therapeutic approach remains difficult for laryngotracheal stenoses involving the glottic and the supraglottic level as well as for those that have not responded to previous attempts at repair. In a few cases, despite a meticulous preoperative assessment, the surgical strategy can only be adopted intraoperatively. The key to surgical success is undoubtedly a careful preoperative treatment of infection and inflammation as well as a meticulous muco-mucosal approximation of healthy margins at the anastomosis.

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Citation Excerpt :
Moreover, high subglottic stenosis as well as long vertical extent (>4–6 cm) represent limitations to surgery.22 Post-surgical restenosis was higher than that reported in other studies,36–40 however we found no patients or stenosis features that could explain these results. Given the small sample size of patients undergoing surgery, this analysis may not be representative.
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Of 115 patients enrolled (mean age 48.5 ± 17.6 years, 53% males), 66.1% had complex stenosis. The most common causes of intubation were respiratory (29.9%), neurological (26.8%) and surgical (19.6%). Complex stenosis was caused by longer intubation, and was more frequent among previously tracheostomized patients. The most common location was the upper third of trachea (60.9%). Most cases were initially treated by interventional bronchoscopy, and although serial dilations were effective in some complex PITS, a higher proportion of simple stenosis was successfully managed with this treatment option. Long-term recurrence after serial dilation was observed in 25.0% of cases. Stent placement was required (19.1%) only for complex PITS. Stent-related complications were frequent (61.9%) and linked to the stenting time (p < 0.001). Overall, there were no procedure-related complications. Surgical intervention was also performed (30.0%), always with complex PITS. Post-surgical recurrences were observed in 24.2% of cases.
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: Presented at the Thirty-first Annual Meeting of The Society of Thoracic Surgeons, Palm Springs, CA, Jan 30–Feb 1, 1995.

View full text

Surgical treatment of nontumoral stenoses of the upper airway

Background.

Methods.

Results.

Conclusions.

Ann Thorac Surg

Ann Thorac Surg

Ann Thorac Surg

J Thorac Cardiovasc Surg

J Thorac Cardiovasc Surg

Circumferiential resection and reconstruction of mediastinal and cervical trachea

Ann Surg

Le traitement des sténoses trachéales après trachéotomie

Indications thérapeutiques, préparation à l'intervention

Ann Chir Chir Thorac Cardiovasc

The management of subglottic laryngeal stenosis bv resection and direct anastomosis

Laryngoscope