Outcome of surgery for laryngotracheal stenosis in grade III and IV subglottic stenosis

Background

Treatment for laryngotracheal stenosis is technically challenging and no therapeutic algorithm exists.

Methods

Thirteen patients with laryngotracheal stenosis were treated. Ten were males and 3 females with an age range of 4–60 years .The cause of airway stenosis was prolong intubation in 10, blunt trauma injury and idiopathic subglottic stenosis in 2 and 1consequence. Preoperative assessment included bronchoscopy, neck and chest CT scan to determine the extension of stenosis. The upper margin of the stricture was 3 mm to 1.0 cm. below the vocal cords; the stenotic segment extended from 3 to 6 cm. All patients except one had tracheostomy for a long period. Two patients had failed previous resections. In 10 patients dilatation and insertion of Montgomery T tube was the initial procedure. Pearson's technique was used for laryngotracheal resection. Suprahyoid laryngeal release was performed in 8. Montgomery T tube were placed in 12 and left in place for 1 year.

Results

Decanulation was done with success in all except 2 in first attempt. Circumferential granulation in one patient was excised and reinsertion of T tube for another 6 months was associated with successful decanulation. A kid who had resection at age 6 with poor compliance came back early to re-tracheostomy. He re-operated at age 14 with successful final decanulation. Endoscopic Laser and / or APC were used in 2 patients after T tube decanulation.

Conclusion

Surgical management of laryngotracheal stenosis is the treatment of choice. However, primary surgery is not always feasible. A consequence or combined approach should considered.