Source: Annual Congress 2002 - Chest trauma, airways and miscellaneous

Abstract

Restoration of the normal tracheal lumen in case of cicatricial stenosis is a challenging problem, especially if annular laryngeal cartilage is involved. An optimal approach for the said clinical situation is endotracheal surgery (ETS) followed by laryngotracheal resection (LTR).
The objective of the study was to evaluate results of surgery for cicatricial cervical tracheal stenoses and to denote the LTR time basing on the data obtained.
From 1998 to 2001 23 patients were treated. 14 patients (61%) underwent ETS: tracheal dilatation (rigid bronchoscopy, general anesthesia) combined with laser recanalization (Nd: YAG laser) followed by tracheal endoprosthetetics (silicone stent). In 14 patients LTR were done: in 9 initially (39%) and in 5 after ETS.
Duration of tracheal endoprosthetics was about 6 to 8 month. The restenosis was diagnosed clinically, on the basis of results of laryngeal and tracheal endoscopy and CT. In 5 of 14 patients (36%) after ETS restenosis developed in 2-3 weeks after the stent removal. LTR in all cases included 5 to 9 tracheal cartilages and annular laryngeal cartilage. There were no major complications and death. In all cases after LTR satisfactory immediate and prolonged results were observed (follow-up 1 to 3 years after LTR).
We conclude that ETS is indicated only for emergency tracheal recanalization. In other cases initially should be done LTR, which is the safe and effective radical treatment.

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I. Mosin, V. Gerasin, S. Tcherny, A. Sidorov, A. Ivanov, A. Gorokhov, D. Nagirnyak, A. Akopov (St.Petersburg, Russia). Surgical treatment for cicatricial cervical tracheal stenoses. Eur Respir J 2002; 20: Suppl. 38, 982

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