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.

Keywords:
Laryngotracheal stenosis, Tracheal stenosis, Intubation complications, Tracheal resection, Airway surgery, Tracheal dilation, Tracheal stent, Argon plasma coagulation
1.
Lorenz R: Adult laryngotracheal stenosis: etiology and surgical management. Curr Opin Otolaryngol Head Neck Surg 2003;11:467–472.
2.
Sarper A, Ayten A, Eser I, et al: Tracheal stenosis after tracheostomy or intubation. Review with special regard to cause and management. Tex Heart Inst J 2005;32:154–158.
3.
Mandour M, Remacle M, Van de Heyning P, et al: Chronic subglottic and tracheal stenosis: endoscopic management vs surgical reconstruction. Eur Arch Otorhinolaryngol 2003;260:374–380.
4.
Cuisnier O, Righini C, Pison C, et al: Prise en charge chirurgicale et/ou endoscopique des sténoses trachéales acquises non tumorales de l’adulte. Ann Otolaryngol Chir Cervicofac 2004;121:3–13.
5.
Herrington H, Weber S, Andersen P: Modern management of laryngotracheal stenosis. Laryngoscope 2006;116:1553–1557.
6.
Grillo HC: Surgical treatment of postintubation tracheal injuries. J Thorac Cardiovasc Surg 1979;78:860–866.
7.
Warner D, Brietzke S: Mitomycin C and airway surgery: how well does it work? Otolaryngol Head Neck Surg 2008;138:700–709.
8.
Valdez TA, Shapshay SM: Idiopathic subglottic stenosis revisited. Ann Otol Rhinol Laryngol 2002;111:690–695.
9.
Giudice M, Piazza C, Foccoli P, et al: Idiopathic subglottic stenosis: management by endoscopic and open-neck surgery in a series of 30 patients. Eur Arch Otorhinolaryngol 2003;260:235–238.
10.
Hoffman GS, Thomas-Golbanov CK, Chan J, et al: Treatment of subglottic stenosis, due to Wegener’s granulomatosis, with intralesional corticosteroids and dilation. J Rheumatol 2003;30:1017–1021.
11.
Grillo HC: Primary reconstruction of airway after resection of subglottic laryngeal and upper tracheal stenosis. Ann Thorac Surg 1982;33:3–17.
12.
Laccourreye O, Bransu D, Seckin S, et al: Cricotracheal anastomosis for assisted ventilation-induced stenosis. Arch Otolarygnol Head Neck Surg 1997;113:1074–1077.
13.
Pena J, Cicero R, Marin J, et al: Laryngotracheal reconstruction in subglottic stenosis: an ancient problem still present. Otolaryngol Head Neck Surg 2001;125:397–400.
14.
Wolf M, Shapira Y, Talmi YP, et al: Laryngotracheal anastomosis: primary and revised procedures. Laryngoscope 2001;111:622–627.
15.
Rea F, Callegaro D, Loy M, et al: Benign tracheal and laryngotracheal stenosis: surgical treatment and results. Eur J Cardiothorac Surg 2002;22:352–356.
16.
Rhee JS, Toohill RJ: Single-stage adult laryngotracheal reconstruction without stenting. Laryngoscope 2001;111:765–768.
17.
Simpson GT, Polanyi TG: History of the CO2 laser in otolaryngology surgery. Otolaryngol Clin North Am 1983;16:739–752.
18.
Smith ME, Elstad M: Mitomycin C and the endoscopic treatment of laryngotracheal stenosis: are two applications better than one? Laryngoscope 2009;119:272–283.
19.
Massoud A, David WM: Adult acquired laryngeal stenosis: a study of prognostic factors. J Otolaryngol 1995;24:243–247.
20.
Brichet A, Verkindre C, Dupont J, et al: Multidisciplinary approach to management of postintubation tracheal stenoses. Eur Respir J 1999;13:888–893.
21.
Quinlan DM, Naslund MJ, Brendler CB: Application of argon beam coagulation in urological surgery. J Urol 1992;147:410–412.
22.
Gale P, Adeyemi B, Ferrer K, Ong A, Brill AI, Scoccia B: Histologic characteristics of laparoscopic argon beam coagulation. J Am Assoc Gynecol Laparosc 1998;5:19–22.
23.
Grund KE, Storek D, Farin G: Endoscopic argon plasma coagulation (APC) first clinical experiences in flexible endoscopy. Endosc Surg Allied Technol 1994;2:42–46.
24.
Morice RC, Ece T, Ece F, Keus L: Endobronchial argon plasma coagulation for treatment of hemoptysis and neoplastic airway obstruction. Chest 2001;119:781–787.
25.
Sato M, Terada Y, Nakagawa T, Li M, Wada H: Successful use of argon plasma coagulation and tranilast to treat granulation tissue obstructing the airway after tracheal anastomosis. Chest 2000;118:1829–1831.
26.
Reichle G, Freitag L, Kullmann HJ, Prenzel R, Macha HN, Farin G: Argon plasma coagulation in bronchology: a new method – alternative or complementary? Pneumologie 2000;54:508–516.
27.
Yasuo M, Tanabet T, Tsushima K, et al: Endobronchial argon plasma coagulation or the management of post-intubation tracheal stenosis. Respirology 2006;11:659–662.
28.
Nouraei SA, Ghufoor K, Patel A, Ferguson T, Howard DJ, Sandhu GS: Outcome of endoscopic treatment of adult postintubation tracheal stenosis. Laryngoscope 2007;117:1073–1079.
29.
Schweinfurth JM: Endoscopic treatment of severe tracheal stenosis. Ann Otol Rhinol Laryngol 2006;115:30–34.
30.
Lund ME, Garland R, Ernst A: Airway stenting: applications and practice management considerations. Chest 2007;131:579–587.
© 2010 S. Karger AG, Basel
2010
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.