CHRONIC LARYNGOTRACHEAL STENOSIS

SURGICAL MANAGEMENT

Abstract

Objective: To evaluate the surgical management of the patients
suffering from chronic laryngotracheal stenosis. Design: Prospective study. Setting: ENT Department
Combined Military Hospital Rawalpindi. Period: May 1998 to Aug 2000. Materials & Methods: Seventeen
consective, diagnosed cases of chronic laryngotracheal stenosis were evaluated by history and thorough ENT
examination. Direct laryngoscopy was performed in all the patients. CT scan was carried out in 12 of them.
Patients were classified according to the McCaffery’s system of staging. The surgical procedures performed
ranged from endoscopic dilatation and CO2 laser excision of stenosis to open reconstructive procedures. Mean
period of follow up for each patient was 8.7 months, during which results of the repair were evaluated by the
absence/recurrence of the symptoms and success in decannulation. Results: Eight patients (47%) had stage-3,
three (17.6%) had stage-1, two (11.9%) had stage-2, and one (5.9) had stage-4 laryngotracheal stenosis. Three
patients (17.6%) suffered from tracheal stenosis only. Five patients (29.4%, including all the patients with stage-1
stenosis) were subjected to endoscopic dilatations or CO2 laser surgery; rest (70.6%, including all those with
stage 2, 3 and 4 stenosis) required complex open reconstructive procedures. Laryngotracheoplasty was
performed in 10 patients (58.8%). T-tube was placed in 8 of them. On the average each patient was subjected
to 4.6 operations involving 1.5 different kinds of surgical techniques. All the patients with stage-1 stenosis
remained asymptomatic during the period of follow up. Recurrence of stenosis was noticed in both the patients
in whom T-tube was removed. Decannulation was successful in 3 out of 5 patients who were wearing
tracheostomy. Conclusion: Treatment should be individualized. Milder form of stenosis requires relatively
simple procedures. Multiple operations and more than one surgical technique are frequently required. Even then
the results are not uniformly satisfying. Decannulation is not always possible. Recurrence rate is high. Long-term
follow up is necessary. Careful preoperative evaluation, selection of most appropriate surgical technique,
meticulous surgical skills and dedicated postoperative follow-up are essential for successful outcome.