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Eur J Cardiothorac Surg 2002;22:352-356
© 2002 Elsevier Science NL

Benign tracheal and laryngotracheal stenosis: surgical treatment and results

^a Division of Thoracic Surgery, University of Padua, Padua, Italy
^b Section of Endoscopic Airways Surgery, Padua General Hospital, Padua, Italy

Received 19 September 2001; received in revised form 20 May 2002; accepted 27 May 2002.

* Corresponding author. Division of Thoracic Surgery, Policlinico Universitario, Via Giustiniani, 2, 35128 Padova, Italy. Tel.: +39-049-8212237; fax: +39-049-8212249
e-mail: federico.rea{at}unipd.it

	Abstract

Top Abstract 1. Introduction 2. Methods 3. Results 4. Discussion Appendix A. Conference... References

 
Objectives: Benign tracheal stenoses remain the most common indications for tracheal resection. We report lessons learned with surgical management of tracheal stenoses in a consecutive series of 65 patients from the beginning of our experience to date. Methods: From December 1991 to January 2001 65 patients underwent primary tracheal and laryngotracheal resection and reconstruction for non-neoplastic stenoses. There were 39 males and 26 females with a median age of 33 years (range 14–74 years). There were 58 cases of postintubation and seven of idiopathic stenosis. A cervical approach was used in 60 patients, and a cervical incision with sternal split in four and with sternotomy in one. We performed 45 (69.2%) tracheal resections and 20 (30.8%) laryngotracheal resections. The length of resection ranged between 1.5 and 4 cm (median 2.5 cm). The range of resected rings was two to eight (median five). Results: Fifty-four patients received a preoperative treatment. Preoperative procedures consisted of laser therapy (37), tracheostomy (38) and endotracheal prosthesis (16). We had major complications in eight patients (12.3%) and minor complications in 15 patients (23%). The most frequent complications were: temporary vocal cord dysfunction (eight patients), wound infection (five patients), anastomotic dehiscence (four patients), vocal cord paralysis (two patients), granulation tissue (two patients), deglutition dysfunction (one patient) and restenosis (one patient). Perioperative mortality was 1.5% (one patient). In classifying final results obtained, 54 patients achieved an excellent result, eight a good result and two satisfactory. Conclusions: The strategy for treatment of airway stenoses is now well established and leads to a high level of success with minimal or no sequelae. Meticulous preoperative assessment and preparation associated with a perfect surgical technique is mandatory to obtain good results. Preoperative treatments (laser and/or endotracheal prosthesis) could increase the extent of injury and the length of stenosis.

Key Words: Trachea • Tracheal stenosis • Laryngotracheal stenosis • Tracheal surgery

	1. Introduction

Top Abstract 1. Introduction 2. Methods 3. Results 4. Discussion Appendix A. Conference... References

 
Inflammatory stenosis of the trachea remains the most common indication for tracheal resection and reconstruction. Segmental tracheal resection allows removal of the stenotic portion of the trachea [1–6]. When the stenosis of the upper trachea also involves the subglottic larynx it cannot be treated by simple circumferential resection because this would destroy the function of the recurrent laryngeal nerves. Many procedures have been devoted to solve this problem and all reported surprisingly good results using single-stage plastic procedures [7–12]. We report our experience with the surgical management of benign tracheal and laryngotracheal stenoses in a consecutive series of 65 patients treated in the last 9 years.

	2. Methods

Top Abstract 1. Introduction 2. Methods 3. Results 4. Discussion Appendix A. Conference... References

 
From December 1991 to January 2001 a total of 65 patients underwent primary tracheal and laryngotracheal resection and reconstruction for non-neoplastic stenosis. They included 39 males and 26 females with an age range of 14 to 74 years (median 33 years). Hospital and office records were reviewed for each patient. Follow-up was obtained by direct patient contact and from office records. Follow-up was obtained in all patients from 1 month to 10 years. Median follow-up was 51 months.

The cause of airway stenosis was iatrogenic in 58 patients, who had undergone an intubation for cardiorespiratory resuscitation. The main causes were polytrauma (34 patients), resuscitation after other kinds of operation followed by respiratory failure (nine patients), neurological problems (four patients), suicide attempts (four patients), acute cardiac failure (three patients), acute respiratory failure in chronic obstructive pulmonary disease (COPD) (three patients) and diabetic ketoacidosis (one patient). Seven stenoses were idiopathic. Three patients had severe ischemic cardiac disease and one had severe diabetes. One of the polytrauma patients had a prior tracheal resection in another hospital and was referred to our Division after a dehiscence, treated with a T-tube.

All patients underwent accurate laryngotracheal studies to determine the extent of involvement of the trachea, the integrity of the vocal cords and the presence or absence of tracheomalacia. We performed in all patients a careful preoperative endoscopic examination of the larynx and trachea: attention should be paid to the state of the tracheal mucosa to assess whether excessive inflammation is present. The extent of involvement and amount of remaining trachea was determined by measurement with a rigid bronchoscope. Neck and chest CT scan, from 1995 with a spiral technique, allows for assessment of the extent of stenosis and the linear amount of normal airway remaining.

The lesions were located at the cervical level in 29 patients (44.6%), at the cervico-thoracic junction level in 14 patients (21.5%) and were intrathoracic in two patients (3.1%); laryngotracheal stenosis was present in 20 patients (30.8%). Seven patients had preoperative signs of tracheomalacia in the site of stenosis.

Fifty-four patients received a preoperative treatment, all performed in other hospitals, which consisted of tracheostomy in 38 patients, laser therapy in 37 patients and endotracheal Dumon prosthesis in 16 patients. In the group of patients treated with the laser, the number of sessions ranged from one to four and the type was a Nd:YAG laser (neodymium: yttrium, aluminium, garnet).

We considered as major risk factors the presence of severe COPD, diabetes mellitus, ischemic cardiovascular disease and wide tracheomalacia.

2.1. Surgical procedures and operative technique
The operative approach was through a cervical collar incision in 60 patients, cervical with sternal split in four and cervical with median sternotomy in one. Surgical procedures were circumferential tracheal resections in 45 patients, circumferential tracheal with partial cricoid resection in 15 patients and circumferential tracheal with complete cricoid resection in five patients. The amount of trachea resected ranged from 1.5 to 4 cm (median 2.5 cm) and the number of rings resected ranged from two to eight (median five rings). Subhyoid laryngeal release was performed in one case. Tracheal and laryngotracheal resections were performed adopting the basic principle of tracheal surgery described by Grillo and Pearson [2,3,11].

2.1.1. Tracheal resection
The patient is placed in a supine position with a bag beneath the shoulders and the head hyperextended. Anaesthesia is obtained via an endotracheal tube placed above the stenosis. After the collar incision, the anterior surface of the trachea is exposed; in the inflammatory stenoses, dissection is performed mainly on the anterior surface of the trachea and carefully on the lateral sides only in correspondence with the stenotic tract for an extension of 1 cm to avoid injury to the vascular supply and to the recurrent laryngeal nerves, which lie in the tracheoesophageal groove. Then, the trachea is divided below the stenotic area, the ventilation is performed with a cross-field endotracheal tube, placed in the distal tracheal tract, the original oro-tracheal tube is withdrawn by the anaesthetist and the end is tied up with sutures, so it can be drawn back before the anastomosis is completed. During the anastomosis the ventilation is ensured from the cross-field tube. After the resection of the stenotic tract, the primary anastomosis is performed with four interrupted sutures of 4-0 polyglactin (Vicryl, Ethicon, Inc., Somerville, NJ) for the membranous pars and with ten to 14 interrupted sutures of 3-0 polyglactin (Vicryl) for the cartilaginous pars; then, a rhino-tracheal tube is placed by the surgeon through the anastomosis and all the knots of the sutures are tied outside.

Patients with pre-existing tracheostomy were directly intubated from the field and then the stoma was resected together with the stenotic tract. Approximation of the tracheal ends after tracheal resection is achieved by simple cervical flexion and, after the closure of the incision, a heavy suture is placed through the chin skin and the presternal skin: these suture are tied with the neck in flexion to protect against sudden hyperextension. The patient is extubated in the operating room and is kept under observation for 24 h in an intensive care unit.

2.1.2. Laryngotracheal resection
Tracheal stenosis that involves the subglottic larynx cannot be managed with simple circumferential resection, because this would destroy the function of the recurrent laryngeal nerves, which enter the larynx just medial to the inferior cornua of the thyroid cartilage. The resection of the anterior portion of cricoid cartilage is performed in an arcuate line from the midline of the thyroid cartilage anteriorly, extending posteriorly along the lower border of the cricoid cartilage, leaving the posterior cricoid plate intact. Primary anastomosis is performed with interrupted absorbable suture material for the membranous pars (4-0 polyglactin, Vicryl) and for cartilaginous pars (3-0 polyglactin, Vicryl). The knots of the membranous wall are tied inside, a rhino-tracheal tube is guided through the anastomosis and then the knots of the cartilage are tied outside. Since 1998, usually we place a running 4-0 polydioxanone (PDS, Ethicon, Inc., Somerville, NJ) suture for the membranous trachea, whose extremities are tied with the sutures of the cartilaginous-membranous angles. Protective distal tracheostomy was performed only in those patients in whom the anastomosis lay very close to the brachiocephalic trunk (two cases).

	3. Results

Top Abstract 1. Introduction 2. Methods 3. Results 4. Discussion Appendix A. Conference... References

 
The outcome was classified as excellent, good, satisfactory, or not satisfactory and was analyzed at the time of hospital discharge and after 3 months. The results were classified as excellent if the voice and respiration were completely normal and radiological examination, bronchoscopy, or both demonstrated an airway that was essentially normal in diameter. Good results were judged in the presence of slight lessening of the maximum volume of the voice, slight hoarseness, slight weakness of voice after prolonged use and adequate breathing for normal activities. Results were classified as satisfactory in the case of a hoarse voice with slight wheezing or shortness of breath on exercise, not sufficient to impair normal activities. Results were not satisfactory, at the hospital discharge, in case of major complications. We had no intraoperative mortality. Perioperative mortality was 1.5% (one patient died due to respiratory failure), so the outcome analysis was made on 64 patients.

At the hospital discharge time, 46 patients had excellent results, eight had good results, two had satisfactory results and eight were not satisfactory. After three months 54 patients had excellent results, eight had good results, two had satisfactory results and none had not satisfactory results. In the whole series of patients the anastomotic results were classified as excellent in 54 cases and in ten patients the calibre was slightly inferior than the remaining portion of the trachea, without functional impairment.

Perioperative major complications occurred in eight patients (12.3%): anastomotic dehiscence (four patients, two of whom had severe cardiac disease and severe diabetes), treated successfully with surgical debridement and temporary Montgomery T-tube (E. Benson Hood Laboratories, Inc., Pembroke, MA); vocal cord paralysis (two patients), managed with laser therapy in one case and with cordectomy in the other case; restenosis (one patient), treated with laser therapy; deglutition dysfunction (one patient), in the case of laryngeal release, which required functional re-education.

Minor complications occurred in 15 patients (23%): temporary vocal cord dysfunction (eight patients), which necessitated no specific treatment; superficial wound infection (five patients), managed with drainage and treatment with conservative therapy; anastomotic granulation tissue (two patients), treated with laser and steroid therapy.

Thirty-eight patients with preoperative tracheostomy had a morbidity rate of 10.5% (four patients), and 27 patients without preoperative tracheostomy had a morbidity rate of 14.8% (four patients).

	4. Discussion

Top Abstract 1. Introduction 2. Methods 3. Results 4. Discussion Appendix A. Conference... References

 
The strategy for treatment of airway stenoses is now well established and leads to a high level of success with minimal or no sequelae [1]. Tracheal stenoses without involvement of the subglottic region often are easy to cure. Inflammatory stenosis involving the subglottic region represents a major therapeutical challenge [12,13]. In the preoperative assessment the precise topography of the injury with exact location and length of the stenosis, the length of the tracheal involvement, the presence of inflammation and oedema at the border of stenosis must be defined. In fact, patients with severe inflammatory signs should be excluded from surgery and re-evaluated after a suitable period of observation, until the stenosis is stabilized.

Rigid bronchoscopy represents the best preoperative diagnostic procedure for inflammatory tracheal stenosis; helical (spiral) CT with a 1–1.5 thin section has allowed multiplanar reconstruction of high quality, permitting detailed evaluation of tracheal stenosis [14]. From the analysis of our experience, we believe that CT scan does not always add further information to the rigid bronchoscopy and can be useful in patients that underwent a previous surgical tracheal procedure or in patients with idiopathic laryngotracheal stenosis, in order to obtain more information on the extraluminal region.

The endoscopic management of benign stenoses may be essential for maintenance of a safe airway while awaiting definitive surgical treatment and in same cases the stenosis may be managed by direct rigid bronchoscopy dilatation.

Recent years have seen a prolific increase in use of the laser for management of cicatrizial lesions of the airway [15]. However, experts in laser therapy agree that only thin webline strictures can be removed definitively by laser treatment [16]. Laser resection provides only temporary benefit in patients with larger circumferential lesions. Furthermore, repeated laser resection undoubtedly increases the extent of injury in some cases and may result in damage to the cricoid posterior plate. Similarly, the use of an endotracheal prosthesis could increase the length of stenosis and we recommend avoiding this treatment in all patients who are candidates to receive surgical operations. We prefer the use of a tracheostomy and a Montgomery silicon rubber T-tube if a prolonged period is needed prior to correction of the stenosis, either because of systemic considerations or because of the inflammatory state of the trachea. In fact, in our analysis, the tracheostomy is a condition that does not increase the morbidity rate. We believe that laser and endotracheal prosthesis should be used as a therapeutic option only in patients with absolute contraindications to surgery. In our experience the presence of a single risk factor constitutes only a relative exclusion criteria, which becomes absolute in the case of an association of more than one.

Regarding the surgical technique, we adopted the basic principles of tracheal reconstruction introduced by authors with large experience [1,3,7,8,11,17–20]. These principles include avoidance of excessive anastomotic tension, maintenance of tracheal blood supply and meticulous dissection and anastomosis. We adopt interrupted absorbable sutures for anastomosis (3-0 or 4-0) in all patients and we did not observe major complications related to anastomotic granulation.

Recently we have started to use monofilament absorbable sutures (PDS) for a running suture of the posterior wall of the trachea in case of laryngotracheal anastomosis in order to avoid tying the knots of the sutures inside the tracheal lumen when an interrupted suture technique is adopted. In those patients who require preoperative tracheostomy and a T-tube, we prefer to replace the T-tube with a tracheostomy tube 1–2 weeks before the operation to allow the subglottic larynx to recover from the irritation caused by the proximal end of the T-tube.

Our remarkable results (95% are excellent or good results) are related to a careful selection of patients and to the strict adoption of technical details suggested by authors of huge experience in this field of surgery [1,5,11].

All patients with major complications received preoperative multiple laser treatment and/or endotracheal prosthesis, in other institutions, with curative attempt. Out of those patients, one had severe diabetes and two had severe ischemic arteriopathy. Maybe associated illness and the repeated preoperative procedure may play a role in postoperative complications, even if we are not able to prove this from our results.

Even in the case of major complications, we were able to obtain in six out of eight patients a good result, using a conservative treatment (tracheostomy and stenting with a Montgomery T-tube). Only one patient died in the perioperative period for respiratory failure: she was a 64-year-old female with severe COPD. Because it is difficult to predict which patients will be at risk for early relapse of acute respiratory failure, we are very cautious in resecting patients with severe COPD.

Our results confirm that a surgical approach is the best option to treat benign tracheal and laryngotracheal stenoses. Meticulous preoperative assessment and preparation associated with a perfect surgical technique are mandatory to obtain good results. It must also be remembered that in very high risk patients for surgery a permanent T-tube may be the best solution.

	Footnotes

 
Presented at the joint 15th Annual Meeting of the European Association for Cardio-thoracic Surgery and the 9th Annual Meeting of the European Society of Thoracic Surgeons, Lisbon, Portugal, September 16–19, 2001.

	Appendix A. Conference discussion

Top Abstract 1. Introduction 2. Methods 3. Results 4. Discussion Appendix A. Conference... References

 
Mr K. Jeyasingham (Winterbourne Down, UK): Could you tell me what population does your center serve? Is it a referral center for almost the whole of Italy or northern Italy or is it a restricted population?

Dr Rea: We receive many patients outside our community, and many cases we receive from the Center of Bronchology and Laser Therapy, and this is why we have a very high number of patients that had a preoperative procedure like repeated laser and stent.

Dr M. Ximenes (Brasilia, Brazil): I want to ask you about the T-tube, have you used it, and if you do, what is your strategy in this technique, how long do you leave it there, when you remove it, what kind of results you get with the tube?

Dr Rea: We believe that the T-tube is the best prosthesis you can use in these kind of patients. We use it for one or two months, then we remove the T-tube and put just the tracheostomy cannula, and we observe the patients in order to evaluate if you have inflammation in the trachea. For the young patients we believe that the best option is surgery, but in some patients, mainly the patients with COPD, now we are very cautious to operate on this group of patients. We prefer to maintain a T-tube.

Dr S. Eggeling (Berlin, Germany): I agree with you that endoscopic examinations before surgery may be worse for the outcome, so I would like to ask you if you have experience with virtual bronchoscopy reconstructed from CT scan? We have experience with virtual bronchoscopy since 1998 and consider it very useful in the preoperative planning.

Dr Rea: We believe that it is important when you would like to know something more of the extraluminal situation, because the visual bronchoscopy it is not able to give information regarding the oedema, and it is very important to operate on the patient when you have no inflammation.

Dr D. Dougenis (Patras, Greece): How many times did you need to dilate the stricture before intubating the patient and go on with the procedure, and how far did you dilate?

You said you had four cases of dehiscence, but then you had only one case of restenosis. My second question is: what happened with these cases with the tracheal dehiscence? They didn't develop any stenosis? And finally, how you are dealing with the restenosis?

Dr Rea: For the patients with dehiscence we had it prevalently in the anterior wall, and we stent the patients with a T-tube, and we used conservative treatment. For the restenosis, it was for excessive granulation, and we tried laser therapy and dilation. Regarding the necessity to dilate the patients, we believe it is possible to have a patient with a 5 or 6 mm and to plan the surgery, and it is better to avoid to dilate the patients.

Dr Dougenis: You mean 5 mm in stricture, diameter of stricture?

Dr Rea: Yes.

Dr Dougenis: A 5 mm diameter of stricture cannot accept any kind of cannula, even the 4 mm where the added cannula cannot go through?

Dr Rea: Yes, but you don't need to because if you plan to operate on the patient, you can ventilate the patient up above the stenosis, then you cut the trachea and you can intubate the patient through the operating field.

Dr G. Friedel (Gerlingen, Germany): You had four cases of complete resection of the cricoid cartilage and you have no permanent recurrent laryngeal nerve palsy, but I wonder, do you really resect the whole cricoid cartilage?

Dr Rea: When I say complete cricoid, it is all completely the anterior wall of the cricoid. We leave the plate. We did one patient who had the posterior plate. But we had four patients with vocal cord palsy, and all these patients were in that group.

Mr Jeyasingham: I know you answered the question with regard to virtual bronchoscopy. You said you would prefer to do rigid bronchoscopy for the assessment. What objections do you have for using the flexible bronchoscope for assessment? I find it very useful to assess the dynamic state of the tracheal stricture and the vicinity of the stricture.

Dr Rea: We prefer the rigid bronchoscopy because the patient is quiet and you can ventilate the patient. I think it is not very important to assess, mainly in the young patient, if you have a good dynamic of the trachea.

	References

Top Abstract 1. Introduction 2. Methods 3. Results 4. Discussion Appendix A. Conference... References

 

1. Grillo H.C., Donahue D.M., Mathisen D.J., Wain J.C., Wright C.D. Postintubation tracheal stenosis. Treatment and results. J Thorac Cardiovasc Surg 1995;109:486-493.[Abstract/Free Full Text]
2. Grillo H.C. The management of tracheal stenosis following assisted respiration. J Thorac Cardiovasc Surg 1969;57:52-71.[Medline]
3. Grillo H.C. Surgical treatment of postintubation tracheal injuries. J Thorac Cardiovasc Surg 1979;78:860-875.[Abstract]
4. Pearson F.G., Andrews M.J. Detection and management of tracheal stenosis following cuffed tube tracheostomy. Ann Thorac Surg 1971;12:359-374.[Medline]
5. Couraud L., Jougon J., Velly J.F., Klein C. Sténoses iatrogénes de la voie respiratoire. Evolution des indication thérapeutiques. A partir de 217 cas chirurgicaux. Ann Chir Thorac Cardiovasc 1994;12:359-374.
6. Bisson A., Bonnette P., El Kadi B. Tracheal sleeve resection for iatrogenic stenoses (subglottic laryngeal and tracheal). J Thorac Cardiovasc Surg 1992;104:882-887.[Abstract]
7. Grillo H.C., Mathisen D.J., Wain J.C. Laryngotracheal resection and reconstruction for subglottic stenosis. Ann Thorac Surg 1992;53:54-63.[Abstract]
8. Grillo H.C. Primary reconstruction of airway after resection of subglottic laryngeal and upper tracheal stenosis. Ann Thorac Surg 1982;33:3-18.[Abstract]
9. Ogura J.H., Roper C.L. Surgical correction of traumatic stenosis of the larynx and pharynx. Laryngoscope 1962;72:468-480.
10. Gerwat J., Bryce D.P. The management of subglottic stenosis by resection and direct anastomosis. Laryngoscope 1974;84:940-947.[Medline]
11. Pearson F.G., Cooper J.D., Nelems J.M., Van Nostrand A.W.P. Primary tracheal anastomosis after resection of the cricoid cartilage with preservation of recurrent laryngeal nerves. J Thorac Cardiovasc Surg 1975;70:806-816.[Abstract]
12. Couraud L., Martigne C., Houdelette P., Dumas P.J., Morales F. Intérèt de la resection cricoidienne dans le traitment des sténoses cricotrachéales après intubation. Ann Chir Thorac Cardiovasc 1979;33:242-246.
13. Grillo H.C., Mark E.J., Mathisen D.J., Wain J.C. Idiopathic laryngotracheal stenosis and its management. Ann Thorac Surg 1993;56:80-87.[Abstract]
14. Quint L.E., Whyte R.I., Kazerooni E.A., Martinez F.J., Cascade P.N., Lynch J.P., 3rd, Orringer M.B., Brunsting L.A., 3rd, Deed G.M. Stenosis of the central airways: evaluation by using helical CT with multiplanar reconstructions. Radiology 1995;194(3):871-877.[Abstract/Free Full Text]
15. Sharpe D.A.C., Dixon K., Moghissi K. Endoscopic laser treatment for tracheal obstruction. Eur J Cardiothorac Surg 1996;10:722-726.[Abstract]
16. Shapshay S.M., Beamis J.F., Jr., Hybels R.L., Bohigian R.K. Endoscopic treatment of subglottic and tracheal stenosis by radial laser incision and dilatation. Ann Otol Rhinol Laryngol 1987;96(6):661-664.[Medline]
17. Grillo H.C. Tracheal surgery. In: Ravitch M., Steichen F., eds. Atlas of general thoracic surgery. Philadelphia, PA: W.B. Saunders, 1987:293-331.
18. Couraud L., Jougon J.B., Velly J.F. Surgical treatment of nontumoral stenosis of the upper airway. Ann Thoracic Surg 1995;60:250-260.[Abstract/Free Full Text]
19. Pearson F.G., Brito-Filomeno L., Cooper J.D. Experience with partial cricoid resection and thyrotracheal anastomosis. Ann Otol Rhinol Laryngol 1986;95:582-585.[Medline]
20. Maddaus M.A., Toth J.L.R., Gullane P.J., Pearson F.C. Subglottic tracheal resection and synchronous laryngeal reconstruction. J Thorac Cardiovasc Surg 1992;104:1443-1450.[Abstract]

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This Article Abstract Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Federico Rea Andrea Zuin Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Rea, F. Articles by Sartori, F. Search for Related Content PubMed PubMed Citation Articles by Rea, F. Articles by Sartori, F. Related Collections Trachea and bronchi