Endoscopic treatment of benign tracheal stenosis: a single-centre study

BACKGROUND

Benign tracheal stenosis is relatively rare but remains a significant chronic disease due to its drastic symptoms including dyspnoea and inspiratory stridor, and consequent negative effect on quality of life. Traditionally, the surgical approach by resection of the stenotic tracheal segment has been the therapy of choice. However, endoscopic techniques have arisen and may offer a safe and less invasive alternative.

OBJECTIVES

The aim of the retrospective study was to evaluate procedure-related safety and outcome of endoscopic treatment of benign tracheal stenosis at a single centre.

METHODS

The study included all patients at our institution who between 2013 and 2022 had received endoscopic treatment of benign tracheal stenosis by rigid tracheoscopy, radial incision by electric papillotomy needle and dilation (endoscopic tracheoplasty) followed by triamcinolone acetonide as a local submucosal injection and additionally, from 2020, budesonide inhalation.

RESULTS

A total of 22 patients were treated in a total of 38 interventions, each resulting in immediate improvement of symptoms. There were no peri-interventional complications or mortality. Of the 38 interventions, 11 received no triamcinolone acetonide administration, resulting in a 54.5% recurrence rate after an average of 21.1 (±18.0) months, while 27 had local triamcinolone acetonide, with a 37% recurrence rate. Since 2020, we additionally initiated post-interventional budesonide inhalation as recurrence prophylaxis for newly admitted patients and patients with recurrences(n = 8), of whom only one (12.5%) has to date experienced a recurrence.

CONCLUSION

Our results indicate that endoscopic tracheoplasty offers a safe and successful, minimally invasive alternative to open surgery for patients with benign tracheal stenosis. We recommend local administration of triamcinolone into the mucosa as an additional treatment to decrease the risk of recurrence. However, given the uncontrolled study design and low sample size, safety and effectiveness cannot be conclusively demonstrated. Nonetheless, our findings suggest promising avenues for further investigation. Further studies on the additional benefit of inhaled corticosteroids are warranted.

Not only acute respiratory failure: COVID-19 and the post-intubation/tracheostomy upper airways lesions†

Background

An increasing number of patients have been subjected to prolonged invasive mechanical ventilation due to COVID-19 infection, leading to a significant number of post-intubation/tracheostomy (PI/T) upper airways lesions. The purpose of this study is to report our early experience in endoscopic and/or surgical management of PI/T upper airways injuries of patients surviving COVID-19 critical illness.

Materials and Methods

We prospectively collected data from patients referred to our Thoracic Surgery Unit from March 2020 to February 2022. All patients with suspected or documented PI/T tracheal injuries were evaluated with neck and chest computed tomography and bronchoscopy.

Results

Thirteen patients (8 males, 5 females) were included; of these, 10 (76.9%) patients presented with tracheal/laryngotracheal stenosis, 2 (15.4%) with tracheoesophageal fistula (TEF) and 1 (7.7%) with concomitant TEF and stenosis. Age ranged from 37 to 76 years. Three patients with TEF underwent surgical repair by double layer suture of oesophageal defect associated with tracheal resection/anastomosis (1 case) or direct membranous tracheal wall suture (2 cases) and protective tracheostomy with T-tube insertion. One patient underwent redo-surgery after primary failure of oesophageal repair. Among 10 patients with stenosis, two (20.0%) underwent primary laryngotracheal resection/anastomosis, two (20.0%) had undergone multiple endoscopic interventions before referral to our Centre and, at arrival, one underwent emergency tracheostomy and T-tube positioning and one a removal of a previously positioned endotracheal nitinol stent for stenosis/granulation followed by initial laser dilatation and, finally, tracheal resection/anastomosis. Six (60.0%) patients were initially treated with rigid bronchoscopy procedures (laser and/or dilatation). Post-treatment relapse was experienced in 5 (50.0%) cases, requiring repeated rigid bronchoscopy procedures in 1 (10.0%) for definitive resolution of the stenosis and surgery (tracheal resection/anastomosis) in 4 (40.0%).

Conclusions

Endoscopic and surgical treatment is curative in the majority of patients and should always be considered in PI/T upper airways lesions after COVID-19 illness.

'Is there something wrong with your voice?' A qualitative study of the voice concerns of people with laryngotracheal stenosis

BACKGROUND

Acquired laryngotracheal stenosis (LTS) is a rare condition that causes breathlessness and dyspnoea. Patients have reconstructive airway surgery to improve their breathing difficulties, but both LTS and the surgery can cause voice difficulties. The existing evidence base for management of voice difficulties for adults with LTS focuses on symptoms. There is limited information to provide clinical guidance for speech and language therapists (SLTs) and a limited understanding of the impact of voice changes on adults with LTS.

AIM

To investigate the lived experience of adults with laryngotracheal stenosis (LTS), who have had reconstructive surgery; here focussing on voice concerns with the aim of guiding clinical care for SLTs.

METHODS AND PROCEDURES

A phenomenological, qualitative study design was used. Focus groups and semi-structured interviews were completed with adults living with LTS who had had reconstructive surgery. Audio recordings were transcribed and inductive thematic analysis was used by the research team to identify themes and sub-themes.

OUTCOMES AND RESULTS

A total of 24 participants (five focus groups and two interviews) took part in the study before thematic saturation was identified in analysis. Three main themes were identified specific to the experience of living with LTS: the Medical, Physical and Emotional journey. All participants referenced voice difficulties as they related to each of these overall themes. Sub-themes directly related to voice included experience of surgery, information provision, staff expertise/complacency, symptoms, symptom management, identity, support networks, impact on life and living with a chronic condition.

CONCLUSIONS AND IMPLICATIONS

In this qualitative study participants have described the integral part voice difficulties play in their lived experience of LTS and reconstructive surgery. This is considered in the context of their clinical care and the need for individualised management and information provision throughout the course of their condition. The broader research literature relating to voice difficulties is explored with links made to people with LTS and recommendations made for future research into people living with LTS and dysphonia.

WHAT THIS PAPER ADDS

What is already known on this subject Adults with laryngotracheal stenosis (LTS) experience voice changes as a result of their condition, and the surgeries necessary as a treatment. These changes can lead to altered pitch, vocal fatigue, loss of pitch range and loss of volume control. Although there are known psychosocial implications both to living with a chronic condition and voice difficulties there has been no research exploring this in adults with LTS, and there is minimal clinical guidance for speech and language therapists (SLTs) working with these patients. What this paper adds to existing knowledge This research is the first study to explore the lived experience of adults with LTS who undergo reconstructive surgery, focusing on their voice concerns. This study demonstrates the multifactorial impacts of voice changes on all aspects of the lives of adults with LTS and the need for individualised information provision and clinical care to help support them. What are the potential or actual clinical implications of this work? Adults with LTS want expert SLTs to facilitate their care and support them throughout their LTS journey alongside other support networks. They want to be carefully prepared for reconstructive surgery and given clear information about symptoms and management of their voice difficulties. This has led to the reorganisation of the care pathway at our centre, and the introduction of a patient-led pretreatment session.

Novel airway-cartilage combined model for medialization laryngoplasty and laryngotracheal reconstruction surgery planning

BACKGROUND

The clinical outcomes of surgical treatments for vocal cord paralysis and tracheal stenosis, such as medialization laryngoplasty and laryngotracheal reconstruction, vary owing to the complex anatomy and physiology of the human upper airway. However, advances in three-dimensional (3D) simulation and printing ushered its use on an office-based workstation to aid in several surgical areas.

METHODS

The preoperation neck computed tomography image was loaded into the InVesalius 3.0 software for manual segmentation of airway and nearby important anatomic landmarks including hyoid bone, thyroid cartilage, and cricoid cartilage. The 3D model of the desired anatomy structure was manufactured and used for presurgical planning and rehearsal of the surgery.

RESULTS

We review cases of four patients: two cases of unilateral vocal palsy undergoing medialization laryngoplasty and two cases of tracheal stenosis patients who used the air-cartilage combined model.

CONCLUSION

Preoperation planning of the medialization thyroplasty could be more precise by prevision of the paralyzed vocal cord plane. Tracheal surgery could benefit from a preoperative design of segmented length. The novel airway-cartilage combined model offers new insight into vocal cord and trachea surgery.

Predictors of Anastomotic Complications After Resection and Anastomosis for Tracheal Stenosis

Resection and anastomosis is an effective option for the management of complex tracheal stenosis, however, it's not without the complications. This study aims at evaluating various factors predicting anastomotic complications after trachea resection and anastomosis. This is a retrospective analysis of database from a dedicated thoracic surgical unit in New Delhi, India over 7 years. An analysis of demographic details, perioperative variables including complications were carried out. Analysis of various factors predicting anastomotic complications was performed. Out of 65 patients in the study, 49 (75.3%) were males and 16 (24.7%) were females. Median age of the patients was 31 years. Stenosis was cervical in 80%, cervico-thoracic in 15.4% and thoracic in 4.6% of patients. Median length of stenosis was 2.9 cm (1-4.2). 53 (81.6%) patients had some kind of preoperative intervention, where as rest 12 (18.4%) patients had no intervention at all. Out of 65 patients, 26 (40%) had crico-tracheal anastomosis while 39 (60%) had tracheo-tracheal anastomosis. Median length of resected tracheal segment was 3.3 cm (1-5). Overall complication rate (anastomotic + non-anastomotic) was 18.4% in which anastomosis related were in 4 (6.1%) patients. Resection of tracheal segment ≥ 3.5 cm, presence of diabetes mellitus and pre-operative use of corticosteroids were statistically significant factors for the onset of complications. Perioperative mortality rate was 1.5% (n = 1). Length of resection > 3.5 cm, presence of diabetes mellitus and pre-operative prolonged use of corticosteroids were significant predictors for the anastomotic complications.

Laryngotracheal resection can be performed safely without a guardian Chin stitch-a single-centre experience including 165 consecutive patients

OBJECTIVES

A tension-free anastomosis is crucial to minimize the risk of airway complications after laryngotracheal surgery. The 'guardian' chin stitch is placed to prevent hyperextension of the neck in the early postoperative period. This manoeuvre was introduced early in tracheal surgery and is now routinely performed by many airway surgeons. However, the evidence for or against is sparse.

METHODS

We performed a retrospective analysis of all adult patients receiving a (laryngo-)tracheal resection at our department from October 2011 to December 2019. According to our institutional standard, none of the patients received a chin stitch. Instead, a head cradle was used to obtain anteflexion of the neck during the first 3 days and patients were instructed to avoid hyperextension of the neck during the hospital stay. The postoperative outcome and the rate of anastomotic complications were analysed.

RESULTS

A total of 165 consecutive patients were included in this study. Median age at surgery was 53 years (18-80). Seventy-four patients received a tracheal resection, 24 a cricotracheal resection, 52 an extended cricotracheal resection including dorsal mucosectomy and 15 a single-stage laryngotracheal reconstruction. The median resection length was 25 mm (range 10-55 mm). One hundred and sixty-two out of 165 (98.2%) patients had an unremarkable postoperative course. One patient (0.6%) had partial anastomotic rupture after a traumatic reintubation, which required revision surgery and re-anastomosis. Two patients (1.2%) after previous radiation therapy (>60 Gy) developed a partial necrosis of the anastomosis, resulting in prolonged airleak and fistulation. At follow-up, bronchoscopy 3 months after surgery, 92.7% (127/137) of the patients had a proper anastomosis, 6.6% (9/137) had minor granuloma formations at the site of the anastomosis, which were all treated successfully by endoscopic removal. One patient received dilatation for restenosis (0.7%).

CONCLUSIONS

After sufficient mobilization of the central airways, postoperative anteflexion of the neck supported by a head cradle is sufficient to prevent excessive anastomotic tension and dehiscence. Considering the risk for severe neurological complications associated with the chin stitch, the routine use of this manoeuvre in laryngotracheal surgery should not be recommended.

Balloon dilation laryngoplasty for acquired subglottic stenosis at a tertiary center in India

To evaluate outcomes of balloon dilation laryngoplasty for laryngeal stenosis. It is a retrospective study done at Civil Hospital Ahmedabad from Feb 2017 to Jan 2019. All patients treated with laryngeal balloon dilation with acquired subglotticstenosis with normal vocal cord mobility. Stenosis severity, Measured using the Cotton and Meyer classification, and McCaffery grading system. A total of 10 patients of acquired subglotticstenosis ranging in age from 16-64 y (5 [50%] with grade II stenos is, 3 [30%] with grade I stenosis, and 2 [9%] with grade IIIstenos is) were included. A total of 10 balloon dilation laryngoplasties were performed, and 9 (90%) were deemed successful. Four of the 5 patients undergoing primary dilation (90%) had successful outcomes, and in the other 1 [10%], outcomes were unsuccessful and required either laryngotracheal reconstruction or tracheotomy. Five balloon dilations were performed as a secondary procedure after recent open surgery; all of the procedures (100%) were successful, and thus surgical revision was avoided. After balloon dilatation,among 7 tracheostomised patients, 6 patient got decannulated. Balloon dilation laryngoplasty is an efficient and safe technique for the treatment of both primary and secondary acquired laryngotrachealstenosis. Minimal intervention with maximum results.

Analysis of 40 patients who underwent tracheal resection due to benign complex tracheal stenosis

BACKGROUND

Benign tracheal stenosis is a common complication in patients followed up in intensive care units. We aimed to analyze the etiology, diagnostic approaches, treatment methods for benign tracheal stenosis, and the predicting factors for complications after tracheal resection for benign stenosis.

MATERIAL-METHOD

Forty patients who underwent tracheal resection reconstruction due to benign tracheal stenosis were analyzed retrospectively. Predictive factors for complications were determined by statistical analysis.

RESULTS

There were 23 patients (57.5%) in the intubation group, 11 patients (27.5%) in the tracheostomy group, and 6 patients (15%) in the subsequent tracheostomy group. Preoperatively, rigid dilatation was applied to all patients between 2 and 6 sessions (median = 3). Tracheal resections were performed in all patients after rigid dilatations. The mean of the resected segment lengths is 32.1 ± 8.8 mm. There was a statistically significant difference between preoperative bronchoscopic measurements, preoperative tomography measurements, and intraoperative measurements of the stenosis segment (ꭓ2 (2) = 71,500; p < 0.001). The patients' mean follow-up period was 27.4 ± 21.7 months (3-84). Mortality due to tracheal surgery and major anastomotic complications were not observed. The minor anastomotic complication rate was 12.5%, the non-anastomotic complication rate was 17.5%. The effect of resection length and surgical experience were found to be statistically significant risk factors for anastomotic complications.

CONCLUSIONS

Rigid dilatation does not provide significant palliation in complex stenosis. Bronchoscopic measurements give closer results than CT measurements in the preoperative estimation of resection length. The risk of anastomotic complications increases when the length of the resection increases and when the surgical experience is less.

Surgical Management of Tracheal Invasion by Well-Differentiated Thyroid Cancer

Simple Summary

Tracheal invasion is a poor prognostic factor in well-differentiated thyroid cancer. Appropriate resection can improve the prognosis and maintain the patient’s quality of life. Shaving resection for superficial tracheal invasion is minimally invasive because it does not involve the tracheal lumen, despite the problematic risk of local recurrence. Window resection for tracheal mucosal and luminal invasion provides good tumor control and does not cause postoperative airway obstruction; however, the need for surgical closure of the tracheocutaneous fistula is a disadvantage of this method. Circumferential (sleeve) resection and end-to-end anastomosis are highly curative, but the risk of fatal complications, such as anastomosis dehiscence, is a concern.

Abstract

Well-differentiated thyroid carcinoma (WDTC) is a slow-growing cancer with a good prognosis, but may show extraglandular progression involving the invasion of tumor-adjacent tissues, such as the trachea, esophagus, and recurrent laryngeal nerve. Tracheal invasion by WDTC is infrequent. Since this condition is rare, relevant high-level evidence about it is lacking. Tracheal invasion by a WDTC has a negative impact on survival, with intraluminal tumor development constituting a worse prognostic factor than superficial tracheal invasion. In WDTC, curative resection is often feasible with a small safety margin, and complete resection can ensure a good prognosis. Despite its resectability, accurate knowledge of the tracheal and peritracheal anatomy and proper selection of surgical techniques are essential for complete resection. However, there is no standard guideline on surgical indications and the recommended procedure in trachea-invading WDTC. This review discusses the indications for radical resection and the three currently available major resection methods: shaving, window resection, and sleeve resection with end-to-end anastomosis. The review shows that the decision for radical resection should be based on the patient’s general condition, tumor status, expected survival duration, and the treating facility’s strengths and weaknesses.

Revision cricotracheal resection: our experience

OBJECTIVE

The incidence of recurrent stenosis after cricotracheal resection is 3-9.5 per cent. Management of such patients is challenging. This study aimed to review our experience in revision cricotracheal resection.

METHODS

The study was conducted in the Otorhinolaryngology Department, Mansoura University Hospitals, Egypt, on nine patients with recurrent stenosis following cricotracheal resection. Revision cricotracheal resection was performed in all patients. Surgiflo was applied on the site of anastomosis to enhance healing.

RESULTS

No intra-operative complications were recorded. Minor post-operative complications occurred in two patients (surgical emphysema and temporary choking); no major complications were reported. Re-stenosis occurred in one patient. Successful decannulation was achieved in eight of the nine patients.

CONCLUSION

Revision cricotracheal resection is the definitive curative treatment for recurrent stenosis after previous unsuccessful resection. It has high success rates, provided that careful pre-operative assessment and meticulous operative technique are performed.

Voice and Swallowing Outcomes Following Airway Reconstruction in Adults: A Systematic Review

OBJECTIVES

Laryngotracheal stenosis is a rare condition characterized by upper airway narrowing. Reconstructive surgical treatment aims to manage the area of stenosis to improve dyspnea and can impact voice and swallowing function. This article critically evaluates the literature about voice and swallowing outcomes in adults with laryngotracheal stenosis who undergo reconstructive surgery.

STUDY DESIGN

Systematic review.

METHODS

Six databases were searched for articles referring to voice and swallowing outcome measures following reconstruction procedures in adults with laryngotracheal stenosis. Screening was completed using predefined inclusion/exclusion criteria.

RESULTS

A total of 143 abstracts were reviewed, with 67 articles selected for full-text review. Twenty studies met the inclusion criteria. Data extraction was completed with the Strengthening Reporting of Observational Studies in Epidemiology checklist with Oxford Centre for Evidence-Based Medicine Level of Evidence used to indicate quality. Risk of bias was assessed using the Risk of Bias Assessment Tool for Non-Randomized Studies. All studies scored a high risk of bias in at least one of the domains. Selection and timing of outcome measures was heterogenous, and there was limited information provided about rationale or reliability.

CONCLUSIONS

The literature acknowledges the importance of voice and swallowing outcomes following airway reconstruction. Studies show correlation between reconstructive surgery and deterioration in vocal function; there are no consistent data about swallowing outcomes. The lack of a core outcome measures set for adults with laryngotracheal stenosis limits the findings of this review. Further research is needed to establish clear criteria for robust and clinically relevant outcome measurement. Laryngoscope, 131:146-157, 2021.

Long-term Results and Functional Outcomes After Surgical Repair of Benign Laryngotracheal Stenosis

BACKGROUND

Laryngotracheal resection and anastomosis (LTRA) is a reliable treatment for benign subglottic laryngotracheal stenosis (BSLTS), but data on functional outcomes are scarce. We assessed the surgical and functional outcomes of LTRA in BSLTS.

METHODS

We retrospectively reviewed consecutive patients who underwent LTRA for BSLTS in 2007 to 2018. The 30-day outcomes were mortality, complications, and success rate. At the last follow-up, patients completed functional questionnaires (visual analog scale [VAS] and modified Medical Research Council scale for dyspnea, a VAS for swallowing, and the Voice Handicap Index) and assessed quality of life.

RESULTS

Of 43 patients with BSLTS, 28 underwent the modified Pearson technique, and 15 Grillo's procedure. During the first 30 days, no patients died, the postoperative complication rate was 44%, and the success rate was 95%. After a mean follow-up of 53 months in 38 patients (88%), 7 patients had restenosis and 36 had late surgical success (95%). In the 34 patients who completed the questionnaires (79%), mean VAS dyspnea scores decreased significantly during rest (-5.4 ± 4.2) and exercise (-5.6 ± 4.4) (P < .001). A trend toward a decrease in modified Medical Research Council scale was found (P = .057; grade 0 in 62% of patients). The Voice Handicap Index indicated that voice impairment was absent to moderate in 30 patients (88%) and severe in 4 (12%). The VAS dysphagia scores were not significantly different before and after surgery. Quality of life gains were reported by 85% of patients.

CONCLUSIONS

Laryngotracheal resection and anastomosis for BSLTS is safe and provides excellent surgical and functional outcomes with an improved quality of life. Laryngotracheal resection and anastomosis is a valid treatment option for BSLTS.

Challenging tracheal resection anastomosis: Case series

OBJECTIVES

This study was conducted to review our experience in Otorhinolaryngology Department, Mansoura University Hospitals, Egypt, in the last 2 years in the management of high-risk patients who underwent cricotracheal resection due to different pathologies.

METHODS

This case series included nine patients with severe, grade III or IV subglottic / cervical tracheal stenosis. These patients were considered high risk patients due to unusual pathology / etiology of stenosis or associated surgical field morbidity. Four patients had recurrent stenosis after previous unsuccessful cricotracheal resection, three patients had subglottic stenosis due to external neck trauma which compromised the surgical field. One patient had upper tracheal neoplasm, and in 1 patient there was upper tracheal stenosis associated with tracheo-esophageal fistula.

RESULTS

Successful decannulation was achieved in all patients (n = 9) without any reported major intraoperative or postoperative compilations.

CONCLUSION

Cases of subglottic / upper tracheal stenosis due to uncommon pathologies like neoplastic lesions, external neck trauma compromising the surgical field and revision cricotracheal resection, can be successfully managed by cricotracheal resection. However, a highly skilled team, well familiar with these surgeries, is mandatory to achieve an optimum outcome.

The role of interventional bronchoscopy in the management of post-intubation tracheal stenosis: A 20-year experience

PURPOSE

Benign tracheal stenosis management is still controversial, and there is no international consensus on the best treatment option. Thus, we aimed to look into the history of PITS and the different strategies used in its treatment. The importance of bronchoscopic treatment was also defined, and its effectiveness and safety were assessed.

METHODS

Retrospective study of patients diagnosed with PITS, who were referred to the Bronchology Department between January 1996 and December 2016.

RESULTS

Of 115 patients enrolled (mean age 48.5±17.6 years, 53% males), 66.1% had complex stenosis. The most common causes of intubation were respiratory (29.9%), neurological (26.8%) and surgical (19.6%). Complex stenosis was caused by longer intubation, and was more frequent among previously tracheostomized patients. The most common location was the upper third of trachea (60.9%). Most cases were initially treated by interventional bronchoscopy, and although serial dilations were effective in some complex PITS, a higher proportion of simple stenosis was successfully managed with this treatment option. Long-term recurrence after serial dilation was observed in 25.0% of cases. Stent placement was required (19.1%) only for complex PITS. Stent-related complications were frequent (61.9%) and linked to the stenting time (p<0.001). Overall, there were no procedure-related complications. Surgical intervention was also performed (30.0%), always with complex PITS. Post-surgical recurrences were observed in 24.2% of cases.

CONCLUSIONS

Interventional bronchoscopy is an efficient and safe modality in PITS management. Further studies are needed for better classification and improved knowledge of PITS pathogenesis, and to achieve international consensus of definition to guide clinicians in their practice.

Multicentric study applying the european laryngological society classification of benign laryngotracheal stenosis in adults treated by tracheal or cricotracheal resection and anastomosis

OBJECTIVES/HYPOTHESIS

Introduction and widespread use of cricotracheal resection and anastomosis (CTRA) as routine treatment for high-grade benign laryngotracheal stenosis (LTS) led to the need for a new classification system that could accurately predict surgical outcomes by integrating crucial stenosis and patient-related information. In 2015, the European Laryngological Society (ELS) proposed a new classification for benign LTS. We retrospectively tested it in adults treated at three referral centers to assess its reliability in predicting surgical outcomes.

STUDY DESIGN

Retrospective cohort study.

METHODS

We included 166 adults treated by open tracheal resection and anastomosis (TRA) and CTRA procedures, restaged according to the ELS classification evaluating grade of stenosis (I-IV, Myer-Cotton), number of subsites involved, and presence of systemic comorbidities. We correlated these parameters with decannulation, number of retreatments, and complications.

RESULTS

Final decannulation was predicted by a proposed ELS score ≥ IIIb, history of previous treatment, and length of resection (P < .05). Decannulation was achieved in 99% of patients without and in 88% of patients with surgical complications (P < .01). The incidence of surgical complications was related to the proposed ELS score (P < .01); an ELS score < IIIb showed a lower complication rate compared to patients with a ≥ IIIb score (32.8% vs. 57.7%, P < .01). Additional treatment was required in 73 (44%) patients (mean = 2.7 ± 2.2, range = 1-11). ELS score ≥ IIIb, length of resection, and occurrence of surgical complications predicted the number of such treatments (P < .05, P < .05, and P < .001, respectively).

CONCLUSIONS

ELS classification of benign LTS is able to accurately predict success in adult TRA/CTRA procedures and may be helpful in choice of therapy and patient counseling.

LEVEL OF EVIDENCE

2b Laryngoscope, 130:1640-1645, 2020.

Laryngo-tracheal resections in the Nordic countries: an option for further centralization?

PURPOSE

We aimed to obtain information on the number of Nordic centers performing tracheal resections, crico-tracheal resections, and laryngo-tracheal reconstructions, as well as the patient volume and the standard regimens associated with these procedures.

METHODS

Consultants at all Departments of Otorhinolaryngology-Head and Neck Surgery (ORL-HNS, n = 22) and Thoracic Surgery (n = 21) in the five Nordic countries were invited (April 2018-January 2019) to participate in an online survey.

RESULTS

All 43 departments responded to the survey. Twenty departments declared to perform one or more of the three types of tracheal resections. At five hospitals, departments of ORL-HNS and Thoracic Surgery perform these operations in collaboration. Hence, one or more of the tracheal operations in question are carried out at 15 centers. The median annual number of tracheal operations per center is five (range 1-20). Great variations were found regarding contraindications (relative and absolute) for surgery, the use of guardian sterno-mental sutures (all patients, 33%; selected cases, 40% of centers), prophylactic antibiotic therapy (cefuroxime +/- metronidazole, penicillin +/- metronidazole, clindamycin, imipenem, or none), post-operative follow-up time (range: children: 3-120 months; adults: 0-60 months), and the performance of post-operative bronchoscopy.

CONCLUSIONS

Fifteen centers each perform a low number of annual operations with significant variations in the selection of patients and the clinical setup, which raises the question if a higher degree of collaboration and centralization would be warranted. We encourage Nordic transnational collaboration, pursuing alignment on central management issues, and establishment of a common prospective database for future tracheal resection surgery.

State of the art in tracheal surgery: a brief literature review

Background

Tracheal surgery requires a highly specialized team of anesthesiologists, thoracic surgeons, and operative support staff. It remain a formidable challenge for surgeons due to the criticality connected to anatomical considerations, intraoperative airway management, technical complexity of reconstruction, and the potential postoperative morbidity and mortality.

Main body

This article focuses on the main technical aspects and literature data regarding laryngotracheal and tracheal resection and reconstruction. Particular attention will be paied to anastomotic and non-anastomotic complications.

Short conclusion

Results from literature confirm that, when feasible, laryngotracheal and tracheal resection and reconstruction is the treatment of choice in cases of benign stricture and malign neoplasm. Careful patient selection, operative planning, and execution are required for optimal results.

Prophylaxis and Treatment of Complications After Tracheal Resection

Tracheal resections are major surgical procedures with a complication rate as high as 44%. Early detection of complications followed by a structured and expedited course of action is critical for achieving a successful outcome. The prevention of complications after tracheal resection starts with a correct indication for resection. A thorough preoperative evaluation, meticulous surgical technique, and good postoperative care in a center that performs airway surgery routinely are important factors for achieving good results.

Single-stage tracheal and cricotracheal segmental resection with end-to-end anastomosis: Outcome, complications, and risk factors

OBJECTIVE

Management of tracheal stenosis remains controversial. Endoscopic interventions commonly provide immediate relief of symptoms, but are associated with high recurrence rates. In contrast, high success rates have been reported in patients undergoing tracheal resection. However, well-defined indications and contraindications for tracheal resection are lacking and previous studies commonly ignore patient-related outcomes (e.g. dyspnoea). We aimed to evaluate the outcome of tracheal resection at our institution and identify risk factors for complications.

METHODS

All adult patients undergoing tracheal resection at Aarhus University Hospital between January 2009 and September 2016 were included RESULTS: Twenty-seven patients were included. The most frequent aetiologies for tracheal stenosis were previous tracheostomy (n=8), prolonged intubation (n=3), a combination of the two (n=5), and intraluminal tumour (n=7). Sixteen patients underwent high tracheal resection, seven patients low tracheal resection, and four patients partial cricotracheal resection. Surgical success (no dyspnoea and no need for additional intervention) was achieved in 74% of patients. Four of six patients undergoing resection because of malignant disease were recurrence-free during the follow-up period. Fifteen (56%) patients suffered complications (transient or permanent). Four (15%) patients had recurrent stenosis and underwent reintervention. Other permanent complications included idiopathic hoarseness (15%), unilateral recurrent nerve palsy (11%), and dysphagia (7%). Previous treatment (endoscopic and open surgery) (OR=5.5, p=0.06) and chronic diseases (OR=8.3, p=0.02) were associated with increased risk for complications.

CONCLUSIONS

Tracheal resection was efficient treatment for the alleviation of dyspnoea in adults with tracheal stenosis. However, complications were frequent and careful preoperative patient selection and information are crucial.

Prevention and management of complications following tracheal resections-lessons learned at the Massachusetts General Hospital

Tracheal surgery has developed and evolved over the last 50 years, becoming an integral part of the clinical practice of modern thoracic surgeons. Today, surgeons can safely and effectively operate on most patients suffering from post-intubation tracheal stenosis, tracheal tumors and other pathologies that result in an abnormal shape and function of the central airways. The Massachusetts General Hospital (MGH) in Boston witnessed first-hand the birth and growth of tracheal surgery under Dr. Hermes Grillo, becoming a reference center and accumulating one of the largest institutional experiences in the world. This vast experience of the management of patients with tracheal pathologies has allowed our group at MGH to refine the care of these patients, including their judicious preoperative evaluation, meticulous surgical treatment, and dedicated postoperative care. However, this experience has also provided valuable lessons on the potential complications that can arise after tracheal surgery. Here, we attempt to accumulate our institutional knowledge and experience to provide a summary of the key aspects to prevent complications following tracheal resections. Unfortunately, complications can occur despite strict adherence to the core principles of tracheal surgery, and therefore, we also highlight our institutional experience with the early recognition and management of the most common and dreaded complications.

Concentric photothermal coagulation with basket-integrated optical device for treatment of tracheal stenosis

A basket-integrated optical device is developed to consistently treat tubular tissue by centering an optical diffuser in the lumen. Four nitinol arms in conjunction with the optical diffusing applicator are deployed to induce homogeneous circumferential light emission and concentric photothermal coagulation on tracheal tissue. A 1470-nm laser light is employed for the tissue testing at various irradiation conditions and evaluated in terms of thermal gradient and temperature evolution. Preliminary experiments on liver tissue demonstrate the concentric development of the radial thermal coagulation in the tissue (eccentric ratio = ~5.5%). The interstitial tissue temperature increases with the total amount of energy delivery (around 65°C). Ex vivo trachea testing yields up to 16.5% tissue shrinkage due to dehydration as well as uniform ablation of the cilia and goblet cells in a mucosa layer under 7-W irradiation for 10 s. The proposed optical device may be a feasible therapeutic method to entail the circumferential coagulation in the tubular tissues in a reliable manner.

Subglottic tracheal stenosis

Benign subglottic stenosis represents a major therapeutic challenge. Interventional bronchoscopic treatment has a limited role in this setting due to anatomical and technical reasons. The benefit with these techniques is generally temporary, due to frequent recurrences, need for repeated procedures and risk of extending the area of damage. Laryngotracheal resection is at present the curative treatment of choice. Literature data show that surgical treatment may allow very high success rates at long term with low perioperative morbidity and mortality. Technical aspects and results are reported and discussed.

Complications After Tracheal and Cricotracheal Resection and Anastomosis for Inflammatory and Neoplastic Stenoses

Objective:

This study aimed to evaluate complications and success rates of tracheal resection and anastomosis (TRA) and cricotracheal resection and anastomosis (CTRA) in patients treated in 2 academic institutions.

Methods:

Retrospective charts review of 137 patients submitted to TRA/CTRA. Fifty (36.5%) had neoplastic (group A) and 87 (63.5%) benign (group B) stenoses. Using univariate analysis, age, medical comorbidities, previous radiotherapy, type of TRA/CTRA, association with neck dissection and thyroidectomy, length of resected airway, and preoperative tracheotomy were evaluated to identify factors predictive of complications and outcomes.

Results:

The mean length of resected airway was 2.7 and 3 cm in groups A and B, respectively. Overall decannulation and complication rates for group A were 96% and 36%, and 99% and 46% for group B, respectively. Length of airway resected and presence of preoperative tracheotomy had a statistically significant effect on major surgical complications. Age older than 70 and cardiovascular and pulmonary comorbidities were significantly associated with the incidence of major medical complications. No statistically significant difference was found considering the complication rates of group A versus group B.

Conclusion:

Even though the overall success rate of TRA/CTRA is high, it should always be regarded as a major surgical procedure with a non-negligible incidence of complications.

Predictors for postoperative complications after tracheal resection

BACKGROUND

Tracheal resection and anastomosis is the gold standard for the treatment of tracheal stenosis. The objective of this study is to evaluate the complications after tracheal resection for benign stenosis and the predicting factors for such complications.

METHODS

A retrospective study was made involving patients with benign tracheal or laryngotracheal stenosis who underwent surgical resection and reconstruction between February 2002 and January 2009. Complications related and unrelated to the anastomosis were studied. Categorical variables were presented as percentage and continuous variables as mean and standard deviation. Predicting factors were determined by univariate analysis. Factors with p less than 0.05 were used for multivariate regression. Logistic regression models were also employed for dependent variables. Statistical significance was set for p less than 0.05.

RESULTS

Ninety-four patients (18 female, 76 male) were included. Complications occurred in 42 (44.6%). Twenty-one percent had anastomotic complications. The most common complication was restenosis (16%). Nonanastomotic complications occurred in 23.2%. Wound infection occurred in 10.6%. Clinical comorbidities, previous tracheal resection, and the length of tracheal resection were statistically significant factors for complications. Previous tracheal resection was the most significant factor and was highly associated with anastomotic complications (odds ratio 49.965, p=0.012). The greatest number of complications was found in the laryngotracheal reconstruction group, and in resections more than 4 cm. Mean follow-up was 19±14 months. At the end of the study, 86 patients (91.4%) were breathing normally. There was no mortality in this series.

CONCLUSIONS

Comorbidities, previous tracheal resection, and the length of tracheal resection more than 4 cm were statistically significant factors for the onset of complications.

Surgical treatment of non-malignant laryngotracheal stenosis

The objectives of this study were the following: (1) to analyze the results of surgical treatment of non-malignant subglottic laryngeal and tracheal stenosis, (2) to evaluate the feasibility and technical aspects of the video mediastinoscopy for the mobilization of the mediastinal trachea, (3) to evaluate the influence of the early internal condition of the anastomosis on the development of restenosis. From 1996 up to 2013, 75 patients aged 11-78 years underwent surgery for post-intubation/tracheostomy (71 patients), post-traumatic (3 patients), and idiopathic (1 patient) subglottic laryngeal and tracheal stenosis. Twenty-three (30.7 %) patients with subglottic laryngeal and upper tracheal stenosis underwent cricotracheal resection and thyrotracheal anastomosis (group A), while 52 (69.3 %) patients with tracheal stenosis underwent tracheal resection and cricotracheal or tracheotracheal anastomosis (group B). The length of the resected segment in patients of groups A and B was 28-55 (42 ± 11) mm and 18-65 (36 ± 14) mm, respectively, (p = 0.22). Perioperative complications within 30 days occurred in eight (34.8 %) patients of group A, and in six (11.5 %) patients of group B (p = 0.04). There was one intraoperative and one postoperative death on the third day due to heart failure. The excellent results were achieved in 63 (86.3 %), satisfactory in 8 (11.0 %), and unsatisfactory in 2 (2.7 %) patients. The incidence rate of perioperative complications is related to the location of the stenosis and the type of the resection and anastomosis. Video mediastinoscopy simplifies the mobilization of the mediastinal trachea, which allows for carrying out the anastomosis with minimal tension. Early internal abnormalities of the anastomosis predict its restenosis.

Postintubation laryngotracheal stenosis: assessing the success of surgery

OBJECTIVE

This study evaluated the outcome in adult patients with laryngotracheal stenosis (LTS) and assessed the effect of procedures on their quality-of-life scores.

METHODS

The study included 15 adult patients with LTS (11 males [73.3%], 4 females [26.7%]; mean age, 32 years [range, 10-52 years]) treated at the Department of Otolaryngology Head and Surgery Clinic, İzmir Atatürk Research Hospital, Turkey, from 1997 to 2008. Success of the surgery is evaluated by decanullation rate, Short form-36 (SF-36), and the Medical Research Council dyspnea scale.

RESULTS

The etiology of the LTS was intubation related in 14 cases (93.3%) and idiopathic in 1 case. According to the Myers-Cotton classification, 2 (13%), 8 (54%), and 5 (33%) patients were at stages 2 to 4, respectively. Fourteen patients had a mean follow-up of 57 months (range, 24-256 months). The stenotic segment involved 1 to 3 cm (mean, 1.7 cm) of trachea, and 2 to 5 tracheal rings (mean, 3.1) were resected. Postoperative decannulation was achieved in 13 patients (86.6%). In the short form-36 questionnaire, all of the parameters except for "role-emotional" were found to be significant (P < 0.01). The Medical Research Council dyspnea scale assessment revealed a significant (P < 0.001) decrease postoperatively.

CONCLUSIONS

Segmental resection with primary anastomosis is an effective method and can be used as the first option in selected cases of advanced stenosis.

Tracheobronchial stenosis: causes and advances in management

Tracheobronchial stenosis, narrowing of the airways by neoplastic or nonneoplastic processes, may be focal, as occurs with postintubation tracheal stenosis or a focal narrowing from a tumor, or more diffuse, such as those caused by inflammatory diseases. Symptoms develop when the narrowing impedes flow and increases resistance within the airways. Computed tomography defines the extent and severity of disease; endoscopy facilitates understanding of the cause so that an algorithm for treatment can be devised. Bronchoscopic interventions include balloons, ablative treatment, and stenting to provide symptomatic relief. Surgical resection may be curative and a multidisciplinary approach to tracheobronchial stenosis is required.

Customized tracheostomy cannula as a therapeutic adjunct in tracheal stenosis

Tracheotomy is often successfully used to manage tracheal stenosis, as a temporizing measure prior to definitive treatment or a long-term remedy. In some patients, where a sizeable portion trachea is stenotic, the fixed arm of an ordinary tracheotomy tube may not be of sufficient length to satisfactorily maintain the distal tracheal lumen, and commercially available adjustable tubes may not be at hand in certain clinical settings. Herein, we describe a simple method of constructing a temporary tracheotomy tube with an adjustable distal arm, allowing custom fit at the patient bedside.

Outcome of surgical treatment for proximal long segment post intubation tracheal stenosis

BACKGROUND

Post intubation long segment tracheal stenosis is a serious problem which usually requires multiple methods of treatment. The aim of this study was to evaluate the results of surgical treatment in long segment post intubation tracheal stenosis.

METHODS

Between 2004 to 2008, 20 patients with proximal long segment tracheal stenosis and resection of over 40% of tracheal length, were analyzed in terms of age, sex, clinical symptoms, etiology of stenosis, length of stenosis and resection, role of suprahyoeid release with bilateral hyoeid bone cutting maneuver, post operative complications and life quality 3 year after surgery.

RESULTS

M/F was 2/5, with the average age of 23.5 ± 0.5 years. Average length of stenosis was 4.2 ± 0.4 cm and the average length of resected segment was 5.2 ± 0.4 cm. Early postoperative complications occurred in 4 patients (20%), 5 patients (25%) had late stenosis and 4 of them were treated with multiple dilation and one patient needed tracheostomy and prolonged T. tube. We didn't have any mortality. 80% of patients had excellent surgical results in follow up period.

CONCLUSION

Surgery is the best method of treatment in long and multi segment tracheal stenosis.

Surgical management of scleromatous laryngotracheal stenosis

OBJECTIVE

Scleroma is a chronic specific granulomatous disease of the upper respiratory tract caused by Klebsiella Rhinoscleromatis. It usually affects the subglottic region and upper trachea resulting in various degrees of stenosis. Patients with laryngotracheal stenosis may present with stridor, shortness of breath or exercise intolerance and may be tracheostomy dependent. In this work, we presented the experience of our Institute in the management of patients with scleromatous laryngotracheal stenosis using the already designed procedures for traumatic laryngotracheal stenosis.

PATIENTS AND METHODS

The study was a non controlled prospective study. It was conducted in Oto-Rhino-Laryngology and Head and Neck Surgery Department of Zagazig University Hospitals, Egypt. It included 38 patients with scleromatous subglottic stenosis and/or upper tracheal stenosis. The patients were classified into four grades according to Myer-Cotton's scale. The surgical treatment modalities included endoscopic CO2 laser surgery with dilatation, laryngotracheal reconstruction, and partial cricotracheal resection with thyrotracheal anastomosis.

RESULTS

The average follow-up period was 32.1 months. Twenty four patients (63%) had an excellent outcome. Nine patients (24%) had a good outcome. Five patients (13%) were still tracheostomy dependent. Eleven patients (29%) developed postoperative granulation tissue. The overall success rate was 87%.

CONCLUSION

Scleromatous laryngotracheal stenosis is considered a challenging surgical problem. It requires a multidisciplinary approach by well-trained personnel. The surgical techniques designed for cases of laryngotracheal stenosis of a traumatic etiology can be applied for cases of scleroma with approximately the same success rates.

The effect of cartilaginous reinforcing sutures on initial tracheal anastomotic strength: a cadaver study

OBJECTIVE

During tracheal resection with primary anastomosis, cartilaginous reinforcing sutures may be placed outside of the primary anastomosis with the goal of preventing early dehiscence. The direct effect of such reinforcing sutures on anastomotic strength has not been previously investigated. The goal of this study was to determine if the addition of cartilaginous reinforcing sutures adds to tracheal anastomosis stability.

STUDY DESIGN

Prospective cadaver study.

SETTING

This research was conducted at an anatomy lab at Indiana University School of Medicine.

SUBJECTS AND METHODS

Twelve cadaver tracheas were harvested. Each trachea was bifurcated, with 1 segment of each trachea transected and anastomosed using circumferential sutures and the remaining tracheal segment undergoing the same procedure with the addition of cartilaginous reinforcing sutures. Segments (proximal versus distal) were alternated to control for potential anatomic-based strength differences. The force necessary for anastomotic rupture was measured, and a Wilcoxon signed-rank test was used to compare means.

RESULTS

Analysis demonstrated the mean anastomotic rupture point for tracheas with reinforcing sutures was 297 N (95% confidence interval = 241.1-352.9), while the mean for trials without reinforcing sutures was 173 N (95% confidence interval = 142.63-203.37; P = .0054). The point of rupture occurred at the anastomosis in 1 case with reinforcing sutures and in 8 of 11 cases without reinforcing sutures.

CONCLUSIONS

Cartilaginous reinforcing sutures were found to provide a higher force requirement for tracheal anastomotic rupture when compared with anastomoses without these sutures. This improved stability in tracheal anastomosis may result in a decreased risk of early tracheal rupture after anastomosis.

Late complications of nickel-titanium alloy stent in tracheal stenosis

OBJECTIVES/HYPOTHESIS

To investigate and treat the late complications of using nickel-titanium alloy stents in laryngotracheal, bronchial, and esophageal stenosis patients who developed severe laryngotracheal stenosis (SLS).

STUDY DESIGN

Retrospective clinical study.

METHODS

Thirteen patients with SLS or tracheoesophageal fistula secondary to insertion of a nickel-titanium alloy stent for treatment of laryngotracheal, bronchial, or esophageal stenosis treated between May 2004 and March 2010 were retrospectively analyzed. Of the 13 total patients, nine had one stent placed, and four had two stents placed. The late complications observed were glottic and/or subglottic extension of cervical tracheal stenosis (n = 6), new stricture of the thoracic trachea (n = 4), severe left bronchial stricture with massive left pulmonary collapse (n = 1), and cervical tracheoesophageal fistula (n = 2).

RESULTS

Six patients with glottic and/or subglottic to cervical tracheal stenosis underwent successful laryngotracheal reconstruction. Two patients with subglottic and upper thoracic tracheal stenosis were successfully treated by staged operation for the stenosis. Two patients with subglottic and distal thoracic tracheal stenosis are still undergoing treatment. One patient with severe left bronchial stricture and massive left pulmonary collapse has been treated but has not achieved full recovery. One patient with cervical tracheoesophageal fistula underwent successful repair but died later from metastatic disease. One patient with tracheoesophageal fistula died from massive hemorrhage and asphyxiation induced by the stent, which had not been removed.

CONCLUSIONS

The nickel-titanium alloy stents should be used with extreme caution in patients with laryngotracheal, bronchial, or esophageal stenosis treatment that can be corrected by surgical therapy.

Laryngotracheal stenosis: clinical profile, surgical management and outcome

Despite the availability of various surgical options, management of laryngotracheal stenosis (LTS) still remains an enigma. Proper selection of surgical technique in each clinical setting is the key for successful outcome. The purpose of this article is to guide one in selection of appropriate surgical procedures depending upon various stenosis parameters. Aim To record the clinical profile of cases with LTS. To assess the outcome following various surgical interventions based on site, severity, cause of stenosis and to derive conclusions regarding treatment options in various stenosis. Materials and Methods It is a study of 60 cases with chronic LTS. It includes retrospective study of 30 cases treated from 2004 and prospective study of 30 cases from Jan 2007 to Dec 2009. A total of 60 cases with LTS were enrolled in the study. Patients were assessed clinically by eliciting detailed history and analyzing previous records. After assessment of extent of stenosis, they were subjected to surgical interventions (endoscopic/open approach). Outcome after surgical interventions was assessed. Results 60 patients were included in the study, in the age group of 2.5-50 years. There were 46 (77%) male patients and 14 (23%) female patients. Intrinsic trauma, secondary to prolonged intubation was the most common cause of LTS, seen in 23 (38%) cases followed by post traumatic stenosis (strangulation-18 (30%), blunt injury-15 (25%), penetrating neck injury-4 (7%)). Stenosis was divided into 6 types based on subsite involvement. Of which, cervical trachea was the commonest site of involvement (25/60 cases). Majority of cases had fixed vocal cords at presentation (55%), more commonly due to post traumatic injury. 60 cases had undergone a total of 110 surgical procedures (endoscopic-56,open approach-54). In the end, overall decannulation rate is 93.3%. In site wise tracheal stenosis, isolated subglottis, combined glottis and subglottic stenosis had decannulation rate of 100% each and with mobile vocal cords, the success rate is 96%. Conclusions Post traumatic stenosis with fixed vocal cords is more common in our practice. Categorizing stenosis into various subtypes helps in treatment planning and predicts surgical outcome. Tracheal or subglottic stenosis with mobile vocal cords has better success rate.

An experimental model to investigate initial tracheal anastomosis strength

OBJECTIVES/HYPOTHESIS

Early anastomotic dehiscence is a devastating complication of segmental tracheal resection. Although wound healing, patient comorbidities, and anastomotic tension are all influential factors, there is a paucity of information available on initial tracheal stability after various tracheal anastomosis techniques in human tissue.

STUDY DESIGN

Prospective cadaver study.

METHODS

We present a novel, inexpensive pulley-based system to apply symmetric tension on the trachea in a longitudinal direction to the point of anastomotic dehiscence. The validity of this mechanism was confirmed with trials using incrementally increasing quantities of the same suture type. Twenty-four trials were then performed on 12 cadaver tracheas (six fresh and six preserved) to compare anastomotic strength with two commonly used suture materials (3-0 polyglactin [Vicryl] vs. 3-0 polydioxanone [PDS]).

RESULTS

Validation studies demonstrated that the force increased appropriately with an increasing number of sutures tested. In the tracheal anastomoses, tracheal suture pull-through was the most common mechanism of dehiscence, regardless of suture type. No significant difference in anastomotic stability was detected between the fresh versus preserved cadaver tracheas. The mean anastomotic strength was slightly greater for Vicryl (179.9 N) when compared to PDS (161.5 N), but the difference did not reach significance (P = .207).

CONCLUSIONS

We introduce an inexpensive tool for measuring initial tracheal anastomosis stability with human cadavers, which demonstrated no difference in the tracheal pull-through strength of Vicryl and PDS.

[Experiences with treatment of extended laryngo-tracheal stenosis with employment of transversal resection of trachea]

The aim of this study is to evaluate the results obtained in Department of Otolaryngology et Oncology with transversal resection of trachea acc. to Pearson technique for postintubation stenosis.

METHODS

from January 2000 to January 2008 ten patients with subglottic postintubation stenosis underwent surgical treatment, using Pearsons method of operation with preservation of recurrent nerves and no postopereative tracheostomy. Mean stenosis length was 2 cm, the length of of airway resection was 1,5-4 cm.

RESULTS

There was no surgical or postoperative complications, all the patients get totally health, no restenosis was observed. The results confirm that the Pearsons method of operation is an adequate treatment for subglottic stenosis.