Operative and non-operative treatment of benign subglottic laryngotracheal stenosis

Ciccone, Anna Maria; Giacomo, Tiziano De; Venuta, Federico; Ibrahim, Mohsen; Diso, Daniele; Coloni, Giorgio F.; Rendina, Erino Angelo

doi:10.1016/j.ejcts.2004.06.020

Cited by 69 publications

(73 citation statements)

References 17 publications

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“…Major series of laryngotracheal resections published in literature [3][4][5][6][7][8][9][10][11] report good results rates ranging between 87% and 100%, and almost no mortality (generally under 1%), thus affirming the role of surgery as the treatment of choice.…”

Section: Discussionmentioning

confidence: 99%

“…Therefore, in our experience [8], we have preferred to treat patients with high surgical risk or non-stabilized stenosis using laser resection and/or endoluminal stenting, in order to avoid tracheostomy.…”

Section: Discussionmentioning

confidence: 99%

“…Endoscopic treatment modalities, including laser and stenting, whose application in tracheal surgery has greatly increased in the last years, have a limited role in subglottic stenosis due to anatomic and technical reasons [8]. The latter techniques are therefore mainly employed to stabilize the stenosis before surgical resection or to achieve an acceptable palliation in patients not suitable for surgery; the benefit is however temporary and endoscopic controls and repeated procedures are often necessary [12,13].…”

Section: Introductionmentioning

confidence: 99%

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Long-term results of laryngotracheal resection for benign stenosis☆

D’Andrilli¹,

Ciccone²,

Venuta

et al. 2008

European Journal of Cardio-Thoracic Surgery

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Objective: We report the long-term results of our 16-year experience with laryngotracheal resection for benign stenosis. Methods: Between 1991 and 2006, 35 consecutive patients (19 males, 16 females) underwent laryngotracheal resection for subglottic postintubation (32) or idiopathic (3) stenosis. Mean age was 43 years (range 14-71). At the time of surgery 13 patients presented with tracheostomy and 7 with a Dumon stent. The upper limit of the stenosis was from 0.6 to 1.5 cm below the vocal cords. The length of airway resection ranged between 1.5 and 6 cm. Suprahyoid release was performed in two patients and pericardial release in one. Nine patients had psychiatric and/or neurological post-coma disorders. Mean follow-up is over 5 years (61 months; range 3-194). Results: There was no perioperative mortality. Thirty patients (85.7%) had excellent or good anatomic and functional results. Four patients (11.4%) presented restenosis at a distance of 25-110 days from the operation. Restenosis was successfully treated by endoscopic procedures in all four patients. One patient (2.9%) presented anastomotic dehiscence that required temporary tracheostomy closed after 1 year with no sequelae. Three patients (8.4%) had wound infection. Long-term follow-up was uneventful also in patients who had early complications. Conclusions: Long-term follow-up confirms that laryngotracheal resection is the definitive curative treatment for benign subglottic stenosis. Surgical complications can be successfully managed by non-operative procedures. Despite the occurrence of early complications, excellent and stable results can still be obtained at long term. #

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Long-term results of laryngotracheal resection for benign stenosis☆

D’Andrilli¹,

Ciccone²,

Venuta

et al. 2008

European Journal of Cardio-Thoracic Surgery

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show abstract

“…It extends from the inferior margin of the vocal cords to the lower border of the cricoid cartilage. Interventional bronchoscopic treatment modalities including laser and stenting, whose application in tracheal surgery has greatly increased in recent years, have a limited role in subglottic stenosis due to anatomic and technical reasons [6]. These techniques are therefore mainly employed to stabilise the stenosis before surgery or to achieve an acceptable palliation in patients who are not suitable for surgery.…”

Section: Subglottic Resectionsmentioning

confidence: 99%

Tracheal surgery

D’Andrilli

Rendina

Venuta

2016

Monaldi Arch Chest Dis

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Surgical resection and reconstruction of the trachea can be performed both for benign and malignant diseases. The main indications for surgery include inflammatory (generally post-intubation), congenital or post-traumatic stenoses, degenerative lesions, benign or malignant neoplasms. Success can be pursued only by accurate patient selection and timing, meticulous surgical techniques, careful follow up and, when required, multidisciplinary cooperation. Although surgical resection has now become part of our surgical practice, other treatment modalities are approaching a new clinical application era, in particular tracheal transplantation and bioengineering. These new techniques will certainly offer, in the near future, improved chances to treat difficult cases.

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“…Several treatment modalities have been used, ranging from less invasive procedures, such as sequential airway dilatation, laser treatment and stent placement, to major airway surgical resection and reconstruction. [6][7][8] Although dilatation and laser treatment are safe, well tolerated procedures, they usually result in only temporary improvement of symptoms; recurrence is frequent, requiring repeated procedures without a definitive result. Tracheal resection is well established as the definitive treatment for benign tracheal stenosis and has been shown to yield excellent results in selected patients.…”

Section: Introductionmentioning

confidence: 99%

Cervical tracheal resection with cricotracheal anastomosis: experience in adults with grade III–IV tracheal stenosis

et al. 2010

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Introduction: Laryngotracheal stenosis is currently one of the most common complications associated with nasal and orotracheal intubation and tracheotomy. Once established, tracheal stenosis can be a complex and difficult problem to manage.Patients and methods: We retrospectively analysed 2004-2010 data for 12 male patients with postintubation cervical tracheal stenosis (grade III-IV) treated in the otolaryngology department, Mansoura University Hospitals. All patients had a tracheostomy at presentation, and all underwent tracheal resection with primary cricotracheal anastomosis and suprahyoid release.Results: Grade III stenosis was present in five patients (41.7 per cent) and grade IV stenosis in seven patients (58.3 per cent). The length of trachea resected ranged from 2 to 4 cm, representing one to four tracheal rings. In all 12 patients, the procedure allowed successful tracheotomy decannulation. Minor complications comprised surgical emphysema (n = 2) and wound infection (n = 1), and were managed conservatively. Major complications consisted of restenosis (n = 3), managed in two patients by repeated dilatation; one patient was lost to follow up.Conclusion: Segmental tracheal resection with cricotracheal anastomosis was successful in 11/12 (92 per cent) patients with severe cervical tracheal stenosis. The strategy for treatment of airway stenosis is now well established and success rates are high, with minimal or no sequelae.

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Operative and non-operative treatment of benign subglottic laryngotracheal stenosis

Abstract: Laser resection and endoluminal stenting can be a viable alternative to surgery or optimize the timing of operation in patients with subglottic stenosis.

Cited by 69 publications

References 17 publications

Long-term results of laryngotracheal resection for benign stenosis☆

Long-term results of laryngotracheal resection for benign stenosis☆

Tracheal surgery

Cervical tracheal resection with cricotracheal anastomosis: experience in adults with grade III–IV tracheal stenosis

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