[Therapeutic approach and results in the treatment of subglottic tracheal stenosis]

R Jović, B Baros
Medicinski Pregled 2000, 53 (7): 349-53

INTRODUCTION: We had the opportunity to treat upper respiratory tract stenosis, so the aim of this paper was to present results of treatment of subglottic and upper tracheal stenosis in our clinical material.

MATERIAL AND METHODS: Retrospective study included a period of 5 years (1990-1995), and evaluated results of treating 11 patients with subglottic laryngeal stenosis--with stenosis of proximal tracheal part. There were 6 females and 5 males ranging from 2-65 years of age. Nine patients had postintubational stenosis, one patient had corrosive injury, and one had congenital stenosis which occurred in older age. Apart from two patients, the rest were already treated in other institutions in our country (1-6 times) where they underwent laser (6 patients) or open surgical resection (3 patients). Diagnosis of stenosis was based on laryngotracheoscopy, laryngotracheal tomography, and CT.

RESULTS: The patient with congenital subglottic stenosis underwent resection with laryngomicroscopy. Two weeks later, she was decannulated, having good breathing and voice. Two youngest patients, aged 2 and 10 years, underwent dilatation of upper tracheal part and subglottic stenosis, followed by Montgomery T tube placement. The two-years-old boy had the tube for 26 months. During that period, his tube was once replaced with wider one, and after that, he was decannulated. He has a good voice with preserved mobility of vocal cords, but he still has stenosed subglottic level, which partly narrows the lumen, so his tracheotomy is still present. We successfully decannulated a 10-year-old boy, who had the tube for 18 months after stenosis dilatation. In eight patients stenosis of proximal tracheal part and subglottic part of larynx was diagnosed. It was 2.5 to 4 cm long. In three patients we diagnosed tracheal malacia, and in one of them also cricoid malacia with luxation of one arytenoid and ankylosis of the other. In all patients we performed resection of proximal tracheal part with excision of half of cricoid ring. What was left of laryngeal stenosis was cut out and covered with distal tracheal mucosa or Thiersch grafting. In two patients after resection of proximal part of the trachea and part of cricoid ring, end-to-end anastomosis was performed without tube placing, with excellent results. In six patients Montgomery T tube was placed, and in four of them it stayed for 6 to 12 months. These four patients were later decannulated with good functional results. In the rest of two patients, we did not resolve the stenosis of proximal part of trachea and subglottic space of the larynx.

DISCUSSION: In etiology of chronic subglottic stenosis postintubational stenoses are dominate. Methods we used were successful in solving high tracheal and subglottic stenosis if the stenotic part was at cricoid level. In higher subglottic stenosis, other techniques are to be used.

CONCLUSION: We presented cases of 11 patients with high tracheal and/or subglottic laryngeal stenosis. In one patient stenosis was solved by laryngomicroscopy, in two with subglottic stenosis dilatation. Eight patients were operated using segmental resection of proximal tracheal part and part of cricoid ring, using end-to-end method. In our opinion this method gives good results in stenosis which does not spread higher than upper cricoid cartilage. Some patients can be operated without tracheotomy. For higher stenoses, this method is not recommended.

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