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PubMed2002

Morphology of trachea in benign human tracheal stenosis: a clinicopathological study of 20 patients undergoing surgery.

Prolonged tracheal intubation of patients often leads to tracheal stenosis (TS), which may require surgical removal of the narrowed portion of the airway. We studied 20 patients with TS who underwent surgical ablation of the stenotic portion of trachea. The morphology of the tracheal segments was characterized and compared with clinical data and with the prognosis for the disease. We found that TS was usually due to an increase in the width of the mucosa as a result of the fibrosis associated with the chronic inflammation. Plasma cells were the predominant leukocyte type seen in the inflammatory infiltrates of the surgically removed portions of narrowed trachea. In the majority of TS samples, the epithelial surface was intact and presented cilia; in contrast, cilia disappeared when the tracheal lumen was completely obliterated. Mucosal cells and glands were also well preserved in TS samples. The need to remove TS segments was often related to previous tracheal surgery, which was also associated with closing of the tracheal lumen and ossification of cartilage rings. We conclude that (a). chronic inflammation and fibrosis are responsible for the narrowing of trachea in TS patients, (b). metaplastic ossification of cartilage rings only occurs after complete obliteration of the tracheal lumen, and (c). loss of cilia and presence of metaplastic bone tissue are indicators of a poor prognosis for TS.

Adult↗

PubMed2000

Intermediate-term results of the free tracheal autograft for long segment congenital tracheal stenosis.

BACKGROUND/PURPOSE: Since 1996 a new procedure--the free tracheal autograft--has been used to repair long segment congenital tracheal stenosis (LSCTS). The purpose of this report is to examine the intermediate-term results of that technique. METHODS: Between January 1996 and July 1999, 10 infants underwent repair of LSCTS using a free tracheal autograft. Age ranged from 10 days to 23 months (mean age, 6.6 months). Six infants had a pulmonary artery (PA) sling; 5 had intracardiac anomalies. On cardiopulmonary bypass (CPB) the trachea was incised anteriorly through the area of stenosis. The midportion of the stenotic trachea was excised, and an end-to-end anastomosis was made posteriorly. The excised tracheal segment was trimmed and sutured in place anteriorly as a free autograft. In 5 patients the autograft was not long enough, and the upper portion of the tracheal opening was patched with pericardium. RESULTS: There was 1 death 26 days postoperatively in a child that had simultaneous repair of tetralogy of Fallot and required extracorporeal membrane oxygenation postoperatively for cardiac failure. The other 9 children are alive and well at 2 to 44 months postoperatively (mean follow-up, 24 months). One child had autograft dehiscence and required replacement of the autograft with an aortic homograft. Two children have tracheostomies at 6 and 36 months postoperatively. All children have had serial postoperative bronchoscopic examinations. Most recent bronchoscopies have shown widely patent tracheal lumina in all survivors. CONCLUSION: Intermediate-term follow-up of children with a free tracheal autograft continues to support our use of this technique as our procedure of choice for infants with LSCTS.

Abnormalities, Multiple↗

PubMed1999

Recurrent psychogenic coma following tracheal stenosis repair.

Medication, intracranial hemorrhage, infarction, infection, hypoxia, organ failure, and nutritional deficiency may cause unconsciousness following successful emergence from anesthesia. A 39-year-old woman with a history of tracheal stenosis, depression, and anxiety had complete unconsciousness on 3 separate occasions following surgical repair of her tracheal stenosis. In each case, the patient's endotracheal tube had been removed; she was alert and oriented to person, time, and place; and she was admitted to the hospital for observation. Within a few hours after the tube was removed, the patient became abruptly unconscious for periods of 36, 18, and 30 hours. Each time, the results of cardiac, pulmonary, metabolic, and neurologic examinations and radiological studies were normal. We hypothesize that the patient's apparent comas were the result of an underlying conversion disorder precipitated by unresolved psychological conflict surrounding a long history of abuse in which she was repeatedly smothered by a pillow.

Adult↗

PubMed1993

Postintubation tracheal stenosis: diagnosis and management.

Postintubation damage is a potential hazard in any patient intubated with an oral or nasal endotracheal tube or with a tracheostomy tube for ventilatory support. Postintubation tracheal stenosis may be fatal unless it is recognized and treated promptly. This paper reviews the important features of diagnosis and treatment of postintubation tracheal stenosis.

Adult↗

PubMed1996

Endoscopic treatment of tracheal stenosis using the carbon dioxide laser and the Gianturco stent: indications and results.

The self-expandable Gianturco stent was used in 11 patients with tracheal stenosis who where treated from September 1992 through July 1994. Under optical control, the stent was placed through a bronchoscope with an outside diameter of 9 mm after cross-section and dilation of the stenosis were performed with the carbon dioxide laser according to the Shapshay technique. The follow-up period varied from 3 to 22 months, with a mean of 12 +/- 6 months. Pulmonary function tests showed a mean improvement of the peak expiratory flow (50%), from 0.95+/-0.45 L/sec before the operation to 2.13+/-0.86 L/sec after the procedure. Radiologic and fibroscopic controls showed prosthesis stability. Three patients needed a second endoscopic procedure because of malposition of the stent, the formation of granuloma at the superior end of the prosthesis, and the development of a mucous membrane webbing between the two loops of a stent. Due to the lack of long-term follow-up, this technique is reserved for the treatment of severe tracheal stenosis with cartilage impairment in patients who have contraindications for external reconstructive surgery.

Aged↗

PubMed1984

Variable tracheal stenosis related to body position.

We demonstrated a variable extrathoracic tracheal stenosis which developed after technically adequate tracheostomy and was worsened by changes in body position. When the patient's arms were above his head, minimal airway diameter was reduced 31 percent, and maximal inspiratory flow rate 37 percent below values measured with arms down, but expiratory flow rates were preserved. Tracheostomy may disrupt the integrity of tracheal support and allow airway collapse under circumstances of increased extratracheal or decreased intratracheal pressure.

Forced Expiratory Flow Rates↗

PubMedDate not supplied

Pharmacotherapy in tracheal stenosis.

From our experience in the treatment of immunological diseases with a tendency to the formation of granulomas, we conceived the idea of treating pharmacotherapeutically the scar-tissue formation in recurrent tracheal stenosis. We have combined two medicines with different modes of action, namely, klorokin and penicillamine. Two patients with recurrent tracheal stenosis have been treated with remarkable results. After several unsuccessful operations it has now been possible to decannulate both of them and enable them to regain a normal way of living.

Aged↗

PubMed1998

The use of expandable metallic stents for acute tracheal stenosis in the growing lamb.

PURPOSE: Expandable metallic stents (Palmaz stents) have been used in the treatment of tracheobronchial obstruction in children and adults. The authors investigated their utility in the management of acute airway stenosis in a growing animal model. METHODS: A model for tracheal stenosis was developed in young lambs (mean age, 4 weeks; mean weight, 8.6 kg). Via an anterior tracheotomy, a circumferential mucosal injury to the trachea was produced with electrocautery in 31 lambs. In the control group (n = 10) no further intervention was used. In the treatment groups, either serial balloon dilatation of the stricture was performed (n = 6), or expandable metallic stents were inserted across the stricture (n = 15). All animals were monitored daily for signs of respiratory distress. Body weights, fluoroscopic airway measurements and rigid bronchoscopy were performed at least weekly. RESULTS: The average weekly rate of airway growth was 8.2% +/- 5.5% of the tracheal cross-sectional area (CSA). All animals displayed severe stenosis (mean, 90.2% +/- 7.5% of CSA) within 13.1 +/- 4 days after the injury. All animals in the control group had severe respiratory distress, weight loss and died within 14.6 +/- 2.8 days after injury. Serial balloon dilatation of the stricture alone failed to relieve symptoms in all six animals in this group, who died within 20 +/- 1 days after the injury, despite two to three dilatations each. With placement of expandable metallic stents, only 3 of 15 lambs died (two of pneumonia, one of iatrogenic perforation). The remaining 12 remained symptom-free and gained weight during a 2-month follow-up period. However, fluoroscopic examination showed partial collapse of the stents in all of these animals (mean, 44.7% +/- 21.6% of CSA) requiring an average of 2 +/- 0.7 bronchoscopic dilatations. Pathological evaluation showed more pronounced granulation tissue in the stented animals. CONCLUSIONS: The authors conclude that expandable metallic stents provide an effective tool in the management of acute tracheal stenosis. However, airway growth, tissue reaction, and the mechanical properties of the stent require close monitoring and stent adjustment.

Animals↗

PubMed2004

[Modern diagnostics of tracheal stenosis].

BACKGROUND: Numerous new modalities in computertomography (CT), in particular Multislice-Spiral-CT and Virtual Endoscopy, and novel developments in endoscopy and spirometry gave us reason to review the current state of the art in diagnostics of tracheal stenosis (TS). METHODS: This review evaluates the literature of the last decade regarding new trends and methods in diagnostics of tracheal stenosis. Pros and cons are discussed, and the future trends are highlighted. CONCLUSIONS: Spiral-CT scans at collimated slices of < or = 3 mm, PITCH < or = 1.5 and a segmentation level of - 350 HE permit a valid measurement of tracheal lumina. The flow-volume-plot is still the most important investigation to evaluate respiratory function in TS. Peak-Flow-Meters are suitable for patient self monitoring. The selective estimation of the TS related airway resistance using in situ measurements and numerical flow simulation studies are likely to reach importance in future. The ability to obtain exact measures from endoscopic recordings using EndoScan serves quality control in endoscopy. An objective comparison of different treatments becomes possible. Endosonography and methods for in-vitro tissue analysis (Optical Coherence Tomography) are more focused on the early diagnosis of malignant lesions. The Synopsis of endoscopy, CT-scan and spirometry provides the highest diagnostic accuracy today.

Bronchoscopes↗

PubMed2002

Management of tracheal stenosis with a titanium ring and nasal septal cartilage.

Surgical management of subglottic laryngeal and upper tracheal stenosis remains a formidable challenge. The significant number of proposed techniques only highlights the difficulties associated with effectively managing this problem. Between 1996 and 1999, seven patients with stenosis of the upper trachea were treated. The stenosis resulted from long-term intubation during intensive-care hospitalization in five patients and from tracheotomy complications in the other two. Six patients were male and one female, their ages ranging between 13 and 60 years. The mean postoperative observation period was 3 years (1.5-4.5 years). In all patients, the stenosis exclusively involved the upper tracheal segment, measuring from 2 to 5 cm in length. The stenotic area of the trachea is exposed, and the local application of a solution of mitomicin C for a duration of 4 min is performed. A graft consisting of cartilage and mucosa is harvested from the nasal septum and is fixed with sutures to a titanium semi-ring. After the fixation of the graft on the ring, the entire construct is placed on the stenosed segment of the exposed trachea. The graft must cover the anterior exposed face of the trachea with the lateral members of the semicircular titanium ring adjacent to the lateral walls of the trachea, externally. The lateral tracheal walls are attracted laterally with sutures and are attached on the edges of the semicircular titanium ring. Four of the patients in whom no tracheotomy had been performed preoperatively needed none at all intraoperatively, and they were decannulated normally at the end of the procedure. Tracheotomy was deemed necessary for one patient's safety and was maintained for 7 days. In one patient with a preoperative tracheotomy, the point of the tracheotomy was displaced lower on the trachea and was maintained there for 7 days. The course of management described here and employed on seven patients involves a safe surgical procedure with excellent results. The placement of the titanium ring offers very good support for the graft and maintains the patency of the tracheal lumen. The main reasons for the failure of techniques using only cartilage grafts are therefore avoided. The number of cases presented here is certainly too small to establish definite conclusions; however, the initial results are extremely satisfying and urge us to suggest the use of this method in indicated cases.

Adolescent↗

PubMed1976

Tracheal stenosis. A method of dilation with use of the fiberoptic bronchoscope.

Tracheal stenosis is not an uncommon sequel of prolonged endotracheal intubation. In some cases, immediate reconstruction is not feasible. We use the flexible fiberoptic bronchoscope and a lucent, tapered endotracheal tube for tracheal dilation. The fiberoptic bronchoscope is passed through a special T connector into the endotracheal tube and used to guide the tube under direct vision through the stricture.

Adult↗

PubMed1988

Rapid progression of tracheal stenosis associated with tracheopathia osteo-chondroplastica.

Tracheopathia osteochondroplastica (TPO) is a rare, but increasingly recognised condition in which there is accumulation of calcium phosphate with benign submucous proliferation of cartilage and bone beneath the tracheal mucosa, often with squamous metaplasia of the mucosal columnar epithelium. This condition is usually asymptomatic, but may be slowly progressive, causing haemoptysis, dry cough and dyspnoea. We report a case of TPO in which there was rapid progression of tracheal stenosis such that the size of endotracheal tube that the upper airway would accept changed from 8.00 mm to 3.0 mm during a six-week period. This extreme reduction in airway calibre had not been detected on spirometry nine days prior to his final admission. This is the first report of such rapid progression of tracheal stenosis associated with TPO.

Humans↗

PubMed1989

[A case of tracheal stenosis following surgery of esophageal cancer].

A case of 54-year-old man with tracheal stenosis following surgery for thoracic esophageal cancer was reported. It was considered that the stenosis had occurred due to the tracheal ischemia after esophagectomy and lymph node dissection. Importance of preservation of tracheal blood supply was again noticed. On tracheal reconstruction, application of pedicled pleural flap was recognized to be useful in order to repair the leakage from membranous portion that could not be closed by suture.

Anastomosis, Surgical↗

PubMed2000

Esophageal atresia and tracheal stenosis: use of three-dimensional CT and virtual bronchoscopy in neonates, infants, and children.

OBJECTIVE: The objective of this study was to evaluate the use of three-dimensional CT and virtual bronchoscopy in the treatment of neonates, infants, and children with esophageal atresia and tracheal stenosis. CONCLUSION: Long-gap (n = 1) and short-gap (n = 5) esophageal atresia, long-segment stenosis (n = 2), patent poststenting trachea (n = 1), normal trachea without fistula (n = 1), and tracheal bronchus (n = 1) were studied. Fistulas between the lower esophagus and carina were noted in all six cases of esophageal atresia. All CT findings correlated with operative or bronchoscopy findings. Sensitivity and specificity were 100%. Three-dimensional CT and virtual bronchoscopy are accurate and useful techniques in the preoperative assessment of esophageal atresia and tracheal stenosis in neonates, infants, and children.

Bronchoscopy↗

PubMed1980

[The treatment of serve laryngo-tracheal stenosis (author's transl)].

The treatment of severe laryngo-tracheal stenosis raises complex problems and we remain far from having found a universally agreed solution for all of them. The authors describe here their attitude to severe laryngo-tracheal damage without suggesting that this should be applied from the outset or to all cases seen. It consists of an operation faithful to the principle of that of Rethi as greatly improved by P. aboulker and to which we ourselves have remained faithful whilst in our turn suggesting a certain number of technical modifications which whilst in no way changing its principle simplify the performance with a teflon tube equipped with a detachable tip with a teflon diaphragm momentarily occluding the lower airway. We also suggest the use of steel wire sutures in order to hold the two hemi-larynxes and the fragments of tracheal rings apart when the degree of damage suggests the danger of postoperative trachemalacia or in the presence of recurrence of stenosis, a far from rare possibility in the late course following this type of surgery.

Humans↗

PubMed2006

Ventilatory management of severe tracheal stenosis.

We present here a 4 year old child with severe tracheal stenosis and respiratory failure. The patient was not responding to conventional ventilation settings and had significant hypercarbia. The difficulty in mechanical ventilation was handled successfully with specific ventilatory strategy: use of low respiratory rate, long inspiratory time and normal inspiratory time: expiratory time ratio. Thereafter the child was managed surgically and the stenosis was corrected. The child was discharged after a Montgomery T-tube placement.

Child, Preschool↗

PubMed1982

Tracheoplasty--a new operation for complete congenital tracheal stenosis.

This is a report of a case of complete congenital tracheal stenosis confirmed by tracheobronchogram. The stenosis also involved the origin of the right main bronchus. The membranous portion of the trachea was absent. It was repaired through a sternotomy and right thoracotomy aided by partial cardiopulmonary bypass. The posterior trachea was opened from larynx to carina and on into the right main bronchus, and each posterior tracheal edge was sewn to the anterior wall of the esophagus with a running Prolene suture. Three months after repair bronchoscopy showed that the new membranous trachea was epithelialized and the entire airway was of good caliber; the only problem was a diffuse tracheomalacia. He died in his seventh postoperative month after a major airway complication due to tracheotomy, which occurred after an elective bronchoscopy. It is obvious that this operation is technically feasible. It was hoped that his airway would become sufficiently stable to allow the tracheotomy tube to be removed at some time in the future.

Bronchi↗

PubMed2006

[Laryngeal mask application for a case of unpredictable adult tracheal stenosis].

A 69-year-old man with chronic renal failure was scheduled for artero-venous shunt surgery for sustained hemodialysis. On the pre-anesthesia interview, the patient complained of no respiratory symptom. Chest x-ray showed some tracheal deviation. There was no past history of the respiratory system such as bronchitis, bronchial asthma, tumor, trauma or previous tracheal intubation. General anesthesia was induced smoothly with thiopental and suxamethonium. Face mask ventilation could be done easily. The vocal cord was exposed fully by standard McIntosh laryngoscope. However, a neither ID 7.5 nor 6.5 mm tracheal tube could be inserted into the trachea. Then, a size 4.0 laryngeal mask airway (LMA) was inserted smoothly and ventilation was maintained adequately. The surgery was done smoothly. Seven days after, bronchofiber scopic findings showed tracheal stenosis. The cause was unknown but not from inflammation or tumor. The patient complained no respiratory distress after the surgery. In such unpredictable tracheal stenosis with easy mask ventilation, LMA is a considerable option for respiratory management.

Aged↗