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PubMed1993

Tracheal approach to pulmonary artery sling associated with funnel-shaped tracheal stenosis.

Pulmonary artery sling with concomitant funnel-shaped tracheal stenosis is a rare but potentially lethal congenital condition. Conventional surgical division and reanastomosis of the aberrant left pulmonary artery to the main pulmonary artery carries a high risk of postoperative ventilatory difficulty from an uncorrected tracheal stenosis. A primary tracheal approach via a right thoracotomy without pulmonary bypass is described.

Bronchoscopy↗

PubMedDate not supplied

Vascularized hyoid interposition for subglottic and upper tracheal stenosis.

Chronic subglottic and upper tracheal stenosis can be treated successfully with lumenal augmentation using a vascularized hyoid-sternohyoid muscle interposition into the stenotic area. Successful decannulation was achieved in eight of nine patients. Follow-up periods varied from 6 months to 36 months. Concomitant laryngeal stenosis and vocal cord paralysis were treated successfully at the same time. The major complication was occasionally delayed but successful decannulation due to granulation tissue. Minimal wound and peritracheal stoma infections probably accounted for the granulation tissue.

Adolescent↗

PubMed1982

Effects of surgery on airway mechanics in tracheal stenosis.

12 patients suffering from severe extrathoracic tracheal stenosis mainly caused by long-term artificial ventilation were investigated by comparing their airway mechanics before and after tracheal sleeve resection and during long-term follow up. The investigations included body plethysmography, flow-volume relation, effect of bronchodilator, bronchial challenge and endoscopic estimation of the tracheal diameter. Tracheal sleeve resection in stenosis doubles the tracheal diameter from 5.9 to 11.0 mm. Resistance parameters and forced expiratory flow values reflected the significant improvement best. Airway structure remains stable during long-term follow-up, and effort-dependent parameters improve further. Compared to normal volunteers with artificially induced stenosis patients show a higher tolerability for airway narrowing. A tracheal diameter of 5 mm produces severe complaints and distinct functional distortions which are shown in specific airway resistance of 7.5 cm H2O X s, specific airway conductance of 0.02 cm H2O-1 X s-1 and FEV1 of 1 l X s-1. These values are absolute indications for resection. Tracheal stenosis after long-term artificial respiration can be influenced slightly by bronchodilator therapy. Nonspecific bronchial hyperreactivity is present, suggesting increased reagibility of the bronchial smooth muscles.

Acetylcholine↗

PubMed1991

Resection for congenital tracheal stenosis.

A case of congenital tracheal stenosis is reported. The diagnosis was made on plain X-ray, tomography and computerized axial tomography of the trachea when the child was 8 years old. The operative approach was via a median sternotomy and anaesthesia maintained with dual simultaneous ventilation of the right upper lobe bronchus and distal trachea. Histology of the stenotic area revealed the cartilaginous rings to be completely encircling the trachea.

Child↗

PubMed1997

Slide tracheoplasty in the management of congenital tracheal stenosis.

Long-segment congenital tracheal stenosis (LSCTS) is a rare condition. Originally, it was felt to be uniformly fatal; however, advances in technique have made surgical repair and survival possible. Our objective is to report results and technique of slide tracheoplasty for the treatment of LSCTS in the context of the overall experience at the Children's Memorial Hospital in Chicago. We reviewed 37 cases of infants and children with LSCTS. Thirty of the 37 infants underwent surgical intervention. Slide tracheoplasty resulted in survival in 1 of 2 infants, and pericardial patch tracheoplasty resulted in survival in 21 of 28 (75%). Of the 30 patients who had surgical repair, 7 (23%) have died, and 1 has been lost to follow-up (3%). Follow-up has ranged from 6 months to 13 years. Slide tracheoplasty is a satisfactory adjunct to existing techniques. With early diagnosis and appropriate management of LSCTS, survival is possible in a majority of patients.

Anastomosis, Surgical↗

PubMed2006

Management of congenital tracheal stenosis in infancy.

OBJECTIVE: Congenital tracheal stenosis (CTS) is a very infrequent malformation. Till recently, the outlook for these patients was dismal because medical management was the only way of treatment. Surgical and endoscopical techniques developed in the last years have improved the prognosis. We review the short- and long-term outcomes of a single institution experience in the management of children with CTS, comparing different treatment modalities. METHODS: Between 1991 and 2004, 19 cases of CTS have been managed in our Unit. Respiratory symptoms varied from mild stridor on exertion to severe distress. Bronchoscopy was performed for diagnostic purposes in all cases; other imaging techniques (computed tomography (CT), magnetic resonance imaging (MRI), bronchography, angiography, doppler-ultrasound) were performed on an individual basis. According to clinical and endoscopical features, patients were classified into three groups. The following data have been studied in each case: sex, age at diagnosis and treatment, anatomical type, associated anomalies, treatment modality, complications, outcome and time of follow-up. RESULTS: Ten boys and nine girls have been included in this study. Age at diagnosis ranged from 3 days to 7 years (median, 4 months) and 84% of cases showed associated anomalies. Five patients presented mild or no symptoms and have been managed expectantly. The other 14 cases were operated on because of persistent or severe clinical symptoms. The following procedures were performed: slide tracheoplasty (n = 7), costal cartilage tracheoplasty (n = 5), tracheal resection and reconstruction (n = 3), endoscopical dilatation (n = 3), stent placement (n = 1), and laser resection (n = 1). Three patients required two or more procedures and surgical survival rate is 78%. Overall mortality in the series is 21% and all survivors (15 patients) are asymptomatic or show mild symptoms with respiratory infections only. Follow-up is complete, ranging from 8 months to 12.3 years (mean, 5 years). CONCLUSIONS: Bronchoscopy is our preferred diagnostic tool. Selection of the type of treatment depends on the patient's clinical status and the anatomical pattern of the stenosis. In symptomatic cases with short-segment stenosis (<30% of total tracheal length), we prefer tracheal resection with end-to-end anastomosis; for long-segment stenosis (>30%), slide tracheoplasty is our procedure of choice.

Abnormalities, Multiple↗

PubMed2003

Endoluminal stenting for tracheal stenosis.

This prospective clinical study evaluates the role of endoluminal stents in the maintenance of a tracheal lumen after management of stenosis. Tracheal stenosis may be due to a variety of causes, and it is a significant health problem. Most patients either remain tracheostomized for prolonged periods of time or undergo several major surgical interventions. The most common sequel is restenosis at the site of repair either after augmentation or resection anastomosis. In this study, 16 patients with different pathologies causing tracheal stenosis or collapse are presented. All patients had the tracheal lumen re-established either endoscopically or by an open procedure. The stent was then placed to support the site of repair and prevent restenosis. A patent well-epithelialized lumen was achieved in 11 cases with a follow-up of 3-24 months. Complications were encountered in five cases: three misplaced stents, one tracheal erosion with a Dumon stent and one granulomatous obstruction. The technique, complications and follow-up of these patients are described with recommendations for the management of such patients.

Aged↗

PubMed2002

Slide tracheoplasty for severe congenital long segment tracheal stenosis in infants: surgical and anesthetic management.

Congenital long segment tracheal stenosis is the rare occurrence of an intrinsic narrowing of the trachea due to a complete cartilagenous ring. It is difficult to manage and can be life threatening especially when these patients who are usually neonates or infants have the pathological pattern of a long segment and have to come for surgical correction. Despite many technical reports on how to correct this anormaly, currently, the technique of "slide tracheoplasty" is claimed to be the most successful with the good immediate and long-term outcomes. But because of the rare and life threatening disease, so we were encouraged and write this report about the disease and its management. These are the case series reports of 4 infants with a history and diagnosis of severe long segment congenital tracheal stenosis who needed a difinite surgical repair. The authors decided to use the surgical technique of "slide tracheoplasty" with successful outcome. In two of the cases, patients needed cardioplumonary bypass support during the surgical repair. All of these patients did well after the operation except one patient with a history of congenital heart disease (tetralogy of Fallot) who needed an emergency surgical repair and was reoperated upon with pericardial patch. In this reports the authors did not find any benefit from tracheostomy. Also, details of surgical and anesthetic procedure were discussed with the conclusion that the surgical technique of slide tracheoplasty should be the surgical of choice for the management of congenital long segment tracheal stenosis.

Anesthesia, General↗

PubMed2003

An unusual aspect of tracheal stenosis. Case report.

lnjury of the tracheal mucosa at the decubitus site of the endotracheal tube cuff during prolonged endotracheal intubation and resulting fibrin deposits may predispose for the development of tracheal stenosis. Frequent endoscopic control examinations, following the increased use of dilation tracheostomy techniques, have revealed a considerable number of these once misrecognized complications in laryngeal and tracheal structures alike. The case reported here appears to confirm this sequence of events. Timely operative endoscopy using a pair of pincers mounted on a rigid endoscope permitted the removal of the fibrin membrane causing the tracheal lumen stenosis and allowed us to achieve complete and definitive recalibration of the trachea, with restoration of spontaneous breathing. Cortisone therapy prolonged for 5 days probably prevented recurrence of the stenosis. Follow-up was carried out in 3 phases. The 1(st) phase included early control using tracheal endoscopy; 2(nd) comprised neck CT scan to examine the tracheal lumen 15 days after endoscopic control, and the 3rd phase involved medical examination after about 3 months and neck radiography in 2 projections.

Aged↗

PubMed2002

[Postintubation tracheal stenosis; problems associated with choice of management].

We experienced a case with tracheal stenosis due to postintubation damage, or so-called cuff stenosis. A 50-year-old man who attempted suicide by pounding nails into his head and chest using carpenter's tools was treated by endotracheal intubation and immediately underwent emergency surgery in July 2000. The patient was placed on artificial ventilation with oral endotracheal intubation, and a tracheostomy was performed 4 days after the operation. After that, his respiration recovered and he was weaned from the respirator. He was discharged 22 days after surgery with no respiratory symptoms. Two days after discharge, he complained of wheezing and dyspnea. Medical examination revealed that the cervical trachea had a severe circumferential stenosis 2.5 cm from the second tracheal cartilage. On retrospective inspection, the region of stenosis was compatible with the cuff site of the endotracheal tube used for the emergency operation. At first we tried nonoperative treatment, considering his mental state. However, we found that surgical treatment was ultimately necessary. A 2.5 cm sleeve resection of the trachea (5 tracheal cartilage rings) was performed, followed by end-to-end suture using 21 stitches with 4-0 MEDIFIT C thread. Pathologically, the surgical specimen showed degeneration and necrosis of tracheal cartilage with excessive growth of granulation tissue. These findings revealed that the etiologic basis of the tracheal stenosis was attributed to pressure necrosis by the cuff. The postoperative course was uneventful. Sixteen months after the surgery, the granulation tissue had not recurred, and problematic stenosis was not visible in the trachea. In this report, we discussed a reasonable management of postintubation tracheal stenosis. Tracheoplasty has been proposed as the most reliable method for treating tracheal stenosis. However, the best treatment in each case is still somewhat controversial because various nonoperative treatment methods are recently available, including laser phototherapy, argon plasma coagulation, mechanical dilatation, stent replacement, and drug treatment. Therefore, it is very important to judge properly the absolute indication for surgical treatment. If granulations are removed successfully by the above-described nonoperative methods, attempts at repair lead only to regrowth of granulation tissue as long as there is necrotic tracheal cartilage. Thus, the determinant of treatment methods is whether postintubation damage extends to tracheal cartilage or not. For now, there is no accurate diagnostic study for viability of cartilage preoperatively. In the literature, symptoms due to airway stenosis occurred rapidly within one month in the case of patients with necrosis of tracheal cartilage. We concluded that the period between extubation and development of symptoms is very informative in the management of postintubation tracheal stenosis. Surgical approaches should be selected for a patient with a rapid and progressive course after extubation when the patient can tolerate it.

Humans↗

PubMedDate not supplied

Airway management of a patient with tracheal stenosis for surgery in the prone position.

PURPOSE: When tracheal intubation is required in a patient with an uncollapsible tracheal stenosis, the tip of the tube is usually positioned proximal to the stenosis. Only the tip of the tube may be in the trachea and the tube can be dislodged. We report the successful airway management of a patient with an uncollapsible tracheal stenosis who underwent cranial surgery in the prone position. CLINICAL FEATURES: A 49-yr-old man with the saber-sheath trachea (stenosis of the entire intrathoracic trachea) was scheduled for a posterior fossa surgery for resection of a cerebellar tumour. Anesthesia was induced by allowing the patient to inhale spontaneously oxygen and increasing concentrations of sevoflurane up to 5%, without airway obstruction. After injection of vecuronium, an airway exchange catheter was inserted orally into the trachea. A laryngeal mask airway was then inserted with the exchange catheter in place and, with the aid of a fibrescope, a 6.0-mm reinforced tracheal tube was passed through the laryngeal mask into the trachea so that the tip of the tube was about 1 cm proximal to the stenosis. The patient was turned to the prone position and the operation proceeded uneventfully. CONCLUSIONS: The laryngeal mask and an airway exchange catheter were used as backups to tracheal intubation in this patient with tracheal stenosis in the prone position. Should the trachea be extubated accidentally, it may be re-intubated through the laryngeal mask and ventilation may be possible through the laryngeal mask or the exchange catheter.

Anesthetics, Inhalation↗

PubMed1987

Congenital tracheal stenosis: role of CT and high kV films.

Congenital tracheal stenosis is an intrinsic narrowing of the tracheal lumen due to complete cartilaginous rings. We evaluated the role of the chest radiograph, high kV films, CT and bronchoscopy in five patients with congenital tracheal stenosis. CT was superior to chest radiography and high kV films in the evaluation of the presence and extent of the stenosis. CT was superior to bronchoscopy in the evaluation of the distal extent of the stenosis in two patients. In addition, CT is useful in ruling out external compression of the trachea by a mass or associated vascular anomaly.

Bronchoscopy↗

PubMed1999

Surgical management of idiopathic tracheal stenosis.

Most nonmalignant upper tracheal stenoses are caused by prolonged endotracheal intubation or tracheostomy, and idiopathic stenosis is uncommon. A 43-year-old woman complained of increasing shortness of breath during exercise over a year prior to admission. She had no significant past medical history, including endotracheal intubation. Bronchoscopy and tracheal tomography revealed nonmalignant circumferential upper tracheal stenosis 20 mm long. Single-stage surgical resection with cricotracheal anastomosis completely relieved her respiratory symptoms. Idiopathic tracheal stenosis is extremely rare, and the treatment of choice is surgery.

Adult↗

PubMed1992

Surgical considerations in tracheal stenosis.

From 1969 to 1990, 43 patients with tracheal stenosis were treated at the University of Mississippi Medical Center. Seventy-four percent of these patients (n = 32) had intrinsic tracheal stenosis, most frequently as a complication of prolonged endotracheal trauma. A total of 41 distinctly separate stenotic segments were identified in the 32 patients. The stenoses were considered moderate or severe in 33 (80%) of the 41 cases and the length of the stenotic segment was greater than 1 cm in 23 (56%) of the cases. An overall 70% success rate was achieved following 93 surgical procedures in this group. The concurrent presence of glottic/subglottic stenosis, multiple segments of stenosis, bilateral vocal cord paralysis, tracheoesophageal fistula, and a tendency to marked hypertrophic scar formation were found to be significant factors in the surgical management of this patient group.

Adolescent↗

PubMed1983

Management of intractable and extensive tracheal stenosis by implantation of cartilage graft.

A variety of methods have been developed to solve the problem of extensive tracheal stenosis. Endoscopic resection with injection of steroids was performed with some success. Resection with end-to-end anastomosis has been attempted in localized tracheal stenosis, but it is not practical in extensive tracheal stenosis. As an alternative to the above procedures, we performed a simpler operation to increase the diameter of the narrow trachea. We treated three children (a 7-month-old, a 2-year-old, and a 3-year-old) who had severe tracheal stenosis. The trachea was explored through a cervical transverse incision. The anterior wall of the trachea at the level of the stenosis was opened longitudinally and the scar in the tracheal lumen was resected. A free-cartilage graft measuring 1 X 4 cm was taken from the third costochondral junction and was wedged and sutured in place into the tracheal opening. This resulted in increasing the internal diameter of the stenotic trachea. A nasotracheal tube was left in place at the end of the procedure for 48 hours. The children are still asymptomatic 19, 10, and 8 months postoperatively. The careful selection and preparation of the patients for this procedure is discussed.

Cartilage↗

PubMed2002

Spontaneous respiration via an open trachea for resection of a high tracheal stenosis in a child.

The successful management of tracheal stenosis requires compromise between the competing interests of the surgical and anaesthetic teams and the resources available. A seven-year-old girl with marked tracheal stenosis was successfully managed spontaneously breathing via an open trachea and a laryngeal mask. Anaesthesia was maintained by propofol infusion. When the trachea was opened, supplemental oxygen was administered via a modified cholangiocatheter placed into the distal segment. At no point was the trachea intubated.

Anastomosis, Surgical↗

PubMed1980

[Tracheal stenosis and keloid disposition (author's transl)].

Patients with disposition for cicatricial keloid are expected to get tracheal stenosis by long time intubation. Latest after 48 hours the respiration done by respirator should be managed by tracheotomy tube. Instead of classic tracheotomy an epitheliced tracheotomy should be preferred. For the therapy of tracheal stenosis--excision of tracheal stenosis and end to end anastomosis as well as tracheal groove by Rethi with transplantation of mucosa--the application of triaminolonacetonoid has proved to avoid restenosis by secondary keloid.

Adolescent↗

PubMed1992

Severe lower tracheal stenosis in infancy.

16 infants with severe distal tracheal stenosis (TS) seen from 1978-1988 are reviewed. Diagnosis was established by endoscopy and confirmed by radiographic methods, including magnetic resonance imaging (MRI) in three cases. Types of TS ranged from segmental stenosis to complex lesions involving the carina and bronchi. Associated vascular anomalies were found in nine patients (56%). All patients needed long-term intubation or a tracheostomy (seven cases) for stenting of the airway. Patients with congenital TS (CTS) were treated by tracheal resection (two survivors), dilatation (one survivor, two non-survivors), or observation (two non-survivors). Patients with pulmonary artery sling (PAS) were treated by division of the vascular sling (three survivors, one non-survivor), or combined vascular and tracheal surgery (one non-survivor). One patient with dilated pulmonary arteries compressing both main bronchi died in spite of oxygen therapy. Two cases of compression by an anomalous aorta were managed with dilatation (one survivor, one non-survivor). One patient with a severe stricture after a tracheal resection was successfully treated by dilatation. The overall mortality was 50%. We conclude that 1. endoscopic examination of the tracheobronchial tree and thorough evaluation of associated anomalies is mandatory in symptomatic patients; 2. if indicated surgical correction is the treatment of choice for tracheal stenosis; 3. dilatation and stenting of the stenosis are invaluable tools in the management of these infants.

Abnormalities, Multiple↗