A case of idiopathic tracheal stenosis

Idiopathic tracheal stenosis (ITS) is an extremely rare disease. We report the case of a 32-year-old woman with ITS. She had no history of previous surgery, endotracheal intubation, neck trauma, granulomatous disease, or any other severe respiratory tract infections. She presented with progressive dyspnea on effort and had been treated for bronchial asthma for 3 years. Chest radiography and laboratory examinations revealed no abnormalities. Bronchoscopy demonstrated almost circumferential tracheal stenosis extending for 10 mm from about 20 mm below the vocal cords. Luminal diameter was about 4 mm at the narrowest. Bronchoscopic biopsy revealed increased fibrous tissue and chronic inflammatory cell infiltration (nonspecific inflammatory tissue). These finding are compatible with idiopathic stenosis as reported by Grillo et al. After tracheostomy, the patient was treated by tracheal segmental resection (two rings) with end-to-end anastomosis of the cartilaginous trachea. Symptoms of tracheal stenosis were completely relieved and no recurrence has been observed as of 3 years postoperatively.     

Subglottic and tracheal stenosis associated with multifocal fibrosclerosis

This is the first case report in the literature of idiopathic subglottic and tracheal stenosis in a patient diagnosed with multifocal fibrosclerosis (MFS). The patient had unilateral orbital pseudotumour, bilateral pretibal cutaneous manifestations and raised thyroid antibodies, which might indicate subclinical thyroid involvement. Urgent permanent tracheostomy was needed. The patient also underwent tracheal dilatation for her dysphonia. There was no evidence of brain, lung, liver or renal involvement. Although extremely rare, laryngologists should consider the possibility of such a diagnosis in a stridulous patient with multifocal fibrotic manifestations.     

Two-stage repair of extensive subglottic tracheal stenosis

Summary The authors describe an open technique that has been used over the past 25 years to reconstruct the subglottic tracheal region in two stages after extensive laryngotracheal stenosis. After submucosal resection of fibrous tissue and reconstruction of the subglottic and tracheal skeleton by means of two autologous osseous grafts, a large laryngotracheostomy is created during the initial stage. Some weeks later, in the second stage, the anterior wall is closed, using two cervical hinge-door flaps. Ten patients have undergone this procedure, with a minimum follow-up of 3 years. All of the patients were decannulated upon completion of the treatment without recurrence of stenosis during the follow-up period.     

硅胶T型管在喉气管重建中的应用

目的:观察硅胶T型管在喉气管重建中应用的效果,并探讨其使用方法。方法:采用喉气管重建术治疗喉气管狭窄患者297例,全部患者术前均依靠气管切开通道呼吸,术后均采用硅胶T型管支撑3～6个月。结果:全部患者中,289例(97.3%)治愈拔管,恢复正常呼吸及功能性发声。经1～10年随访,疗效可靠,无再狭窄发生。结论:在喉气管重建中,T形硅胶管是一种安全有效的支撑器,在应用中注意一些细节问题,可避免并发症的发生,获得满意疗效。     

Radiological evaluation of chronic laryngotracheal stenosis

Sixteen cases of chronic laryngotracheal stenosis were assessed. They underwent complete ENT evaluation including indirect laryngoscopy, direct laryngoscopy, microlaryngoscopy and tracheoscopy. Preoperatively plain X-ray of soft tissue neck and computed tomography (CT) was done. Good correlation was seen between the endoscopic assessment of the stenotic segment and the CT finding.     

The role of endoluminal self-expanding stents in the management of pediatric tracheal stenosis

OBJECTIVE: Review of our experience in the management of pediatric tracheal stenosis using endoscopic techniques and self-expanding intraluminal stents. METHODS: Thirteen children (aged 1 week to 14 years) with various causes of tracheal stenosis were treated. A total of 15 stents were used, 13 self-expanding nitinol stents and 3 silicone self-expanding stents. Follow-up ranged from 6 month to 8 years. RESULTS: There were no stent related mortalities. Serious complications occurred in 4 patients [30.7%] but all were managed successfully. The most frequent problem was granulation tissue formation. Patient follow-up ranged from 6 months to 8 years. In the short-term (18-24 months) 12 stents remained patent and functional. On the longer term (5 years) 3 stents required removal, one required replacement and another resulted in stenosis. CONCLUSION: Endoluminal stenting can have an increasing role in the management of selected cases pediatric tracheal stenosis with acceptable morbidity and stable long-term results.