Management of benign laryngotracheal stenosis – A 5-year experience of Indian tertiary care setup

Abstract

Introduction: Laryngotracheal stenosis (LTS) implies a partial or complete cicatricial narrowing of the larynx and/or trachea. Surgical management is technically challenging owing to complex anatomy and delicate nature of airway structures. The present study aims to study clinical profile, management, and surgical outcome of LTS in a tertiary care setup of India. Materials and Methods: All patients with LTS treated between 2011 and 2016 were included in this study. They underwent endoscopic assessment followed by definitive management which included endoscopic and external surgical techniques. The success of treatment was defined by decannulation, acceptable voice quality, and glottic competence. Results: A total of 106 patients with benign LTS were treated. Prolonged intubation was the single largest cause (70.7%). Tracheal stenosis formed the largest group (43.4%) followed by subglottic stenosis (26.4%). About 37.7% of patients underwent endoscopic management. Among external approaches, 32.07% of patients underwent resection-anastomosis surgeries including partial cricotracheal resection (PCTR) and tracheal resection with end-to-end anastomosis. Nearly 12.3% ofpatients underwent various forms of laryngotracheoplasties. About 7.5% of patients underwent both in the form of extended- PCTR or reconstruction surgery followed by resection-anastomosis. Nearly 7.5% of patients required Montgomery T-tube insertion while three underwent hyo-epiglottopexy for laryngomalacia. A total of 100 patients (94.3%) have been successfully decannulated. Conclusions: The use of appropriate size, low pressure cuffed tubes, and early tracheostomy will go a long way in preventing LTS. The precise assessment of laryngotracheal complex is the cornerstone of management. Choice of treatment depends on location, severity, and length of stenosis, as well as on patient comorbidities, history of previous interventions, and expertise of the surgical team. Goal of any treatment modality should be to achieve a patent airway, glottic competence and acceptable voice quality.