Idiopathic Stenosis Research Articles

Surgery for tracheal and laryngotracheal stenosis: a historical case series.

Benign (laryngo-)tracheal stenosis is a relatively rare pathology and its surgical treatment is performed only at few specialized centres. This study aims to investigate outcomes after (laryngo-)tracheal resection-anastomosis, to explore potential risk factors for postoperative complications and to assess whether, over a 33-year period, there were major changes in surgical indications, techniques or outcomes. Retrospective, single-centre review of all consecutive patients who underwent tracheal or laryngo-tracheal resection/anastomosis for benign pathologies from 1990 to 2023. Overall, 211 patients underwent tracheal (149 patients, 70.6%) and laryngo-tracheal (62 patients, 29.4%) resection-anastomosis. Of these, 195 patients (93.8%) were affected by iatrogenic stenosis, while 13 (6.2%) suffered from idiopathic stenosis. The median length of stenosis was 25mm (interquartile range 1-3, 20-30). The overall morbidity rate was 27.5%, while major morbidity occurred in 10.5% of cases. One patient (0.5%) died in the postoperative period. Glottic oedema (17 patients, 8.1%), granulations (12 patients, 5.7%) and restenosis (10 patients, 4.7%) were the main complications. The only independent risk factor for postoperative complications was the length of the resected airway (P = 0.019). In the latest half of the study period, an older median age was observed, and no patient with idiopathic tracheal stenosis underwent surgery. Postoperative outcomes were comparable between surgical eras. Surgical treatment of (laryngo-)tracheal stenosis is challenging and should be performed by specialized centres. In our experience, morbidity and mortality rates were satisfactory, and in most cases, patients could breathe without tracheostomy. The length of the stenosis was the most significant risk factor for postoperative complications.

The role of local expression of hormone receptors in the genesis of idiopathic tracheal stenosis.

Tracheal stenosis in adults is usually the result of mechanical injuries either from direct trauma, tracheotomy or intubation. Idiopathic stenosis in the cricotracheal section is a rare condition and occurs almost exclusively in females. Therefore, an influence of the female sexual hormones estrogen and progesterone has been assumed previously. Tracheal specimens of 27 patients who received tracheal resection for either idiopathic tracheal stenosis (ITS) (n=11) or posttraumatic tracheal stenosis (PTTS) (n=16) between 2008 and 2019 in our surgical department were included and retrospectively analyzed. Immunohistochemical staining of tracheal specimens concerning the hormone receptor status of progesterone and estrogen was performed. While post-tracheotomy stenosis occurred in males (n=6) as well as in females (n=10), none of the patients with idiopathic stenosis were males. All of the idiopathic stenosis (n=11; 100%) showed a strong expression of the estrogen receptors (ERs) in the fibroblasts and expression of progesterone receptors (PRs) in fibroblasts in 8 of 11 (72.7%). In the post-tracheotomy patients, only 3/16 (18.8%) showed slight staining of PRs and 6/16 (37.5%) of ERs. Of those, only one male patient presented with expression of ERs and PRs and another male patient presented with isolated PRs. Oral intake of hormone compounds was seen in 11/27 (40.7%) patients: 7/11 (63.6%) in the ITS group and 4/16 (25%) in the PTTS (noteworthy that the PTTS group included 6 male patients). Although the number of patients is small, our results show that the expression of female sexual hormone receptors in the fibroblasts of the trachea is a persistent finding in ITS. Surgery provided good results with a favorable long-term outcome without recurrence of stenosis for ITS and PTTS. Further investigation with a special focus on hormones is needed to assist in the prevention of this rare disease.

Cricotracheal resection: a rare procedure in adults

<p>Benign or malignant tumors originating in the cricotracheal region (cricoid cartilage and first tracheal ring) are considered rare events in adult patients. Although there are several treatment options for benign tumors, cricotracheal resection remains the gold standard treatment for malignant tumors. The objective of the present study is to describe the cases that have been treated at our institutions. We selected five cases from a database of 800 clinical records. Three cases were treated at the national cancer institute, Mexico, and two in other institutions. All cases were treated by the same surgeon. Out of four women and one man, with a median age of 52 years, there were two cases of adenoid cystic carcinoma, two of idiopathic stenosis, and one of hemangiopericytoma. All underwent cricotracheal resection with laryngotracheal anastomosis and are still alive. Stenosis or primary tumors of the cricotracheal region can be initially treated with endoscopy. However, cricotracheal resection remains the gold standard treatment as it is a safe surgical procedure with minimal and acceptable sequelae. It also improves disease-free period, overall survival, and quality of life, albeit with a low and acceptable morbidity rate.</p><p> </p>

S2528 Conservative vs Surgical Management of Benign Idiopathic Pyloric Stenosis in Adults: An Atypical Entity

S2528 Conservative vs Surgical Management of Benign Idiopathic Pyloric Stenosis in Adults: An Atypical Entity

Epiphora; Successful Response to Systemic Steroids vs Topical Steroids

Purpose: Topical steroids are considered to be the first line of treatment for some forms of idiopathic punctal stenosis causing epiphora. We present a case of epiphora, which was unresponsive to traditional management, but responded to one week of systemic steroids. Observations: A 48-year-old male with no significant medical history, was referred to us for excessive tearing. He was seen earlier by an ophthalmologist for redness in one of his eyes. He was prescribed Pataday (Olopatadine) eye drops and Zylet (Tobramycin, Lotepriol) eye drops for both eyes. The patient was seen again after a week of treatment without much improvement. His treatment was changed to Alrex (Loteprednol) and Azasite (Azithromycin) eye drops. The redness of the eye disappeared in a week but patient noticed excessive tearing of his eyes. He was referred to reconstructive ophthalmologist for treatment of possible punctal stenosis. On examination the height of tear meniscus was increased and diagnostic lacrimal probing and syringing of the lacrimal drainage system demonstrated both lacrimal drainage system patent. Punctal stenosis was diagnosed. Over the next couple of weeks, patient underwent multiple syringing of the lacrimal duct system with temporary relief of symptoms. He was also prescribed Tobradex (Tobramycin+Dexamethasone) eye drops to be used for a month. Eye drops helped for the duration of treatment but symptoms returned after a couple of days of discontinuing eye drops. Patient also received ductal probing and punctal dilation in the office without much relief. Mini perforated plugs were placed in both puncta resulting in temporary relief. At the same time the intra ocular pressure started to rise and Tobradex eye drops were discontinued immediately. After almost three months of treatment and continuation of debilitating symptoms of epiphora, patient decided to consider surgical intervention and consulted an ENT surgeon for second opinion. Since he was responding to topical steroids, which was causing an increase in his intra ocular pressure, the ENT surgeon suggested Medrol Pack (Prednisolone for a week). Patient was symptom free after 4 days of treatment and by 7th day, his eyes were back to normal with complete disappearance of epiphora symptoms. Conclusions and importance: Systemic steroids can be beneficial in patients suffering from Idiopathic/Iatrogenic punctal stenosis unresponsive to topical steroids and conventional treatments.

Laryngeal mask versus endotracheal tube for airway management in tracheal surgery: a case-control matching analysis and review of the current literature.

The endotracheal tube (ETT) and the laryngeal mask airway (LMA) are possible strategies for airway management during tracheal resection and reconstruction for tracheal and laryngotracheal stenosis. The goal of the study was to analyse and compare outcomes in the LMA and ETT groups. Between 2003 and 2020, a total of 184 patients affected by postintubation, post-tracheostomy and idiopathic stenosis who had tracheal or laryngotracheal resections and reconstructions via a cervicotomy were retrospectively enrolled in this single-centre study. In 29 patients, airway management was achieved through LMA during tracheal surgery, whereas in 155 patients, it was achieved through ETT. A case-control matching analysis was performed with a 1:1 ratio, according to age, gender, body mass index, aetiology and length of stenosis (1-4 cm), resulting in 22 patients managed through LMA (LMA group) matched with 22 patients managed through ETT (ETT group). No significant differences were found in the reintubation rate, 30-day mortality and postoperative length of stay. Operative time was shorter in patients with LMA (96.23 ± 34.72 min in the ETT group vs 76.14 ± 26.94 min in the LMA group; P = 0.043). Intensive care unit (ICU) admission rate and stay were lower in the LMA group [18 in the ETT group vs 8 in the LMA group, odds ratio = 10.17, confidence interval (CI) 95% 1.79-57.79; P = 0. 009; 22.77 ± 16.68 h in ETT group vs 9.23 ± 13.51 h in LMA group; P = 0.005]. Dysphonia was more frequent in the ETT group than in the LMA group (20 in the ETT group vs 11 in the LMA group, odds ratio = 13.79, CI 95% 1.86-102; P = 0.010). LMA is a feasible option for airway management in tracheal surgery, with lower operative time, ICU admission rate, ICU length of stay and postoperative dysphonia occurrence.

Long-term postoperative outcomes in patients with cicatricial tracheal stenosis depending on surgical approach

To analyze the long-term postoperative outcomes in patients with cicatricial tracheal stenosis and to determine the indications for various surgical strategies. There were 976 patients with benign cicatricial tracheal stenosis for the period 2001-2017. Tracheal stenosis occurred after mechanical ventilation and tracheostomy in 910 (93.2%) patients. Other causes were neck trauma, burns, previous surgery or tuberculosis. Idiopathic stenosis was observed in 41 (4.2%) patients. Multiple-stage reconstructive treatment was possible due to benign nature of disease. There were 2.4 operations per a patient, and 976 patients underwent 2327 procedures. Circular tracheal resection was preferred (n=396). Surgical complications occurred in 107 (4.6%) cases, mortality rate - 0.3%. In long-term period, 42 patients died for various causes. In most cases (n=34, 80.9%), mortality was associated with concomitant diseases or consequences of trauma rather cicatricial tracheal stenosis or its treatment. Eight patients died from cicatricial tracheal stenosis or its treatment (7 patients after staged repair, 1 after circular tracheal resection). Four patients died due to asphyxia following T-tube obturation with a tracheobronchial secret or unjustified decannulation. For various reasons, 41 (6.2%) patients continued their treatment in other hospitals (4 patients died). Mortality rate in this group was 9.8%. Favorable long-term outcome was observed in 90.1% of patients, good and unsatisfactory results - in 7.2% and 1.8% of patients, respectively. Circular tracheal resection ensured better functional outcome. Surgical treatment of cicatricial tracheal stenosis is associated with low incidence of postoperative complications and mortality. However, further improvement in long-term results is associated with advanced rehabilitation programs for concomitant diseases. Treatment of cicatricial tracheal stenosis should be carried out at specialized hospitals.

Postoperative outcome of tracheal resection in benign and malignant tracheal stenosis.

Tracheal or cricotracheal resection is the standard of care for definitive treatment of tracheal stenosis. However, the incidence is low, the management is complex, and only a few centres have reported their experience. Therefore, more clinical reports on this topic are needed. We performed a retrospective analysis of all patients who underwent tracheal or cricotracheal resection for malignant or benign tracheal stenosis in our institution between 2001 and 2016. Fisher’s exact test was used for analysis of complications and recurrence. P-value <0.05 was considered statistically significant. 37 patients, aged 19–74, underwent tracheal (n = 21, 56.8%) or cricotracheal (n = 16, 43.2%) resection for idiopathic (n = 15, 40.5%), neoplasm-related (n = 11, 29.7%), postintubation/-tracheotomy (n = 10, 27%), and congenital (n = 1, 2.7%) stenosis. Cervical incision was applied in 28 patients (75.7%), and an extended access (5 thoracotomy, 3 hemiclamshell, 1 partial-sternotomy) was required in 9 patients (24.3%). Mediastinal lymphadenectomy was done in 7 patients (18.9%), all with neoplasm-related stenosis. Median resection length was 2.8 cm (range 1.0–6.0), and longer than 4.0 cm in 6 cases (16.2%). Release manoeuvre was performed in 7 patients (18.9%). All patients were extubated immediately after surgery and median hospital stay was 5 days (range 3–15). Median follow-up was 6 months (range, 1-93). There was no 30-day mortality, and no dehiscence or fistula occurred at the suture line. Complications were seen in 11 patients (29.7%), significantly correlating to malignant stenosis (p = 0.011) and surgical procedure, meaning extended access (p = 0.011), mediastinal lymphadenectomy (p = 0.016), and release manoeuvres (p = 0.016). Temporary hoarseness was the most common complication (n = 5, 13.5%), but remained persistent in only one patient (n = 1, 2.7%). Recurrence was seen only in patients with idiopathic stenosis (n = 5, 13.5%). Our results confirm good efficacy for surgical resection of tracheal stenosis. The complication rate is relatively low in comparison to the literature, suggesting the importance of managing tracheal stenosis in a tertiary referral centre.

Surgery for laryngotracheal stenosis: Improved results

ObjectiveLaryngotracheal resection is still considered a challenging operation and few high-volume institutions have reported large series of patients in this setting. During the 5 years, novel surgical techniques as well as new trends in the intra- and postoperative management have been proposed. We present results of our increased experience with laryngotracheal resection for benign stenosis. MethodsBetween 1991 and May 2019, 228 consecutive patients underwent laryngotracheal resection for subglottic stenosis. One hundred eighty-three (80.3%) were postintubation, and 45 (19.7%) were idiopathic. Most of them (58.7%) underwent surgery during the past 5 years. At the time of surgery, 139 patients (61%) had received tracheostomy, laser, or laser plus stenting. The upper limit of the stenosis ranged between actual involvement of the vocal cords to 1.5 cm from the glottis. ResultsThere was no perioperative mortality. Two hundred twenty-two patients underwent resection and anastomosis according to the Pearson technique; 6 patients with involvement of thyroid cartilage underwent resection and reconstruction with the laryngofissure technique. Airway resection length ranged between 1.5 and 8 cm (mean, 3.8 ± 0.8 cm) and it was >4.5 cm in 19 patients. Airway complication rate was 7.8%. Overall success of airway complication treatment was 83.3%. Definitive success was achieved in 98.7% of patients. Patients presenting with idiopathic stenosis or postcoma patients showed no increased failure rate. ConclusionsLaryngotracheal resection for benign subglottic stenosis is safe and effective, and provides a very high rate of success. Careful intra- and postoperative management is crucial for a successful outcome.

Intracranial hypertension due to spinal cord tumor misdiagnosed as pseudotumor cerebri syndrome: case report

BackgroundIsolated onset of intracranial hypertension due to spinal cord tumor is rare, thus, easily leading to misdiagnosis and delay in effective treatment.Case presentationHerein, we describe a 45-year-old female patient who manifested isolated symptoms and signs of intracranial hypertension and whose condition was initially diagnosed as idiopathic intracranial hypertension and transverse sinus stenosis. The patient received a stent implantation; however, no improvements were observed. One year later her symptoms exacerbated, and during rehospitalization a spinal imaging examination revealed a lumbar tumor. Pathologic evaluation confirmed schwannoma, and tumor resection significantly improved her symptoms, except for poor vision.ConclusionsSpace-occupying lesions of the spine should be considered in the differential diagnosis of idiopathic intracranial hypertension, even in the absence of spine-localized signs or symptoms.

Technique of laryngotracheal resection in subglottic stenosis.

Cervical stenosis of the trachea caused by tracheotomy, tumor or induced by inflammatory disease can be treated by resection and anastomosis with good early and long-term results. Involvement of the ring cartilage makes the procedure technical demanding and increases the risk of morbidity. We describe our technique of laryngotracheal resection and reconstruction and compare the perioperative results with standard trachea resection. Between January 2005 and September 2018, we performed 92 standard cervical tracheal resections and 50 laryngotracheal resection including 6 procedures with widening of the ring cartilage. The resections were realized by direct anastomosis using dorsal flaps and/or interposition of rib cartilage in the posterior part of the ring cartilage. In one case intraoperative tracheotomy and intralaryngeal stenting was used. Patient records have been analyzed for perioperative data retrospectively. The main cause for stenosis or defect of the trachea and operation is preceding tracheotomy. Idiopathic stenosis, tumors and subglottic stenosis in Wegener disease are less common. Healing of the anastomosis was not disturbed in any patient. In two patients, bronchoscopic resection of granulation tissue was necessary. Tracheotomy in the course of treatment for intralaryngeal swelling or recurrent nerve palsy was necessary in 3 patients including one intraoperative tracheotomy for glottic stenting. Postoperative tracheostomy was closed in all patients within 3 months. Pulmonary complications and persistent recurrent nerve palsy occurred in 4 and 2 of the patients, respectively. Two patients died of pulmonary complications. The laryngotracheal resection is a relevant part of cervical tracheal surgery. It can be performed without significant elevated morbidity and is able to restore lung function and quality of voice.

Papilledema due to Bilateral Stenosis of the Foramen of Monro

Papilledema is a key diagnostic factor in the management of several neurological conditions. Papilledema has a variety of causes related to increased intracranial pressure (ICP), several of which require prompt surgical or medical intervention due to potential vision or life-threatening consequences. Magnetic resonance imaging (MRI) of the brain is key to making the correct diagnosis and management decisions. Case Report: This case report illustrates acute onset papilledema in a young Caucasian male due to acquired hydrocephalus from a rare condition, idiopathic stenosis of the foramen of Monro. An MRI performed following the eye examination prompted a referral to neurology and neurosurgery for urgent intervention, leading to eventual good visual outcome for the patient. The important role of eye care providers in diagnosis, referral, and post-surgical management is emphasized.

Left-sided portal hypertension caused by idiopathic splenic vein stenosis improved by splenectomy: a case report

BackgroundSplenic vein stenosis and occlusion, which are known causes of left-sided portal hypertension, often occur secondary to trauma, pancreatitis, or invasion or compression by pancreatic tumors. However, few reports have described idiopathic splenic vein stenosis.Case presentationA 70-year-old man was referred to our hospital for examination of isolated gastric varices. He had no history of liver disease, pancreatitis, or abdominal trauma. Computed tomography revealed stenosis of almost the entire length of the splenic vein, and development of gastric fundal and short gastric varices. No inflammatory changes or neoplastic lesions of the pancreas were observed in any imaging study. The patient was diagnosed with left-sided portal hypertension caused by idiopathic splenic vein stenosis, and splenectomy was performed. The postoperative course was smooth, and improvement of the gastric varices was shown by upper gastrointestinal endoscopy at 3 months after the operation.ConclusionsIdiopathic splenic vein stenosis is an extremely rare cause of left-sided portal hypertension. Splenectomy is one of the most effective treatments for left-sided portal hypertension caused by idiopathic splenic vein stenosis.

Tracheal resection for tracheal stenosis

Anatomically, patients with refractory tracheal stenosis benefit from tracheal resection, depending on the medical comorbidities or challenging tracheal anatomy, which is often the reason for denial of this option in these patients. We evaluated 15 patients undergoing tracheal resection at our institution from May 2016 through December 2017. Eleven patients had a history of previous tracheostomy, six in place at the time of resection. One had idiopathic stenosis with no known comorbidities. Major comorbidities included chronic obstructive pulmonary disease, non-insulin-dependent diabetes mellitus, hypertension, and cardiovascular disease. One had a left ventricular assist device, and one was a lung transplant recipient. All had primary resection through the cervical approach with a median length of 3.5 cm. Fourteen patients were eventually decannulated. One patient had re-resection 1 year later for recurrent stenosis. Twelve were alive at a median follow-up of 15 months with patent airways. In conclusion, tracheal stenosis patients have significant comorbidities that increase the risks after resection. However, these patients should still be considered for surgery for an improved quality of life and eventual resolution of severe stenosis.

Laryngo-Tracheal Resection as an Alternative to Permanent Tracheostomy

Cervical stenosis of the trachea caused by tracheotomy, tumor or without defined reason (idiopathic) can be treated by resection and anastomosis with good early and long-term results. Involvement of the ring cartilage makes the procedure technically demanding and increases the risk of morbidity. We describe our technique of laryngotracheal resection and reconstruction and compare the perioperative results with standard tracheal resection. Between January 2005 and December 2015, we performed about 800 procedures on the trachea including 76 standard cervical tracheal resections and 35 laryngotracheal resection. Resections were carried out with direct anastomosis without intraoperative tracheotomy or intralaryngeal stenting. Patient records were retrospectively analysed for perioperative data. The main cause of stenosis or defect of the trachea and operation was preceding tracheotomy. Idiopathic stenosis, tumors and subglottic stenosis in Wegener disease were less common. There were no disturbances of healing of the anastomosis in any patient. Tracheotomy in the course of treatment for intralaryngeal swelling or recurrent nerve palsy was necessary in 3 (standard) and 2 (laryngotracheal) patients. Postoperative tracheostomy was closed in all patients within 3 months. Pulmonary complications and recurrent nerve palsy occurred in 5/4 and 2/2 of the patients without significant differences between the 2 groups. One patient died in each group from pulmonary complications. The laryngotracheal resection is a relevant part of cervical tracheal surgery. It can be performed without significantly higher morbidity and can restore lung function and quality of voice.

Circular tracheal resection for acquired tracheal stenosis: evaluation of early and long-term outcomes

To present single-center experience and results of surgical treatment of acquired tracheal stenosis. There were 99 patients with acquired tracheal stenosis for the period from January 2008 to December 2017. Median age was 39 (28; 55) years (range 19-79 years), male/female ratio - 64/35. There were 59 patients with tracheostomy-related stenosis, 31 - post-intubation injury, 6 - posttraumatic stenosis, malignant and idiopathic stenosis was observed in 2 and 1 patients, respectively. Single-stage circular tracheal resection or staged surgical approach were preferred depending on localization and severity of stenosis, respiratory function at admission, severity of concomitant diseases and possibility of prolonged head adduction, presence of tracheostomy and cervical tissues inflammation, functional state of laryngeal structures. Single-stage circular tracheal resection was applied in 44 (44.4 %) out of 99 cases. In 55 (55.6%) patients staged approach was preferred: Montgomery T-tube placement followed by tracheoplasty after 6-12 months - 27 patients; tracheoplasty on prefabricated endotracheal stent - 8 patients; staged endotracheal treatment (including Dumon prosthesis deployment) - 12 patients. In 11 cases circular resection was done as a final stage of treatment. There was no in-hospital mortality after circular tracheal resection. Morbidity included anastomotic dehiscence - 2 (3.6%), recurrent stenosis in 6 months after surgery - 1 (1.8%), granulation tissue growth followed by stenosis - 4 (7.3%), wound infection - 3 (5.5%) cases), postoperative pneumonia - 2 (3.6%) patients, respectively. Tracheal resection is preferred for tracheal stenosis management. Alternative techniques are life-saving procedures, but could potentially extent the length of stenosis and delay recovery of the patient.

Improved White Matter Cerebrovascular Reactivity after Revascularization in Patients with Steno-Occlusive Disease.

One feature that patients with steno-occlusive cerebrovascular disease have in common is the presence of white matter (WM) lesions on MRI. The purpose of this study was to evaluate the effect of direct surgical revascularization on impaired WM cerebrovascular reactivity in patients with steno-occlusive disease. We recruited 35 patients with steno-occlusive disease, Moyamoya disease (n = 24), Moyamoya syndrome (n = 3), atherosclerosis (n = 6), vasculitis (n = 1), and idiopathic stenosis (n = 1), who underwent unilateral brain revascularization using a direct superficial temporal artery-to-MCA bypass (19 women; mean age, 45.8 ± 16.5 years). WM cerebrovascular reactivity was measured preoperatively and postoperatively using blood oxygen level-dependent (BOLD) MR imaging during iso-oxic hypercapnic changes in end-tidal carbon dioxide and was expressed as %Δ BOLD MR signal intensity per millimeter end-tidal partial pressure of CO2. WM cerebrovascular reactivity significantly improved after direct unilateral superficial temporal artery-to-middle cerebral artery (STA-MCA) bypass in the revascularized hemisphere in the MCA territory (mean ± SD, -0.0005 ± 0.053 to 0.053 ± 0.046 %BOLD/mm Hg; P < .0001) and in the anterior cerebral artery territory (mean, 0.0015 ± 0.059 to 0.021 ± 0.052 %BOLD/mm Hg; P = .005). There was no difference in WM cerebrovascular reactivity in the ipsilateral posterior cerebral artery territory nor in the vascular territories of the nonrevascularized hemisphere (P < .05). Cerebral revascularization surgery is an effective treatment for reversing preoperative cerebrovascular reactivity deficits in WM. In addition, direct-STA-MCA bypass may prevent recurrence of preoperative symptoms.

Predictors of recurrence after surgical treatment of idiopathic progressive subglottic stenosis.

SUMMARYIdiopathic progressive subglottic stenosis is a rare cause of tracheal narrowing. Partial cricotracheal resection and anastomosis can cure idiopathic stenosis, even if some patients may require multiple interventions and experience voice and swallowing deterioration. We investigated risk factors for retreatment and assessed the impact of crico-tracheal resection on functional parameters. We conducted a retrospective multicentric study on 44 female patients (mean age 52.6 ± 13.1 years) affected by idiopathic stenosis and treated by crico-tracheal resection between 2002 and 2016. Functional outcomes after crico-tracheal resection were assessed by the airway-dyspnoea-voice-swallowing score (range 1-5, with “1” expressing normal and “5” completely altered function). Previous treatments, grade of stenosis, site, airway comorbidities, age and resection length were tested as predictors of postoperative complications and number of additional treatments, using bivariate and multivariate analysis. The overall decannulation rate was 97.3%. The dyspnoea score improved (mean variation 1.4 ± 1.0; p < 0.001), while voice and swallowing were negatively affected (mean variation 1.6 ± 0.9 and 0.5 ± 0.7, respectively; p < 0.001). Airway comorbidities were associated with a higher rate of complications (p < 0.05). Retreatments were more frequent in patients with postoperative complications (p < 0.05). The length of resection correlated with the number of subsequent treatments (R = 0.52; p < 0.01). At multivariate analysis, post-operative complications were predicted by comorbidities and disease stage (p < 0.05); number of retreatments was linked to the length of resection (p < 0.05) as well as with the application of mitomycin C (p < 0.001). Crico-tracheal resection for idiopathic progressive subglottic stenosis offers good functional results in terms of airway patency. These data suggest that a higher complication rate can be expected in patients affected by comorbidities. Moreover, more extensive surgical resection seems to be associated with the occurrence and number of subsequent retreatments. On the contrary, the local application of an anti-proliferative drug does not seem to be of use in preventing recurrences.

Laryngotracheal resection: perioperative management and surgical technique

In the landscape of tracheal surgery, subglottic stenosis still represents a demanding condition because of the technical and functional implications surrounding the peculiar anatomy of the lower larynx. Since the basis for a safe and complete surgical excision of subglottic stenosis with primary laryngotracheal anastomosis have been described, results from large published series have reported excellent and durable success in this setting in view of low morbidity and mortality rates, thus affirming the role of surgery as the definitive treatment of choice for benign stenosis. In recent years, novel techniques are been developed that pertain in particular the treatment of idiopathic stenosis. This article focuses on tricks and tips about the main technical aspects and perioperative management in the field of laryngotracheal resection.

The modern approach to the treatment of subglottic laryngeal stenosis

We have examined a total of 14 patients presenting with subglottic laryngeal stenosis. The etiological factors and underlying conditions of laryngeal stenosis were the prolonged intubation in 4 patients, Wegener granulomatosis in 6 patients, and idiopathic stenosis of the larynx in 4 patients. All the patients underwent balloon dilatation with the application of the video endoscopic technique. The surgical treatment of all the patients made it possible to achieve the persistent expansion of the lumen of the subglottic part of the larynx, to shorten the periods of the in-patient treatment and rehabilitation of the patients. Restenosis of laryngeal lining stenting was observed in one patient presenting with Wegener's granulomatosis which was associated with the relapse of the underlying disease.