Management Of Airway Stenosis Research Articles

Use of a modified endotracheal tube for self-expandable metallic Y-shaped airway stent deployment without rigid bronchoscope or fluoroscopic guidance.

Self-expandable metallic Y-shaped airway stents (SEMYS) are commonly used in the management of airway stenosis and fistulae caused by thoracic neoplasms. A new technique using a slightly modified regular endotracheal tube has been developed for the deployment of SEMYS with flexible bronchoscopy alone. The technique and devices are described. To date, successful deployment of SEMYS with this method has been carried out successfully in 17 out of 20 patients without major complications while the other 3 required conversion to rigid bronchoscopy because of limited pharyngeal cavity space, massive hemorrhage and severe cicatrization of the airway, respectively. This simplified deployment technique with the modified endotracheal tube enables safe, simple and fast insertion of SEMYS in a regular bronchoscopy suite, which may benefit the vast less privileged institutions where SEMYS are necessary but rigid bronchoscopy and fluoroscopy are not available. The skill of the bronchoscopist, cautious selection of patients and effective coordination of the operating team are crucial for the procedure.

Three-dimensional (3D) Printed Model to Plan the Endoscopic Treatment of Upper Airway Stenosis.

Endoscopic management of tracheal stenosis may be challenging, especially in the case of complex stenosis placed near the vocal folds, and needing stent placement. Herein, we evaluated the utility of the three-dimensional (3D) airway model for procedural planning in a consecutive series of patients with complex airway stenosis and scheduled for endoscopic treatment. This strategy was applied to 7 consecutive patients with tracheal stenosis unfit for surgery. The model was printed in a rubber-like material, and almost 7 hours were needed to create it. All patients presented respiratory failure with a mean value of 3.4±0.4 Medical Research Council (MRC) dyspnea scale, 47±3.9 forced expiratory volume in 1 second (FEV1%), and an impairment in the 6-minute walking test (6MWT) (mean value, 175±53 m). The mean length of the stenosis was 19±3.4 mm; 3 of the 7 (43%) patients presented a subglottic stenosis. In 4/7 (57%) patients the stenosis was >5 mm, but its treatment required the placement of a stent because of the presence of tracheal cartilage injury. The mean operation time was 22.7±6.6 minutes. No complications were observed during and after the procedure. A significant increase of MRC (3.4±0.4 vs. 1.6±0.5; P=0.003), of FEV1% (47±3.9 vs. 77±9.7; P=0.001), and of 6MWT (175±53 vs. 423±101; P=0.0002) was observed after the procedure (mean follow-up, 11.1±8.8 mo). Our 3D airway model in the management of airway stenosis is useful for procedural planning, rehearsal, and education. The fidelity level of the 3D model remains the main concern for its wider use in patient care. Thus, our impressions should be confirmed by future prospective studies.

Various Techniques on Distinct Cases of Tracheal Stenosis

Narrowing of the airway caused by several factors is a serious condition manifesting different  signs and symptoms. Immediate attention is needed and treatment must be performed as this is a  life-threatening condition. In the past decade, there have been massive advancements in the management  of airway stenosis. Some of these are stent placement, tracheal reconstruction and tumor debulking. This article focuses on six different cases with distinct strategies in conducting treatment.

Different Approaches on Various Cases of Tracheal Stenosis

Narrowing of the airway caused by different diseases is a serious condition manifesting varying signs and symptoms. Immediate attention and treatment must be performed as this is a life-threatening condition. In the past decade, there has been massive advancement on the management of airway stenosis. Some of these are stent placement, tracheal reconstruction and tumor debulking. This article focuses on 5 different cases with distinct strategies in conducting treatment and management of airway stenosis.

The role of T-tubes in the management of airway stenosis†

When the T-tube is inserted as a temporary stent, it is unclear whether keeping it longer in place has any benefit on the outcome. Among 1738 patients with airway stenosis (1996-2011), 134 underwent T-tube placement (mean duration = 14.3 months); temporarily while waiting for an appropriate time for surgery in 53 (Group 1), as an adjunct after a complex laryngotracheal resection in 27 (Group 2), after surgical failure in 43 (Group 3) and permanently in 11 unresectable strictures (Group 4). A logistic regression model was used for statistical analysis. Seventy percent of patients were males (age = 33.6 ± 17 years). The main cause was postintubation/post-tracheostomy stenosis in 87% of patients. The stenosis (29.6 ± 14 mm, 5-80 mm) was located in the subglottis in 33%, trachea in 47% and both in 20% of cases. To assess the effect of T-tubes on stabilizing the airway after decannulation, 50 patients who still had a T-tube at the end of follow-up or for <1.5 months were excluded. Of the remaining 84, 31.5, 91.5 and 32.5% of patients in Groups 1, 2 and 3 were stable at least 3 months after decannulation. Moreover, 70% of those who were decannulated at or before 6 months and 53.7% of those who were decannulated after 6 months underwent another intervention (P = 0.17). The age, sex, cause, site of stenosis and even duration of T-tube insertion (P = 0.07) showed no significant effect on the decannulation outcome. Although it seems that keeping the T-tube in place for >6 months may increase the chance of successful decannulation, it was not confirmed in our study.

Comparison of Virtual and Fiberoptic Bronchoscopy in the Management of Airway Stenosis

Noninvasive imaging methods can be valuable tools for diagnosing thoracic diseases, especially malignancies. The aim of this study was to compare the effectiveness of conventional and virtual bronchoscopy in the follow-up of patients with large airway stenosis. Twenty-three consecutive patients with stenoses of the trachea and/or the main bronchi were enrolled in this prospective observer study. The causes of stenosis included malignant or benign tumours, goiter, and postintubation stenoses. Patients were evaluated before and after treatment (which included mechanical dilation, laser photocoagulation, stent implantation, radiotherapy, chemotherapy, and surgical resection). The mean time between baseline and follow-up endoscopy was 140 days. No significant differences were observed between the estimated and measured data from bronchofibroscopy and virtual bronchoscopy. Exact measurement of stenoses was performed with virtual bronchoscopy.

Use of microdebrider in glottic stenosis following airway stenting

Stent placement may induce granulation tissue, occlude the stent lumen, and exacerbate respiratory symptoms. Microdebrider was designed to treat laryngeal papillomas and airway stenosis. However, little research exists on the management of airway stenosis following airway stenting with microdebrider. This study describes two cases of glottic stenosis caused by airway stenting successfully treated with mibrodebrider.

Bioabsorbable Self-reinforced Poly-l-Lactide, Metallic, and Silicone Stents in the Management of Experimental Tracheal Stenosis

The aim of the present study was to compare, in rabbits, the biocompatibility and suitability of a bioabsorbable spiral stent made of self-reinforced poly-L-lactide (SR-PLLA) in the management of experimental tracheal stenosis with stents made of metal and silicone. Tracheobronchial stenosis, and its management, is still problematic because stenoses are not always amenable to surgical resection and reconstruction, especially concerning anastomotic problems and stenosis after lung transplantation. Stenosis can be handled with stenting, although the ideal stent has yet to be developed; all the stents available have their disadvantages. Because stenting of the airways can be only temporary, stents made of bioabsorbable materials, theoretically, offer benefits. Tracheal stenosis was created in rabbits by the extramucosal resection of cartilaginous arches of the cervical trachea. After a few weeks, the animals were operated on again, and those stenoses that had developed were dilated with a balloon. Stents then were implanted in the area of stenosis to keep the dilated trachea open. All the animals in the group with silicone stents had to be killed because of respiratory difficulties: their stents had a tendency to occlude because of internal encrustation, and they developed a hyperplastic polyp at the ends of the stents. The SR-PLLA and metallic stents were tolerated well, and after follow-up ended the animals were put to death. This experimental study showed that silicone stents had a tendency to occlude and that stents made of metal and of SR-PLLA were well tolerated and can be used in the management of airway stenosis.

Stenting therapy for stenosing airway diseases.

Tracheobronchial stents have proved very valuable in the management of airway stenosis due to a variety of causes, both benign and malignant. These include benign strictures which are post-traumatic (e.g. after intubation), post anastomotic (e.g. after lung transplantation), or post inflammatory (e.g. after inflammatory conditions such as tuberculosis or Wegener's granulomatosis); as well as narrowing due to malignant involvement of large airways. In addition, airway stents have been used to treat tracheobronchomalacia and oesophageal-airway fistulae. The insertion of the stent may need to be combined with other procedures such as airway dilatation, laser photocoagulation, brachytherapy or a mixture of these treatment modalities. Stents have been fashioned out of silicone, wire mesh or a combination of these materials, but the perfect stent has yet to be devised. Common problems include displacement and obstruction with secretions or granulation tissue. Less commonly the stent may perforate the airway wall, sometimes into the accompanying blood vessel. Nonetheless, airway stents are valuable tools in the management of airway narrowing.

Management of Airway Stenosis in Children

Management of Airway Stenosis in Children