Management Of Laryngotracheal Stenosis Research Articles

Management of Laryngotracheal Stenosis in Obesity. Is This Another Co-morbidity that Can Be Improved with Weight Loss Following Bariatric Surgery?

PurposeBariatric surgery improves several obesity-related comorbidities. Laryngotracheal stenosis is a rare condition that is usually managed with repeated endoscopic airway interventions and reconstructive airway surgery. The outcome of these definitive operations is worse in individuals with obesity. There are no studies investigating the effect of weight loss following bariatric surgery in the management of laryngotracheal stenosis.Materials and MethodsIn an observational study, consecutive patients with a BMI over 35 kg/m2 and laryngotracheal stenosis were prospectively recruited to a bariatric and airway stenosis database in two tertiary care centres. Patients were treated with laparoscopic Roux-en-Y gastric bypass or sleeve gastrectomy and control subjects were managed conservatively.ResultsA total of eleven patients with an initial body mass index of 43 kg/m2 (37–45) were enrolled to this study. Six patients underwent bariatric surgery and five subjects were treated conservatively. After 12 months, the total weight loss of patients undergoing bariatric surgery was 19.4% (14–24%) whilst 2.3% (1–3%) in the control group. The annual number of endoscopic airway interventions following bariatric surgery reduced (p = 0.002). Higher weight loss in patients led to less frequent interventions compared to control subjects (p = 0.004). Patients undergoing laryngotracheal reconstruction following bariatric surgery needed less endoscopic intervention, an annual average of 1.9 interventions before vs 0.5 intervention after. Conservatively managed control subjects required more frequent endoscopic intervention, 1.8 before vs 3.4 after airway reconstruction.ConclusionBariatric surgery reduced the number of endoscopic airway interventions and enabled patients to undergo successful definitive airway reconstructive surgery.

Laryngotracheal Reconstruction in the Pediatric Burn Patient: Surgical Techniques and Decision Making.

The management of laryngotracheal stenosis (LTS) in the pediatric burn patient is complex and requires a multidisciplinary approach. The mainstay of treatment for LTS is laryngotracheal reconstruction (LTR), however, limited reports of burn-specific LTR techniques exist. Here, we provide insight into the initial airway evaluation, surgical decision making, anesthetic challenges, and incision modifications based on our experience in treating patients with this pathology. The initial airway evaluation can be complicated by microstomia, trismus, and neck contractures-the authors recommend treatment of these complications prior to initial airway evaluation to optimize safety. The surgical decision making regarding pursuing single-stage LTR, double-stage LTR, and 1.5-stage LTR can be challenging-the authors recommend 1.5-stage LTR when possible due to the extra safety of rescue tracheostomy and the decreased risk of granuloma, which is especially important in pro-inflammatory burn physiology. Anesthetic challenges include obtaining intravenous access, securing the airway, and intravenous induction-the authors recommend peripherally inserted central catheter when appropriate, utilizing information from the initial airway evaluation to secure the airway, and avoidance of succinylcholine upon induction. Neck and chest incisions are often within the TBSA covered by the burn injury-the authors recommend modifying typical incisions to cover unaffected skin whenever possible in order to limit infection and prevent wound healing complications. Pediatric LTR in the burn patient is challenging, but can be safe when the surgeon is thoughtful in their decision making.

Effect of topical application of mitomycin-c as an adjuvant treatment of laryngotracheal stenosis

Background Laryngotracheal stenosis (LTS) has become more frequent because of prolonged endotracheal intubation (PEI). The endoscopic treatment of LTS is often associated with high recurrence rate owing to excessive fibrosis. Mitomycin-c (MMC) inhibits fibroblast proliferation, so it is used at the time of endoscopic dilation to improve outcomes. Objective The aim was to assess the effect of application of topical MMC in the treatment of LTS to prevent recurrence of stenosis. Patients and methods A prospective study was carried out on 20 patients with LTS subjected to endoscopic dilatation. All patients were divided to two groups: group A (case group) included 10 patients with LTS who were subjected to endoscopic dilatation with topical application of MMC (0.5 mg/ml), and group B (control group) included 10 patients with LTS who were subjected to endoscopic dilatation without topical application of MMC. A neck computed tomography scan was done for all patients to detect the site and length of stenotic area. Results In group A, LTS was due to PEI in six (30%) patients, due to laryngoscleroma in three (30%) patients, and due to Wegener’s granulomatosis in one (10%) patients, whereas in group B, it was due to PEI in four (40%) patients, due to rhinoscleroma in four (40%) patients, and due to Wegener’s granulomatosis in two (2%) patients. The most common site of stenosis was subglottic and trachea in both groups. Most of the patients in case group ended up with grade 2 dyspnea (mild dyspnea with no limitation to daily activities), whereas three patients in control group achieved this outcome, with a statistically significant difference (P=0.043). None of the patients in the case group developed postoperative stridor 6 months after surgery, compared with four patients in the control group. Conclusion Topical application of MMC as an adjuvant treatment for endoscopic management of LTS has shown good results, low recurrence rate, and high success rate.

A Modified Laryngeal Stent for Glotto-Subglottic Stenosis: A Novel Stent for Better Outcomes

Management of laryngotracheal stenosis is challenging and laryngotracheal stenosis is generally managed with laryngotracheal reconstruction. Stents are often used as part of the reconstructive surgery. Although most stents adequately stabilize the reconstruction during healing, they often do a poor job of mimicking glottic anatomy, particularly the anterior glottis. Here, we present a modified suprastomal stent designed to stabilize reconstruction after laryngotracheal reconstruction while also improving postoperative glottic anatomy and function. The case of a 15-year-old tracheostomy-dependent patient with glotto-subglottic stenosis who underwent laryngotracheal reconstruction using this modified stent is described. The patient had an excellent outcome with decannulation of her tracheostomy and significant improvement in voice.

The minimal clinically important difference of the dyspnea index in laryngotracheal stenosis.

The Dyspnea Index (DI) is a validated patient-reported outcome (PRO) instrument that has been used in the management of laryngotracheal stenosis (LTS). The minimal clinically important difference (MCID) is an established concept to help determine the change in a PRO instrument that reflects meaningful change for the patient. It is not known what change in the DI is of clinical significance in airway surgery. This study aims to determine the MCID for the DI in patients undergoing surgical treatment for LTS. This is a prospective cohort study in which 26 patients with LTS completed the DI (score range 0 to 40) before and 6 to 8 weeks postoperatively, in addition to a Global Ratings Change Questionnaire (GRCQ), scored from -7 to +7, at the postoperative interval. A hypothesis test was carried out to test the association between GRCQ and change in DI. The MCID for change in DI was determined using anchor-based analysis. Overall mean change in DI was -11, and mean change in GRCQ was +5. Change in DI scores were significantly different among the improvement and no improvement groups (P value <0.002). Area under the receiver operating curve was 0.92, demonstrating high discriminatory ability of the change in DI score. A change of -4 was determined to be the threshold that discriminated between significant improvement and no improvement. A decrease of 4 in the DI can be considered as the MCID for patients with LTS after surgical treatment. 2b Laryngoscope, 130:1775-1779, 2020.

Management of Laryngotracheal Stenosis: A 10-Year Study on the Role of Stents

Introduction Laryngotracheal stenosis (LTS) is mostly due to road traffic accidents, prolonged intubation, and tracheostomy. Objectives This study focused on a 10-year experience on the role of stents in the management of LTS in a tertiary referral hospital. The aims of this study were to study the internal dimensions of the subglottis and upper trachea in the Indian adult population; to study the mucosal response to injury to the subglottis and the trachea; and to develop an ideal stent for use in LTS in a rabbit model. Materials and Methods The authors have been treating patients with LTS since 2000. The present study deals with the experience of 82 cases of LTS treated over the past 10 years using stents as well as surgical procedures such as Shiann Yann Lee tracheoplasty and tracheal resection and anastomosis. The work also involved a focused research on LTS using rabbits by inducing injury to the mucosa of the upper trachea and subglottis and histological study of the response to injury. The study led to the development of new indigenous stent for use in rabbits to prevent LTS. This stent has been patented. Statistical Analysis The study of the subglottis and upper tracheal discussion have been analyzed and proved that the dimension in the Indian adult population was smaller than in Caucasians. The mucosal inflammation following injury at the subglottis and upper trachea can be reversed by topical application of triamcinolone, which was better than Mitomycin on statistical analysis. Results The quality of life measured after treatment of LTS using stents and other methods of reconstructive surgery has given an overall benefit of 90% with no mortality. Conclusion LTS is a preventable disease. It can be prevented by proper care of patients in ICU and correct technique of endotracheal intubation and tracheostomy. Further, it can be avoided using medications during extubation and proper decannulation protocol. The silastic “T” tube stents are useful to improve the quality of life in these patients.

Chemical Ablation of Cartilagineous Tissue in Tracheal Stenosis

Laryngo-tracheal stenosis represents a challenging pathology that requires multi-stage surgical approach, and a multidisciplinary team. The diagnosis is based on clinical examination, endoscopic assessment, and imagistic evaluation. Coblation is a surgical technology based on chemical ablation of the tissue, that is suitable for tracheal stenosis approach.We present our experience with coblation for the management of laryngo-tracheal stenosis, and highlight the advantages, and disadvantages of coblation for tracheal stenosis. We consider chemical ablation of the cartilaginous tissue through coblation a valuable surgical technology for the treatment of tracheal stenosis.

Targeting metabolic abnormalities to reverse fibrosis in iatrogenic laryngotracheal stenosis.

Management of laryngotracheal stenosis (LTS) remains primarily surgical, with a critical need to identify targets for adjuvant therapy. Laryngotracheal stenosis scar fibroblasts exhibit a profibrotic phenotype with distinct metabolic shifts, including an increased glycolysis/oxidative phosphorylation ratio. This study examines the effects of the glutamine antagonist 6-diazo-5-oxo-l-norleucine (DON) on collagen production, gene expression, proliferation, and metabolism of human LTS-derived fibroblasts in vitro. Paired normal and scar-derived fibroblasts isolated from subglottic and proximal tracheal tissue in patients with iatrogenic laryngotracheal stenosis (iLTS) were cultured. Proliferation rate, gene expression, protein production, and cellular metabolism were assessed in two conditions: 1) fibroblast growth medium, and 2) fibroblast growth medium with 1 × 10-4 M DON. DON treatment reduced cellular proliferation rate (n = 7, P = 0.0150). Expression of genes collagen 1 and collagen 3 both were reduced (n = 7, P = 0.0102, 0.0143, respectively). Soluble collagen production decreased (n = 7, P = 0.0056). As measured by the rate of extracellular acidification, glycolysis and glycolytic capacity decreased (n = 7, P = 0.0082, 0.0003, respectively). adenosine triphosphate (ATP) production and basal respiration decreased (n = 7, P = 0.0045, 0.0258, respectively), determined by measuring the cellular rate of oxygen consumption. The glutamine antagonist DON reverses profibrotic changes by inhibiting both glycolysis and oxidative phosphorylation in iLTS scar fibroblasts. In contrast to untreated iLTS scar fibroblasts, collagen gene expression, protein production, metabolic rate, and proliferation were significantly reduced. These results suggest DON and/or its derivatives as strong candidates for adjuvant therapy in the management of iatrogenic laryngotracheal stenosis. Enzymes involved in glutamine metabolism inhibited by DON offer targets for future investigation. NA. Laryngoscope, 128:E59-E67, 2018.

Effect of Increased Body Mass Index on Complication Rates during Laryngotracheal Surgery Utilizing Jet Ventilation.

Objective Jet ventilation has been used for >30 years as an anesthetic modality for laryngotracheal surgery. Concerns exist over increased risk with elevated body mass index (BMI). We reviewed our experience using jet ventilation for laryngotracheal stenosis to assess for complication rates with substratification by BMI. Study Design Case series with chart review. Setting Tertiary care center. Subjects and Methods A total of 126 procedures with jet ventilation were identified from October 2006 to December 2014. Complications were recorded, including intubation, unplanned admission, readmission, dysphonia, oral trauma, pneumothorax, pneumomediastinum, and tracheostomy. Lowest intraoperative oxygen saturation and maximum end-tidal CO2 (ETCO2) levels were recorded. Results Among 126 patients, 43, 77, and 6 had BMIs of <25, 25-35, and 36-45, respectively. In the BMI <25 group, there was 1 unplanned intubation. Mean maximum ETCO2 was 36.51 with no hypoxemia observed. In the BMI 25-35 group, 2 patients required intubation, and 1 sustained minor oral trauma. The mean maximum ETCO2 was 38.85, with 4 patients having oxygen saturation <90%. In the BMI 36-45 group, 2 patients required intubation. The mean maximum ETCO2 was 41 with no hypoxemia observed. BMI and length of stenosis were statistically significant variables associated with incidence of intraoperative intubation. Conclusion Increased BMI was associated with an increase in highest ETCO2 intraoperatively. However, this was not associated with an increase in major complications. Jet ventilation was performed without significant adverse events in this sample, and it is a viable option if used with an experienced team in the management of laryngotracheal stenosis.

Evaluation of Dyspnea Outcomes After Endoscopic Airway Surgery for Laryngotracheal Stenosis

Endoscopic airway surgery is a frequently used procedure in the management of laryngotracheal stenosis (LTS); however, no established outcome measures are available to assess treatment response. To assess acoustics and aerodynamic measures and voice- and dyspnea-related quality of life (QOL) in adult patients with LTS who undergo endoscopic airway surgery. This case series compared preoperative measures and postoperative outcomes among adult patients who underwent endoscopic airway surgery for LTS from September 1, 2013, to September 30, 2015, at the tertiary care Johns Hopkins Voice Center. Patients were excluded if they did not undergo balloon dilation or if they had multilevel or glottic stenosis. The Phonatory Aerodynamic System was used to quantify laryngotracheal aerodynamic changes after surgery. Final follow-up was completed 2 to 6 weeks after surgery. The voice-related QOL instrument (V-RQOL), Dyspnea Index, and Clinical Chronic Obstructive Pulmonary Disease Questionnaire were completed before and after endoscopic surgery. Consensus auditory perceptual evaluation of voice, acoustic measurements, and aerodynamic outcomes were also assessed. Fourteen patients (1 man and 13 women; mean [SD] age, 45.4 [4.3] years) were enrolled. The mean postoperative V-RQOL scores (n = 14) increased from 74.3 to 85.5 (mean of difference, 11.3; 95% CI, 2.2 to 20.3). The mean postoperative Dyspnea Index (n = 14) decreased from 26.9 to 6.6 (mean of difference, -20.3; 95% CI, -27.9 to -12.7); the mean postoperative Clinical Chronic Obstructive Pulmonary Disease Questionnaire scores (n = 9) decreased from 3.2 to 1.0 (mean of difference, -2.2; 95% CI, -3.4 to -0.9). Postoperative mean vital capacity (n = 14) increased from 2.5 to 3.1 L (mean of difference, 0.6 L; 95% CI, 0.3-1.0 L), whereas mean laryngeal resistance (n = 14) decreased from 73.9 to 46.4 cm H2O/L/s (mean of difference, -27.5 cm H2O/L/s; 95% CI, -44.8 to -10.3 cm H2O/L/s) postoperatively. Patients demonstrate statistically and clinically significant improvement in dyspnea-related QOL, whereas a few patients showed a clinically significant improvement in V-RQOL. Dyspnea-related QOL outcomes should be added to airway surgeons' regular assessment of patients with LTS to measure treatment response and inform the decision to perform a second operation, whereas V-RQOL outcomes need additional prospective study with a larger sample size. The Phonatory Aerodynamic System is not an optimal method to quantify changes in laryngotracheal aerodynamics after intervention in LTS.

Management of Laryngotracheal Stenosis - Still Remains a Challenge for Successful Outcome

Abstract Management of laryngotracheal stenosis (LTS) is still an enigma and remains a challenge even for an expert surgical team. The treatment of LTS is quite difficult and often associated with significant risk and complications. Even with the availability of many surgical options, proper selection of surgical technique in each clinical situation is the key behind successful outcome. Selection of appropriate surgical repair depends on the site of stenotic segment, severity, duration, and cause of functional impairment. It requires meticulous preoperative evaluation and planning. No single approach is ideal and often several techniques may be needed before decannulation can be achieved. The purpose of this review article is to discuss the pathophysiology, pre-operative evaluation, surgical principle, surgical technique, graft materials in reconstruction and prevention of LTS and optimum stress given on different suitability of surgical techniques with application of suitable one in relation to site of stenosis and other stenosis parameters.

Pediatric airway surgery: Management of laryngotracheal stenosis in infants and children

ConclusionI think the author succeeded to present in details the different technical aspects of diagnosis and treatment to provide the reader not only with well-established treatment modalities, but also with new concepts of pediatric airway management. This book could be an excellent reference for those going to deal with pediatric airway stenosis. The book achieved its goals, and to my mind it deserves to be read.

Laryngotracheoplasty with T-tube Stenting by Modification of Shiann Yann Lee's Technique

ABSTRACTBackgroundLaryngotracheal stenosis is a challenging problem in laryngology which is often misdiagnosed and improperly treated. It is also on the rise due to increase in the number of accidental trauma, prolonged intubations or tracheostomy. Laryngotracheoplasty by Shiann Yann Lee's technique with T-tube stenting is a common accepted surgical procedure these days.Materials and methodsOurs is a retrospective study of 14 cases of laryngotracheal stenosis over a period of 20 years from 1993 to 2014, who underwent laryngotracheoplasty with T-tube stenting by a modification of Shiann Yann Lee's technique.ResultsIn our study of 14 patients, the incidence of laryngotracheal stenosis was found to be maximum in the age group of 21 to 30 years with a male preponderance. The commonest etiological factor was prolonged endotracheal intubation or cuffed tracheostomy. The commonest site of the stenosis in our study was cervical trachea. The average time for removal of T-tube was 18 months. All the 14 patients had an uneventful period between insertion and removal of T-tube without any complications. The success rate of our study was hence 100%.ConclusionLaryngotracheoplasty with T-tube stenting by our modification of Shiann Yann Lee's technique is an effective and successful method in the management of laryngotracheal stenosis with a success rate of 100%.How to cite this articleKumar MHM, Jayaraju RM. Laryngotracheoplasty with T-tube Stenting by Modification of Shiann Yann Lee's technique. Int J Phonosurg Laryngol 2014;4(2):60-62.

Tracheal T-tube stent for laryngotracheal stenosis: ten year experience.

The purpose of this retrospective study was to evaluate the outcome following stenting over a period of 10 years in patients with chronic laryngotracheal stenosis. Between 2000-2010, out of 111 patients with laryngotracheal trauma, 71 underwent tracheal T-stenting for laryngotracheal stenosis in the Department of Otorhinolaryngology at the Government Medical College and Hospital, Chandigarh, India. All 71 patients underwent stenting by tracheal T-stent through an external approach. The follow-up period ranged from 3-10 years (mean, 3.2 years). The tracheal T-stent was removed after a minimum period of 6-12 months. The majority of patients in this study were aged less than 10 years or between the ages of 20-30 years. A pre-operative tracheostomy (emergency or elective) was performed in all patients. of 71 patients, decannulation was not possible in six (8%). Management of laryngotracheal stenosis is a challenging problem that demands a multidisciplinary approach from surgical teams well trained in this field. The ideal treatment option should be individualized according to patient characteristics. The use of silastic stents has both advantages and disadvantages.

Management of laryngotracheal stenosis in infants and children: the role of re-do surgery in cases of severe subglottic stenosis

Although many advances have improved the treatment of congenital and acquired laryngotracheal stenosis in children over the past two decades, the therapeutic decision-making process remains challenging for pediatric surgeons and otolaryngologists. Severe subglottic stenosis is a complex laryngeal injury that necessitates multiple airway procedures, and the approach depends on the exact nature of the cicatricial lesion and its effect on the vocal cord mobility. Therefore, it is imperative that the pediatric surgeons and otolaryngologists dealing with this situation should be well trained in endoscopy and laser treatment, in addition to open surgical intervention. Open re-do surgery remains the best choice in cases of severe congenital stenosis, glottic immobility, or after two to three endoscopic procedures have been performed without any significant improvement.

Management of Laryngotracheal Stenosis by Laryngoplasty

ABSTRACT This is a prospective study done on six cases of laryngotracheal stenosis. They were operated by laryngoplasty with mucoperichondrial grafting stenting (temporary and permanent). The purpose of the study was to determine the role of laryngoplasty in the treatment of acquired subglottic stenosis. In this study, six patients who presented to the Government General Hospital from March 2011 to April 2012, with subglottic stenosis were enrolled. The details of their etiology, time period with endotracheal intubation, duration between extubation and onset of symptoms, treatment and postoperative recovery on follow-up were recorded and analyzed. It was found that laryngoplasty with cartilage grafting along with T-tube or Dumonts silicone stent placement carries good success rate, with no recurrence. How to cite this article Murthy GSN, Bhimeswar R, Kumar MV, Murthy PSN, Chanukya SU. Management of Laryngotracheal Stenosis by Laryngoplasty. Int J Phonosurg Laryngol 2013;3(2):46-50.

Laryngotracheal Stenosis: Clinical Profile, Surgical Management and Outcome

Despite the availability of various surgical options, management of laryngotracheal stenosis (LTS) still remains an enigma. Proper selection of surgical technique in each clinical setting is the key for successful outcome. The purpose of this article is to guide one in selection of appropriate surgical procedures depending upon various stenosis parameters. Aim To record the clinical profile of cases with LTS. To assess the outcome following various surgical interventions based on site, severity, cause of stenosis and to derive conclusions regarding treatment options in various stenosis. Materials and Methods It is a study of 60 cases with chronic LTS. It includes retrospective study of 30 cases treated from 2004 and prospective study of 30 cases from Jan 2007 to Dec 2009. A total of 60 cases with LTS were enrolled in the study. Patients were assessed clinically by eliciting detailed history and analyzing previous records. After assessment of extent of stenosis, they were subjected to surgical interventions (endoscopic/open approach). Outcome after surgical interventions was assessed. Results 60 patients were included in the study, in the age group of 2.5-50years. There were 46 (77%) male patients and 14 (23%) female patients. Intrinsic trauma, secondary to prolonged intubation was the most common cause of LTS, seen in 23 (38%) cases followed by post traumatic stenosis (strangulation-18 (30%), blunt injury-15 (25%), penetrating neck injury-4 (7%)). Stenosis was divided into 6 types based on subsite involvement. Of which, cervical trachea was the commonest site of involvement (25/60 cases). Majority of cases had fixed vocal cords at presentation (55%), more commonly due to post traumatic injury. 60 cases had undergone a total of 110 surgical procedures (endoscopic-56,open approach-54). In the end, overall decannulation rate is 93.3%. In site wise tracheal stenosis, isolated subglottis, combined glottis and subglottic stenosis had decannulation rate of 100% each and with mobile vocal cords, the success rate is 96%. Conclusions Post traumatic stenosis with fixed vocal cords is more common in our practice. Categorizing stenosis into various subtypes helps in treatment planning and predicts surgical outcome. Tracheal or subglottic stenosis with mobile vocal cords has better success rate.

Management of laryngotracheal stenosis — our experience

To describe our experience in the management of laryngotracheal stenosis (LTS). Prospective study. This study was carried out from 2001 to 2004 on 30 cases. All cases were investigated by spiral computerized tomography and endoscopic examination. There were 21 males and 9 females treated for LTS resulting from trauma (19), intubation (9) and congenital (2). Patients were divided into four groups based on surgical procedures they underwent: group I, endoscopy dilatation group (7 cases); group II, laryngotracheoplasty with Montgomery tube insertion (12 cases); group III, laryngotracheoplasty with Montgomery laryngeal stent insertion (5 cases) and group IV, cricotracheal resection with M-tube insertion (6 cases); The number of patients decannulated in group I, group II, group III and group IV were 4, 10, 0 and 5, respectively. We found statistically significant difference between decannulated and nondecannulated group for site and length of stenosis. Patients undergoing dilatation for LTS require multiple procedures. Open surgical exploration with stent has a better outcome than those with repeated dilatation.

Tracheal resection with primary anastomosis: 10 years experience

Objective The aim of the study was to review clinical, imagiologic, and surgical outcomes of tracheal resection in the management of laryngotracheal stenosis. Methods The study used a retrospective analysis of adult patients managed in a tertiary academic hospital who underwent thyrotracheal, cricotracheal, or tracheal end-to-end anastomosis between 1997 and 2006. Results Twelve patients, aged 15 to 79 years old, were included. Prolonged tracheal intubation was the leading cause of stenosis (11 patients) that was classified according to Myer-Cotton ( Ann Otol Rhinol Laryngol. 1994;103:319–323) classification as follows: grade II (25%), grade III (58%), and grade IV (17%). The stenosis extension ranged from 1 to 6cm. Surgeries varied from tracheal end-to-end anastomosis (n = 5), cricotracheal anastomosis (n = 4), and thyrotracheal anastomosis (n = 3). Extubation was achieved in 11 patients (92%). One patient maintains a T tube stent. The most common complication was the presence of granulation tissue in the anastomosis region (33%). There was no mortality associated. Conclusions Tracheal resection with primary anastomosis appears to be a successful and safe procedure mainly due to its high decannulation rate and few complications associated.

Management of Laryngotracheal Stenosis in Infants and Children

Management of Laryngotracheal Stenosis in Infants and Children