Tracheal T-Tube Stent for Laryngotracheal Stenosis: Ten Year Experience

Document Type : Original

Authors

Department of Otorhinolaryngology, Government Medical College and Hospital, Chandigarh, India.

Abstract

Introduction:
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.
 
Materials and Methods:
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.
 
Results:
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%).
 
Conclusion: 
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.

Keywords

References

1. Courey MS. Airway obstruction, the problem and its causes. Otolaryngol Clin North Am1995; 28(4):  673–84.
2.  Mandour M, Remacle M, Van de Heyning P, Elwany S, Ahmed Tantawy Alaa Gaafar Chronic subglottic and tracheal stenosis: endoscopic management vs. surgical reconstruction. Eur Arch Otorhinolaryngol 2003; 260: 374–80.
3. Thawley SE, Ogura JH. Panel discussion: the management of advanced laryngotracheal stenosis. Use of the hyoid graft for treatment of laryngotracheal stenosis. Laryngoscope 1991: 226–32.
4. George M, Lang F, Pasche Ph, Monnier Ph. Surgical management of laryngotrachael stenosis in   adults. Eur Arch Otorhinolaryngol 2005; 262: 609–15.
5. Zalzal GH, Cotton RT. Glottic and subglottic stenosis. In: Cumming CW (ed) Otolaryngology – Head and Neck Surgery 2000, 2nd edn. Mosby Year Book, St. Louis, Baltimore, Boston, Chicago, London, Philadelphia, Sydney, Toronto.
6. Simpson GT, Polanyi TG. History of the CO2 laser in otolaryngology surgery. Otolaryngol Clin North Am1983; 16(4): 739–52.
7. Simpson GT, Strong MS, Healy GB, Shapshay SM, Vaughan CW. Predictive factors of success or failure in, the endoscopic management of laryngeal and tracheal stenosis. Annals of Otology, Rhinology and Laryngology 1982; 91(4Pt 1): 384–8.
8. Strong MS, Healy GB, Vaughan CW, Fried MP, Shap-shay SM. Endoscopic management of laryngeal stenosis. Otolaryngologic Clinics of NorthAmerica 1979;12(4): 797–805.
9. Backer CL, Mavroudis C, Dunham ME, Lauren DH. Repair of congenital tracheal stenosis with a free tracheal autograft. J Thorac Cardiovasc Surg 1985; 115(4): 869–74.
10. Dayan SH, Dunham ME, Backer CL, Mavroudis C, Holinger LD. Slide tracheoplasty in the management of congenital tracheal stenosis. Ann Otol Rhinol Laryngol 1997; 106(11): 914–19.
11. Delaere P, Liu Z, Feenstra L. Experimental tracheal revascualarization and transplantation. Acta Otorhinolaryngol Belg 1995; 49(4): 407–13.
12. Eliachar I, Stein J, Strome M. Augmentation techniques in laryngotracheal reconstruction. Acta Otorhinolaryngol Belg 1995; 49(4): 397–406.
13. Takahiro M, Shimizu N, Aoe N, Andu A, Date H. Experimental study of tracheal allotransplantation with cryopreserved grafts. J Thorac Cardiovasc Surg 1998; 116(2): 262–6.
14. Triglia JM, Nicolias R, Roman S. Management of subglottic stenosis in infancy and childhood. Eur Arch Otorinolaryngol 2000; 257: 382–5.
15. Pearson FG, Brito-Filomeno L, Cooper JD. Experience with partial cricoid resection and thyrotracheal anastomosis. Ann Otol Rhinol Laryngol 1986; 95(6Pt 1): 582–5.
16. Couraud L, Jougon J, Velly JF, Klein C. Ste´noses iatrogenes de la voie respiratoire. Evolution des indications therapeutiques. Ann Chir Thoracic Cardiovasc 1994; 48: 277–83.
17. Grillo HC, Zannini P, Michelassi F. Complications
18. Couraud L, Brichon PY, Velly JF. The surgical treatment of inflammatory and fibrous laryngotracheal stenosis. Eur J Cardiothorac Surg 1988; 2(6): 410–15.
19. Grillo HC, Donahue DM, Mathisen DJ, Wain JC, Wright CD. Post intubation tracheal stenosis: treatment and results. J Thorac Cardiovasc Surg 1995; 109(3): 486–92.
20. Hanna E, Eliachar. Endoscopically introduced expandable stents in laryngotracheal stenosis: the jury is still out. Otolaryngol Head Neck Surg 1997; 116(1): 97–103.
21. Eliachar I, Goldsher M, Alder O. Combined treatment of concurrent laryngeal and tracheal stenosis. J Laryngol Otol 1981; 9(1): 59–66.
22. Pearson FG, Andrews MJ. Detection and management of tracheal stenosis following cuffed tube tracheostomy. Ann Thoracic Surg 1971; 12(4): 359–74.
23. Colt HG, Dumon JF. Airway stents: present and future. Clin Chest Med1995; 16(3): 465–78.
24. Kurrus JA, Gray SD, Elstad MR. Use of silicone stents in the management of subglottic stenosis. Laryngoscope 1997; 107(11): 1553–8.
25. Montgomery WW. T-tube tracheal stent. Arch Otolaryngol1965; 82(3): 320–1.
26. Zalzal GH. Use of stents in laryngotracheal reconstruction in children: indications,  technical considerations, and complications. Larygnoscope 1988; 98(8): 849–54.
27. D. P. Morris T. Malik MP. Rothera. Combined ‘trache-stent’: a useful option in the treatment of a complex case of subglottic stenosis.The Journal of Laryngology & Otology2001; 115(5): 430–33.
28. Whitehead E, Salam MA. Use of the carbon  dioxide laser with the Montgomery T-tube in the management of extensive subglottic stenosis.Journal of Laryngology and Otology September 1992; 106(6): 829–31.
29. Kurrus JA, Gray SD, Elstad MR. Use of silicone stents in the management of subglottic stenosis. Laryngoscope 1997; 107(11): 1553–56.
 
 
Iranian Journal of Otorhinolaryngology
Volume 26, Issue 1 - Serial Number 1
January and February 2014
Pages 37-42

Files

Share

How to cite

Statistics