How to Overcome Laryngotracheal Stenosis
Weerachai Tantinikorn MD*, Choladhis Sinrachtanant MD*, Paraya Assanasen MD*
Affiliation : * Department of Otolaryngology, Faculty of Medicine Siriraj Hospital, Mahidol University
Objectives : To review and evaluate the outcome of the treatment of laryngotracheal stenosis (LTS).
Design : Descriptive review cases.
Setting : Tertiary care university hospital.
Patients: Series of LTS patients who were treated by the first author (TW) from January 2000 to January
2003.
Main outcome measures : Leading causes of LTS, details of the lesions, therapeutic procedures,
complications of treatment, time to and success in decannulation.
Results : Twenty-one patients (9 females and 12 males), ranging in age from 1 to 32 years old were included
in the present study. Half of the patients were under 10 years old. The most common site of the lesion was the
subglotic lumen (14 cases), followed by the cervical trachea (5 cases). Patients were treated using endoscopic
methods (6 cases), laryngotracheal reconstruction (LTR) (9 cases), tracheal resection (3 cases), and partial
cricotracheal resection (3 cases). Decannulations were achieved in 19 patients (90.5%). Endoscopic
treatment succeeded within 2-4 procedures in properly selected cases. Despite LTR, multiple sessions of
endoscopic laser surgery, and arytenoidectomy, decannulation was not achieved in two of the cases, both of
whom had all-level laryngeal stenosis. Time to decannulation ranged from 2 to 210 days. The major causes
of delayed decannulation were the presence of a large bare area of cartilaginous grafts and restenosis with
granulation tissue formation
Conclusion : Appropriate LTS treatment, which is based on the description of the lesion, results in a high
decannulation rate within a proper time. Multilevel LTS, especially in the supraglottic and glottic area, is
refractory to various treatment modalities, and full function of the larynx may not be restored.
Keywords : Laryngotracheal stenosis, Laryngeal stenosis, Tracheotomy
