Laryngotracheal stenosis

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Laryngotracheal stenosis refers to an abnormal narrowing of the central airways. This can occur at the level of the larynx, trachea, carina or major bronchus. In a small number of patients the narrowing may be present in more than one anatomical location.

Video Laryngotracheal stenosis

Presentations

The most common symptoms of laryngotheal stenosis are the worsening of breathlessness (dyspnea), especially when performing physical activity (dyspnea during activity). The patient may also experience additional respiratory sounds that in more severe cases can be identified as stridor but in many cases can be easily misunderstood as wheezing. This creates a diagnostic trap in which many patients with laryngotracheal stenosis are misdiagnosed with asthma and treated for being considered to have lower respiratory tract disease. This increases the likelihood that patients end up needing major open surgery on benign diseases and can cause late tracheal cancer for curative surgery to be performed.

Maps Laryngotracheal stenosis

Cause

Laryngotracheal stenosis is a general term for large and heterogeneous groups with very rare conditions. The incidence of adult post-intubation laryngotracheal stenosis populations which is the most common benign sub-type of this condition is about 1 in 200,000 adults per year. The main causes of adult laryngotracheal stenosis are:

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Diagnosis

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Treatment

The optimal management of laryngotracheal stenosis is not well defined, especially depending on the type of stenosis. Common treatment options include

1. Tracheal widening using rigid bronchoscope
2. Laser surgery and endoluminal stenting
3. Tracheal resection and laryngotracheal reconstruction

Tracheal widening is used to temporarily increase airway. The widening effect usually lasts from a few days to 6 months. Several studies have shown that as a result of mechanical dilation (self-use) there can be a high mortality rate and a recurrence rate of stenosis higher than 90%. Thus, many authors treat stenosis with laser endoscopic excision (generally either carbon dioxide or neodymium: yttrium aluminum garnet laser) and then by using bronchoscopic dilatation and elongated stenting with T-tubes (generally in silicon).

There are different opinions about treatment with laser surgery.

In highly experienced surgery centers, resection and reconstruction of the trachea (complete end-to-end anastomosis with or without stent while laryngotracheal to prevent airway collapse) is currently the best alternative to fully cure stenosis and allow for good results. Therefore, it can be considered as a gold standard treatment and suitable for almost all patients.

The narrowed portion of the trachea will be cut and the end of the tracheal piece stitched together with the stitches. For long stenosis more than 5 cm, a stent may be required to join the part.

Late June or early July 2010, new potential treatments were tested at Great Ormond Street Hospital in London, where Ciaran Finn-Lynch (11 years old) received transplanted trachea that had been injected with stem cells taken from his own bone marrow. The use of Ciaran stem cells is expected to prevent the immune system from rejecting transplantation, but there are still doubts about the success of the surgery, and several later attempts at the same surgery were unsuccessful.

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Nomenclature

Laryngo stenosis ( Laryngo - : Glottic Stenosis, Subglottic Stenosis, Trachea : narrowing at different throat levels) is a more accurate description for this condition when compared, for example < b> subglottic stenosis technically refers only to a slight narrowing below the vocal fold or tracheal stenosis . However, in infants and young children, subglottis is the narrowest part of the airway and most of the shorthand occurs at this level. Subglottic stenosis is often used to describe narrowing of the central airway in children, and laryngotracheal stenosis is more commonly used in adults.

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See also

• Hermes Grillo pioneer in tracheal resection surgery

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References

References

• Ongkasuwan, Julina (2006-02-09). "Tracheal Stenosis". Baylor College of Medicine. Archived from the original on 2007-02-20 . Obtained 2007-03-17 .

src: erj.ersjournals.com

External links

Source of the article : Wikipedia