title: Idiopathic laryngotracheal stenosis: effective definitive treatment with laryngotracheal resection.
abstract: OBJECTIVE
  Little was known about idiopathic laryngotracheal stenosis when it was first described. We have operated on 73 patients with idiopathic laryngotracheal stenosis, have confirmed its mode of presentation and response to surgical therapy, and have established long-term follow-up.
  
  
  METHODS
  Charts of 73 patients treated surgically for idiopathic laryngotracheal stenosis between 1971 and 2002 were retrospectively reviewed.
  
  
  RESULTS
  All patients were treated with a single-staged laryngotracheal resection, with (36/73) and without (37/73) a posterior membranous tracheal wall flap. Nearly all were women (71/73), with a mean age of 46 years (range, 13-74 years). Twenty-eight (38%) of 73 had undergone a previous procedure with laser, dilation, tracheostomy, T-tube, or laryngotracheal operations. After laryngotracheal resection, the majority of patients (67/73) were extubated in the operating room, and 7 required temporary tracheostomies, only 1 of whom was among the last 30 patients. All were successfully decannulated. There was no perioperative mortality. Principal morbidity was alteration of voice quality, which was mild and tended to improve with time. Sixty-seven (91%) of 73 patients had good to excellent long-term results with voice and breathing quality and do not require further intervention for their idiopathic laryngotracheal stenosis.
  
  
  CONCLUSIONS
  Idiopathic laryngotracheal stenosis is an entity that occurs almost exclusively in women and is without a known cause. It is not a progressive process, but the timing of the operation is crucial. Single-staged laryngotracheal resection is successful in restoring the airway while preserving voice quality in more than 90% of patients. Protective tracheostomy is now rarely required (1/30). Long-term follow-up shows a stable airway and improvement in voice quality.
authors.affiliation: Division of Thoracic Surgery, Massachusetts General Hospital, Boston, MA 02214, USA.
authors.forename: Simon K
authors.initials: SK
authors.lastname: Ashiku
authors.forename: Akin
authors.initials: A
authors.lastname: Kuzucu
authors.forename: Hermes C
authors.initials: HC
authors.lastname: Grillo
authors.forename: Cameron D
authors.initials: CD
authors.lastname: Wright
authors.forename: John C
authors.initials: JC
authors.lastname: Wain
authors.forename: Bruce
authors.initials: B
authors.lastname: Lo
authors.forename: Douglas J
authors.initials: DJ
authors.lastname: Mathisen
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000714:Anastomosis, Surgical; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007825:Laryngectomy / Q000379:methods; D007829:Laryngostenosis / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D019651:Plastic Surgery Procedures / Q000379:methods*; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D013524:Surgical Flaps; D013997:Time Factors; D014135:Tracheal Stenosis / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D014140:Tracheotomy / Q000379:methods; D016896:Treatment Outcome