How to overcome laryngotracheal stenosis.
OBJECTIVE
To review and evaluate the outcome of the treatment of laryngotracheal stenosis (LTS).


METHODS
Descriptive review cases.


METHODS
Tertiary care university hospital.


METHODS
Series of LTS patients who were treated by the first author (TW) from January 2000 to January 2003.


METHODS
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


CONCLUSIONS
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.
Tantinikorn
Weerachai
W
Department of Otolaryngology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand. Siwtk@mahidol.ac.th
Sinrachtanant
Choladhis
C
Assanasen
Paraya
P
D000293:Adolescent; D000328:Adult; D002648:Child; D004106:Dilatation; D004724:Endoscopy; D005260:Female; D006801:Humans; D007442:Intubation, Intratracheal; D007829:Laryngostenosis / Q000601:surgery*; D008297:Male; D012189:Retrospective Studies; D015607:Stents; D014135:Tracheal Stenosis / Q000601:surgery*; D016896:Treatment Outcome