Non-intubation traumatic laryngotracheal stenosis: management policies and results.
Traumatic laryngotracheal stenosis (LTS) is increasing in clinical practice. Causes include external trauma, post-intubation, and iatrogenic injuries. It is a complex problem and many patients undergo multiple procedures to achieve a stable and well-protected airway with adequate voice. We present our experience at Ain-Shams University Hospitals on 15 patients followed-up for 7 years. All patients had traumatic LTS excluding post-intubation injuries. Patients were aged 4-58 years. Nine were the victims of road traffic accidents; five were occupational trauma victims; and one tried to commit suicide by strangulation. The patients underwent a total of 53 procedures (mean 3.5 per patient). A total of seven laryngotracheal reconstruction, six partial cricotracheal resection, and four laser recanalization with stenting were performed. Six patients have mean follow-up of 26.5 months (3-60 months). Six patients had normal speech (GRBAS 0-5), three had a moderate degree of voice disturbance (GRBAS 5-10), and five had severe dysphonia (GRBAS > 10). As regards tolerance for daily activities, we used a modification of the McMaster University asthma quality of life questionnaire [Rea et al. Eur J Cardiothorac Surg 22(3):352, 2002] (using the activities and emotional scores total 112). Four patients could perform above the 90th percentile; all the remaining patients were above the 50th percentile. No patient was totally handicapped as a result of their airway problem and they could tend for their basic activities. The aim of this work is to demonstrate that non-intubation traumatic LTS is a complex problem that usually needs a longer time for reconstruction and a different way of approach. However, most of the patients can be finally rehabilitated with a stable, protected airway and adequate voice albeit at the price of a prolonged series of interventions and a long follow-up.
Mostafa
Badr Eldin
BE
Otolaryngology, Head and Neck Surgery Department, Faculty of Medicine, Ain-Shams University, 48 Ibn el Nafees str, 11371, Nasr City, Cairo, Egypt. bemostafa@entainshams.com
El Fiky
Lobna
L
El Sharnoubi
Mohammed
M
D000293:Adolescent; D000328:Adult; D000402:Airway Obstruction; D002648:Child; D002675:Child, Preschool; D003413:Cricoid Cartilage / Q000293:injuries; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007829:Laryngostenosis / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D007830:Larynx / Q000293:injuries*; D008297:Male; D008875:Middle Aged; D013517:Otorhinolaryngologic Surgical Procedures / Q000379:methods*; D000091402:Prohibitins; D013957:Thyroid Cartilage / Q000293:injuries; D014057:Tomography, X-Ray Computed; D014132:Trachea / Q000293:injuries*; D014135:Tracheal Stenosis / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D016896:Treatment Outcome