title: Management of postintubation tracheal stenosis: appropriate indications make outcome differences.
abstract: BACKGROUND
  Laryngotracheal stenosis is difficult to treat and its etiologies are multiple; nowadays, the most common ones are postintubation or posttracheostomy stenoses.
  
  
  OBJECTIVE
  To provide an algorithm for the management of postintubation laryngotracheal stenoses (PILTS) based on the experience of a tertiary care referral center.
  
  
  METHODS
  A retrospective study was conducted on all patients treated for PILTS over a 10-year period. Patients were divided into a surgically and an endoscopically treated group according to predefined criteria. The characteristics of the two groups were analyzed and the outcomes compared.
  
  
  RESULTS
  Thirty-three consecutive patients were included in the study: 14 in the surgically treated group and 19 in the endoscopically treated group. Our candidates for airway surgery were healthy patients presenting with complex tracheal stenoses, subglottic involvement or associated tracheomalacia. The endoscopic candidates were chronically ill patients presenting with simple, strictly tracheal stenoses not exceeding 4 cm in length. Stents were placed if the stenosis was associated with tracheomalacia or exceeded 2 cm in total length. In the surgically treated group, 2/14 patients needed more than one procedure versus 8/19 patients in the endoscopically treated group. At the end of the intervention, 50% of the patients were decannulated in the surgically treated group versus 84.2% in the endoscopically treated group (p = 0.03). However, the decannulation rates at 6 months and the symptomatology at rest and on exertion on the last follow-up visit were comparable in the two groups.
  
  
  CONCLUSIONS
  Our experience in the management of PILTS demonstrates that both surgery and endoscopy yield excellent functional outcomes if the treatment strategy is based on clear, predefined objective criteria.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Hôtel Dieu de France Hospital, Saint Joseph University, Beirut, Lebanon.
authors.forename: Antoine E
authors.initials: AE
authors.lastname: Melkane
authors.forename: Nayla E
authors.initials: NE
authors.lastname: Matar
authors.forename: Amine C
authors.initials: AC
authors.lastname: Haddad
authors.forename: Michel N
authors.initials: MN
authors.lastname: Nassar
authors.forename: Homère G
authors.initials: HG
authors.lastname: Almoutran
authors.forename: Ziad
authors.initials: Z
authors.lastname: Rohayem
authors.forename: Mohammad
authors.initials: M
authors.lastname: Daher
authors.forename: Georges
authors.initials: G
authors.lastname: Chalouhy
authors.forename: George
authors.initials: G
authors.lastname: Dabar
mesh_terms: D000328:Adult; D000714:Anastomosis, Surgical; D003413:Cricoid Cartilage / Q000601:surgery; D004724:Endoscopy; D005260:Female; D006801:Humans; D007442:Intubation, Intratracheal / Q000009:adverse effects*; D007829:Laryngostenosis / Q000209:etiology / Q000601:surgery*; D054020:Lasers, Gas; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D015607:Stents; D014132:Trachea / Q000601:surgery; D014135:Tracheal Stenosis / Q000209:etiology / Q000601:surgery*; D014139:Tracheostomy / Q000009:adverse effects