title: Surgical management of scleromatous laryngotracheal stenosis.
abstract: OBJECTIVE
  Scleroma is a chronic specific granulomatous disease of the upper respiratory tract caused by Klebsiella Rhinoscleromatis. It usually affects the subglottic region and upper trachea resulting in various degrees of stenosis. Patients with laryngotracheal stenosis may present with stridor, shortness of breath or exercise intolerance and may be tracheostomy dependent. In this work, we presented the experience of our Institute in the management of patients with scleromatous laryngotracheal stenosis using the already designed procedures for traumatic laryngotracheal stenosis.
  
  
  METHODS
  The study was a non controlled prospective study. It was conducted in Oto-Rhino-Laryngology and Head and Neck Surgery Department of Zagazig University Hospitals, Egypt. It included 38 patients with scleromatous subglottic stenosis and/or upper tracheal stenosis. The patients were classified into four grades according to Myer-Cotton's scale. The surgical treatment modalities included endoscopic CO2 laser surgery with dilatation, laryngotracheal reconstruction, and partial cricotracheal resection with thyrotracheal anastomosis.
  
  
  RESULTS
  The average follow-up period was 32.1 months. Twenty four patients (63%) had an excellent outcome. Nine patients (24%) had a good outcome. Five patients (13%) were still tracheostomy dependent. Eleven patients (29%) developed postoperative granulation tissue. The overall success rate was 87%.
  
  
  CONCLUSIONS
  Scleromatous laryngotracheal stenosis is considered a challenging surgical problem. It requires a multidisciplinary approach by well-trained personnel. The surgical techniques designed for cases of laryngotracheal stenosis of a traumatic etiology can be applied for cases of scleroma with approximately the same success rates.
authors.affiliation: Department of Oto-Rhino-Laryngology, Military Medical Academy, Cairo, Egypt. zakariasoliman@yahoo.com
authors.forename: Zakaria
authors.initials: Z
authors.lastname: Soliman
authors.forename: Mohammad
authors.initials: M
authors.lastname: Mobashir
authors.forename: Waleed M
authors.initials: WM
authors.lastname: Basha
authors.forename: Sherif
authors.initials: S
authors.lastname: Askar
authors.forename: Ismail
authors.initials: I
authors.lastname: Elnashar
authors.forename: Abd ElRaof
authors.initials: AE
authors.lastname: Said
mesh_terms: D000293:Adolescent; D000328:Adult; D005260:Female; D006801:Humans; D007829:Laryngostenosis / Q000209:etiology / Q000601:surgery*; D053685:Laser Therapy; D054020:Lasers, Gas / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D013517:Otorhinolaryngologic Surgical Procedures / Q000379:methods; D011446:Prospective Studies; D019651:Plastic Surgery Procedures / Q000379:methods; D012226:Rhinoscleroma / Q000150:complications / Q000601:surgery*; D012720:Severity of Illness Index; D014135:Tracheal Stenosis / Q000209:etiology / Q000601:surgery*; D016896:Treatment Outcome; D055815:Young Adult