Skip to main content
SpringerLink
Log in

Subglottic and Tracheal Stenosis

  • Chapter
  • First Online:
Surgery of Larynx and Trachea

Abstract

Train yourself adequately in laryngotracheal surgery and upper airway endoscopy before address­ing the challenging surgery of laryngotracheal stenosis (LTS). Remember that inappropriate initial management of LTS may lead to permanent intractable sequelae and that the best chance for the patient lies in the first operation. Perform a thorough preoperative assessment of the patient’s medical condition and of the stenosis to choose the best surgical option and timing. Address only mature cicatricial stenosis for a definitive endoscopic or open surgical repair. Perform a bacteriologic aspirate of the trachea prior to any treatment. Treat gastro-oesophageal reflux. Master all types of surgeries starting from appropriate use of CO2 laser for minor stenosis to laryngotracheal reconstruction with cartilage expansion and partial cricotracheal resection for the most severe grades of stenosis.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 169.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Aboulker P, Sterkers JM, Demaldent JE, Sauton P (1966) Modifications apportées à l’intervention de Rethi. Intérêt dans les sténoses laryngo-trachéales et trachéales. Ann Otolaryngol Paris 83:98-106

    Google Scholar 

  2. Alvarez-Neri H, Penchyna-Grub J, Porras-Hernandez JD, Blanco-Rodriguez G, Gonzalez R, Rutter MJ (2005) Primary cricotracheal resection with thyrotracheal anastomosis for the treatment of severe subglottic stenosis in children and adolescents. Ann Otol Rhinol Laryngol 114:2-6

    PubMed  Google Scholar 

  3. Benjamin B (1993) Prolonged intubation injuries of the larynx: endoscopic diagnosis, classification and treatment. Ann Otol Rhinol Laryngol 160:S1-15

    Google Scholar 

  4. Biller HF, Munier MA (1992) Combined infrahyoid and inferior constrictor muscle release for tension-free anastomosis during primary tracheal repair. Otolaryngol Head Neck Surg 107:430-433

    CAS  PubMed  Google Scholar 

  5. Bisson A, Bonnette P, El Kadi B (1992) Tracheal sleeve resection for iatrogenic stenoses. J Thorac Cardiovasc Surg 104: 882-887

    CAS  PubMed  Google Scholar 

  6. Calhoun KH, Deskin RW, Bailey BJ (1988) Near-fatal complication of tracheal T-tube use. Ann Otol Rhinol Laryngol 97: 542-544

    CAS  PubMed  Google Scholar 

  7. Cotton RT (2000) Management of subglottic stenosis. Otolaryngol Clin North Am 33:111-130

    Article  CAS  PubMed  Google Scholar 

  8. Cotton RT, Gray SD, Miller RP (1989) Update of the Cincinnati experience in laryngotracheal reconstruction. Laryngoscope 99:1111-1116

    Article  CAS  PubMed  Google Scholar 

  9. Cotton RT, Myer CM 3rd, O’Connor DM, Smith ME (1995) Pediatric laryngotracheal reconstruction with cartilage grafts and endotracheal tube stenting: the single stage approach. Laryngoscope 105:818-821

    Article  CAS  PubMed  Google Scholar 

  10. Couraud L, Brichon PY, Velly JF (1988) The surgical management of inflammatory and fibrous laryngotracheal stenosis. Eur J Cardiothorac Surg 2:410-415

    Article  CAS  PubMed  Google Scholar 

  11. Couraud L, Jongon JB, Velly JF (1995) Surgical treatment of non tumoral stenosis of the upper airway. Ann Thorac Surg 60:250-260

    Article  CAS  PubMed  Google Scholar 

  12. Dedo HH, Fishman NH (1969) Laryngeal release and sleeve resection for tracheal stenosis. Ann Otol Rhinol Laryngol 78:285-296

    CAS  PubMed  Google Scholar 

  13. Dedo HH, Sooy CD (1984) Endoscopic laser repair of posterior glottic, subglottic and tracheal stenosis by division or micro-trapdoor flap. Laryngoscope 94:445-450

    Article  CAS  PubMed  Google Scholar 

  14. Duncavage JA, Ossoff RH, Toohill RJ (1985) Carbon dioxide laser management of laryngeal stenosis. Ann Otol Rhinol Laryngol 94:565-569

    CAS  PubMed  Google Scholar 

  15. Eckel HE, Wittekindt C, Klussmann JP, Schroeder U, Sittel C (2003) Management of bilateral cricoarytenoid cartilage fixation versus recurrent laryngeal nerve paralysis. Ann Otol Rhinol Laryngol 112:103-108

    PubMed  Google Scholar 

  16. Eliachar R, Eliachar I, Esclamado R, Gramlich T, Strome M (1999) Can topical mitomycin prevent laryngotracheal stenosis? Laryngoscope 109:1594-1600

    Article  PubMed  Google Scholar 

  17. Eliachar I, Nguyen D (1990) Laryngotracheal stent for internal support and control of aspiration without loss of phonation. Otolaryngol Head Neck Surg 103:837-840

    CAS  PubMed  Google Scholar 

  18. Evans JNG, Todd GB (1974) Laryngotracheoplasty. J Laryngol Otol 87:589-597

    Google Scholar 

  19. Froehlich P, Truy E, Stamm D (1993) Role of long-term stenting in treatment of pediatric subglottic stenosis. Int J Pediatr Otorhinolaryngol 27(3):273-280

    Article  CAS  PubMed  Google Scholar 

  20. George M, Lang F, Pasche Ph, Monnier P (2005) Surgical management of laryngotracheal stenosis in adults. Eur Arch Otorhinolaryngol 262:609-615

    Article  PubMed  Google Scholar 

  21. Gerwat J, Bryce DP (1974) The management of subglottic stenosis by resection and direct anastomosis. Laryngoscope 84:940-947

    Article  CAS  PubMed  Google Scholar 

  22. Grillo HC, Donahue DM, Mathisen DJ (1995) Postintubation tracheal stenosis. Treatment and result. J Thorac Cardiovasc Surg 109:486-493

    Article  CAS  PubMed  Google Scholar 

  23. Grillo HC, Mathisen Dj, Wain JC (1992) Laryngotracheal resection and reconstruction for subglottic stenosis. Ann Thorac Surg 53:54-63

    Article  CAS  PubMed  Google Scholar 

  24. Holinger LD (1980) Etiology of stridor in the neonate, infant, and child. Ann Otol Rhinol Laryngol 89:397

    CAS  PubMed  Google Scholar 

  25. Holinger LD. Congenital laryngeal anomalies. In: Pediatric laryngology and bronchoesophagology,. Philadelphia, PA/New York: Lippincott-Raven; 1997

    Google Scholar 

  26. Holinger LD, Green CG, Benjamin B, Shorp JK (1997) Tracheobronchial tree. In: Holinger LD, Lusk RP, Green CG (eds) Pediatric laryngology and bronchoesophagology. Lippincott-Raven, Philadelphia, PA/New York

    Google Scholar 

  27. Jaquet Y, Lang F, Pilloud R, Savary M, Monnier P (2005) Partial cricotracheal resection for pediatric subglottic stenosis: long-term outcome in 57 patients. J Thorac Cardiovasc Surg 130(3):726-732

    Article  PubMed  Google Scholar 

  28. Johnson L, Cotton RT, Rutter MJ (2003) Airway stenosis and eosinophilic esophagitis. Abstract presented at Annual Meeting of the American Academy, May 3, Nashville, TN

    Google Scholar 

  29. Lang F, Pasche P, Monnier P (2001) Sténoses laryngotrachéales. Encycl Med Chir Pneumologie 6-035-A-20:1-20. Elsevier, Paris

    Google Scholar 

  30. Macchiarini P, Verhoye JP, Chapelier A, Fadel E, Dartevelle P (2001) Partial cricoidectomy with primary thyrotracheal anastomosis for postintubation subglottic stenosis. J Thorac Cardiovasc Surg 121:68-76

    Article  CAS  PubMed  Google Scholar 

  31. Maddaus MA, Toth JL, Gullane PJ, Pearson FG (1992) Sub­glottic tracheal resection and synchronous laryngeal reconstruction. J Thorac Cardiovasc Surg 104:1443-1450

    CAS  PubMed  Google Scholar 

  32. McCaffrey TV (1992) Classification of laryngotracheal stenosis. Laryngoscope 102:1335-1340

    Article  CAS  PubMed  Google Scholar 

  33. McQueen CT, Shapiro NL, Leighton S, Guo XG, Albert DM (1999) Single-stage laryngotracheal reconstruction: the Great Ormond Street experience and guidelines for patient selection. Arch Otolaryngol Head Neck Surg 125:320-322

    CAS  PubMed  Google Scholar 

  34. Monnier Ph (2003) A new stent for the management of adult and pediatric laryngotracheal stenosis. Laryngoscope 113: 1418-1422

    Article  PubMed  Google Scholar 

  35. Monnier Ph (1999) Complications laryngées et trachéales après intubation et trachéotomie. In: Cros AM, Bourgain JL, Ravussin P (eds) Les voies aériennes: leur contrôle en anesthésie - réanimation. Pradel Revil-Malmaison, France

    Google Scholar 

  36. Monnier Ph, George M, Monod ML, Lang F (2005) The role of the CO2 laser in the management of laryngotracheal stenosis: a survey of 100 cases. Eur Arch Otorhinolaryngol 262: 602-608

    Article  Google Scholar 

  37. Monnier P, Lang F, Savary M (2003) Partial cricotracheal resection for pediatric subglottic stenosis: a single institution’s experience in 60 cases. Eur Arch Otorhinolaryngol 260:295-297

    Article  CAS  PubMed  Google Scholar 

  38. Monnier P, Savary M, Chappuis G (1993) Partial cricoid resection with primary tracheal anastomosis for subglottic stenosis in infants and children. Laryngoscope 103:1273-1283

    Article  CAS  PubMed  Google Scholar 

  39. Montgomery W (1965) T-tube tracheal stent. Arch Otolaryngol 82:320-321

    CAS  PubMed  Google Scholar 

  40. Montgomery WW (1974) Suprahyoid release for tracheal anastomosis. Arch Otolaryngol 99:255-260

    CAS  PubMed  Google Scholar 

  41. Morimitsu T, Matsumoto I, Okada S, Takahashi M, Kosugi T (1981) Congenital cricoid stenosis. Laryngoscope 91:1356-1364

    Article  CAS  PubMed  Google Scholar 

  42. Myer CM, O’Connor DM, Cotton RT (1994) Proposed grading system for subglottic stenosis based on endotracheal tube sizes. Ann Otol Rhinol Laryngol 103:319-323

    PubMed  Google Scholar 

  43. Ndiaye I, Van de Abbeele T, François M, Viala P, Tanon-Anoh MJ, Narcy P (1999) Traitement chirurgical des ­sténoses laryngées de l’enfant. Ann Otolaryngol Chir Cervicofac 116: 143-148

    CAS  PubMed  Google Scholar 

  44. Ochi JW, Evans JNG, Bailey CM (1992) Pediatric airway reconstruction at Great Ormond Street: a 10-year review. Ann Otol Rhino Laryngol 101:465-468

    CAS  Google Scholar 

  45. Ogura JH, Roper CL (1972) Surgical correction of traumatic stenosis of the larynx and pharynx. Laryngoscope 72:468-470

    Google Scholar 

  46. Pearson FG, Gullane P (1996) Subglottic resection with primary tracheal anastomosis including synchronous laryngotracheal reconstruction. Semin Thorac Cardiovasc Surg 4: 381-391

    Google Scholar 

  47. Pearson FG, Andrews MJ (1971) Detection and management of tracheal stenosis following cuffed tube tracheostomy. Ann Thorac Surg 12:359-374

    Article  CAS  PubMed  Google Scholar 

  48. Rahbar R, Shapsay SM, Healy GB (2001) Mitomycin: effects on laryngeal and tracheal stenosis, benefits and complications. Ann Otol Rhinol Laryngol 110:1-6

    CAS  PubMed  Google Scholar 

  49. Ranne RD, Lindley S, Holder TM, Ashcraft KW, Sharp RJ, Amoury RA (1991) Relief of subglottic stenosis by anterior cricoid resection: an operation for the difficult case. J Pediatr Surg 26:255-259

    Article  CAS  PubMed  Google Scholar 

  50. Rutter MJ, Hartley BEJ, Cotton RT (2001) Cricotracheal resection in children. Arch Otolaryngol Head Neck Surg 127:289-292

    CAS  PubMed  Google Scholar 

  51. Shapshay SM, Beamis JF, Hybels RL (1987) Endoscopic treatment of subglottic and tracheal stenosis by radial laser incision and dilation. Ann Otol Rhinol Laryngol 96: 661-664

    CAS  PubMed  Google Scholar 

  52. Simpson GT, Strong MS, Healy GB, Shapshay SM, Vaughan CW (1982) Predictive factors of success or failure in the endoscopic management of laryngeal and tracheal stenosis. Ann Otol Rhinol Laryngol 91:384-388

    CAS  PubMed  Google Scholar 

  53. Triglia JM, Nicollas R, Roman S (2001) Primary cricotracheal resection in children: indications, technique and outcome. Int J Pediatr Otorhinolaryngol 58:17-25

    Article  CAS  PubMed  Google Scholar 

  54. Vollrath M, Freihorst J, von der Hardt H (1999) Die Chirurgie der erworbenen laryngotrachealen Stenosen im Kindesalter. Erfahrungen und Ergebnisse von 1988-1998. Teil II: Die cricotracheale Resektion. HNO 47:611-622

    Article  CAS  PubMed  Google Scholar 

  55. White DR, Cotton RT, Bean JA, Rutter MJ (2005) Pediatric cricotracheal resection. Surgical outcomes and risk factor analysis. Arch Otolaryngol Head Neck Surg 131:896-899

    Article  PubMed  Google Scholar 

  56. Yellon RF, Szeremeta W, Grandis JR, Diguisseppe F, Dickman PS (1997) Role of subglottic injury, gastric juice and peptide growth factors in a porcine model. Int Anesthesiol Clin 35:115-125

    Article  CAS  PubMed  Google Scholar 

  57. Zalzal GH (1988) Use of stents in laryngotracheal reconstruction in children: indications, technical considerations, and complications. Laryngoscope 98:849-854

    Article  CAS  PubMed  Google Scholar 

  58. Zitch RP III, Mullins JB, Tampler J, Davis WE (1995) Suprahyoid and inferior constrictor release for laryngeal lowering. Arch Otolaryngol Head Neck Surg 121: 1310-1313

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Otolaryngology, Head & Neck Surgery Department, Centre Hospitalier Universitaire Vaudois, Rue du Bugnon 46, CH-1011, Lausanne, Switzerland

    Philippe Monnier (Professor and Chairman)

Authors
  1. Philippe Monnier
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Philippe Monnier .

Editor information

Editors and Affiliations

  1. Mont-Godinne, Univ. Hospital of Louvain at, Yvoir, 5530, Belgium

    Marc Remacle

  2. Hals-Nasen-Ohren Abteilung, Landeskrankenhaus Klagenfurt, St. Veiter Str. 47, Klagenfurt, 9026, Austria

    Hans Edmund Eckel

Rights and permissions

Reprints and permissions

Copyright information

© 2009 Springer-Verlag Berlin Heidelberg

About this chapter

Cite this chapter

Monnier, P. (2009). Subglottic and Tracheal Stenosis. In: Remacle, M., Eckel, H. (eds) Surgery of Larynx and Trachea. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-540-79136-2_12

Download citation

  • DOI: https://doi.org/10.1007/978-3-540-79136-2_12

  • Published:

  • Publisher Name: Springer, Berlin, Heidelberg

  • Print ISBN: 978-3-540-79135-5

  • Online ISBN: 978-3-540-79136-2

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation