A Retrospective evaluation on the Clinical Presentation and Outcomes of Laryngotracheal Stenosis in Patients following Intubation & Tracheostomy

Abstract

Introduction: Laryngotracheal stenosis (LTS) is a complex condition that results in a compromised airway, involving trachea and/or larynx. The etiology of LTS has changed over the years, the common cause now being iatrogenic; post-intubation and post-tracheostomy. The evolution of early injury into stenosis depends on local and systemic factors. Objective of this Study is to analyze, the clinical presentation and outcomes, following management of LTS. Methods: This study was carried out as a Retrospective study .Review and Reports of 200 cases /patients, who were diagnosed as LTS and surgically managed by various Tertiary Medical Institutes and Hospitals over a period of 2 year were included in the study.. Data relating to the types of intervention, complications, and outcome were documented, filled and statistically analysed. Results: Main etiology of LTS was Endotracheal Intubation in 83 % ( 166 ) cases and rest were ( 17%) Post Tracheostomy. The predominant site of stenosis in endotracheal intubated patients is the Tracheal (75.3%) & Subglottic and Upper Tracheal (18%) followed by glottis (6.6%).In Post Tracheostomy / Tracheostomized Cases the Predominant site was Suprastomal.105 patients (52.5%) underwent T-tube stenting with Montgomery T-tube (temporary and permanent). Following resection and anastomosis, 94% had successful outcomes. Cricotracheal resection and anastomosis had a 100% successful outcome. 93% of the patients with LTS were managed successfully with a good outcome, 5 cases (2.5%) failed on tracheostomy, 2% failed on T-tube, and 2.5 % awaiting decannulation. The overall success is more with resection and anastomosis procedures. Long term review showed that the airway, voice, and laryngeal protective mechanisms were well preserved in above 89% of the patients with a satisfactory result. Conclusion: Management of LTS is a challenge. The procedure of choice is tracheal resection and anastomosis for tracheal stenosis but when the glottis and/or the subglottis is involved this surgical approach may not be applicable also it may not be feasible due to the extent of stenosis, underlying disease and general health of the patient.. The progress of resuscitation with improving care for ventilated patients has led to a marked decrease in the incidence of tracheal stenosis compared to the previous years.