Laryngotracheal stenosis treated with multiple surgeries: experience, results and prognostic factors in 70 patients

Abstract

Laryngotracheal stenosis is a complex condition that usually requires multiple procedures to restore physiological respiration. The aim of this study was to evaluate the percentage of decannulation compared to different or multiple surgical treatments. We retrospectively reviewed the charts of 70 patients treated between 1990 and 2005 for laryngotracheal stenosis of various aetiology: iatrogenic stenosis (n = 55), post-traumatic stenosis (n = 11) or other causes (autoimmune disease, n = 3; diphtheria, n = 1). In order to maintain laryngotracheal patency, a Montgomery Safe-T tube was used in all patients as a single dilation treatment or associated with endoscopic and/or open-neck surgery. Fifty-four of the 70 patients (77.1%) were eventually decannulated; 39 of these (72.2%) underwent 3 or fewer surgical procedures, showing a significant difference compared to patients who underwent more than 3 surgeries (p = 0.00002). A total of 257 surgeries were performed. Only seven of 54 patients (13%) were decannulated after more than 5 surgical procedures. Patients over 60 years of age and with a higher grade of stenosis showed a significantly lower success rate (p = 0.0017 and p = 0.007, respectively). There was no significant correlation between the rate of decannulation and gender, aetiology, site of stenosis or surgery. Patients undergoing dilation for laryngotracheal stenosis usually require multiple procedures. The T tube plays an important role in the treatment of this pathology. However, if the tracheostomy is not removed within 3 surgical interventions, the odds of decannulating the patient decrease significantly, and additional surgeries may be of questionable therapeutic benefit.

Keywords: CO2 laser; Laryngotracheal stenosis; Montgomery Safe-T tube.

Figures

Fig. 1.

a) Montgomery tracheal T tube (Safe-T tube) with ring washer and plug; b) An example of a Safe-T tube shown in the correct position with a ring washer advanced to the external skin. In this case, subglottic stenosis was present.

Fig. 2.

Safe-T tube insertion (performed surgically). Medical gauze was inserted into the T tube and a knot was tied at the external opening. The gauze in the tube was pulled out with the laryngoscope (full arrows) until the inferior intraluminal end of the T tube disappeared into the trachea. Forceps were used to pull the inferior intraluminal end of the tube (empty arrow).

Fig. 3.

Bivariate analysis: decannulation vs. number of surgeries (p = 0.00002).

Fig. 4.

Bivariate analysis: decannulation vs. age (p = 0.0017).

Fig. 5.

Bivariate analysis: decannulation vs. grade of stenosis (p = 0.007).