Outcome of endoscopic management of extensive laryngotracheal stenosis

Abstract

Objectives: When performing endotracheal intubation or tracheotomy in unconscious patients in emergent situations, one should consider the possibility of the later complication of laryngotracheal stenosis, which can result in difficulties with decannulation. We analyzed the clinical features of laryngotracheal stenosis to search for its possible etiologic factors and its proper preventive methods. Methods: The medical records of 249 cases of laryngotracheal stenosis out of 2,208 patients who underwent tracheotomy in our hospital during the past 12 years were retrospectively reviewed regarding several parameters, such as the duration of endotracheal intubation, site of tracheostoma, site of stenosis, treatment method, and so forth. Results: Non-otolaryngologists had a tendency to place the tracheostoma at a higher level of the trachea. We identified technical precautions that should be taken into consideration in performing an emergency tracheotomy. Bronchoscopic evaluation and tracheal stent insertion was the most commonly used treatment method. Successful decannulation was achieved in about 70%, and was especially frequent in patients whose endotracheal intubation was less than 20 days. Conclusions: It is desirable that the duration of endotracheal intubation be limited to less than 20 days. A database of patients who undergo tracheotomy should be submitted to careful follow-up to diagnose early development of laryngotracheal stenosis and to prevent long-term complications.