Outcome of endoscopic resection tracheoplasty for treating lambdoid tracheal stomal stenosis

Authors

  • S. A. Reza Nouraei MBBChir, PhD, MRCS,

    Corresponding author
    • National Center for Airway Reconstruction, Department of Otolaryngology, Charing Cross Hospital, London, United Kingdom
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  • Guri S. Sandhu MD, FRCS

    1. National Center for Airway Reconstruction, Department of Otolaryngology, Charing Cross Hospital, London, United Kingdom
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  • The authors have no funding, financial relationships, or conflicts of interest to disclose.

Send correspondence to Dr. Reza Nouraei, Postgraduate Medical Institute, Anglia Ruskin University, Chelmsford, CM1 1SQ, UK. E-mail: RN@cantab.net

Abstract

Objectives/Hypothesis

To evaluate the efficacy of endoscopic resection tracheoplasty (ERT) for treating post-tracheotomy stomal stenosis caused by inward collapse of tracheal ring remnants.

Study design

Prospective observational study.

Methods

Between 2007 and 2012, we treated 40 patients with “lambdoid” tracheal deformity with a two-staged minimally invasive procedure undertaken using suspension microtracheoscopy and high-frequency jet ventilation. The first procedure entailed CO2 laser photoablation of collapsed tracheal rings and dilatation. The second procedure, performed 6 to 8 weeks later, involved ablation of residual structural obstruction, removal of granulation tissue, and intralesional corticosteroid injection. Perioperative patient and lesion characteristics and results of treatment were assessed.

Results

There were 22 males and 18 females, and mean age at first treatment was 59 years. There were 17 cases of scarring at the postero-lateral tracheal groove (trachealis blunting), and 22 patients had age-adjusted Charlson comorbidity scores greater than 4. All patients without trachealis blunting were successfully managed endoscopically, with only one patient requiring one additional endoscopic treatment. Seven patients with trachealis blunting needed additional treatment, and four patients had tracheal resection (P = 0.013). All patients were decannulated, and 75% of patients achieved good dyspnea outcomes. Patients with low morbidities were significantly more likely to achieve good dyspnea outcomes (P < 0.027). There were no treatment-related worsenings of voice or swallowing.

Conclusions

ERT is an effective minimally invasive treatment for intubation-related lambdoid tracheal stenosis. It achieves a successful outcome while avoiding the risks associated with open surgery. We recommend its more widespread use for treating patients with this condition.

Level of Evidence

4. Laryngoscope, 2012

Ancillary