Write the causes of tracheal stenosis? Mention different options of treatment.

Congenital causes:

Longer-segment congenital tracheal stenosis is generally due to complete tracheal rings which are fused posteriorly and may be fused together to form a cartilage plate. (stove-pipe trachea or microtrachea entire length)

50% of cases are associated with:

1. A pulmonary artery sling(25%)
2. Intracardiac lessons (20%)
3. Right sided aortic arch

 

Acquired causes:

The condition is the result of:

1. Intubation/tracheostomy related (most common cause)
2. External injury to the neck and chest
3. Infection: tuberculosis
4. Autoimmune disorder: Sarcoidosis, Papillomatous, Wegeners granulomatosis, Amyloidosis
5. Tracheopathia Osteoplastica
6. Tumours
7. Occasionally after radiation therapy to the neck or chest.

 

Classification:

Structure stenosis

1. Exophytic intraluminal mass
2. Granulation tissue
3. Exrtinsic compression
4. Airways distortion for example kinking
5. Postintubation scarring

Dynamic (fundamental ) stenosis

1. Tent shaped airway
2. Inward bulging of the floppy posterior membrane

 

Degree:

• 0 – none
• 1 – <25%
• 2 – 26-50%
• 3 – 51 – 75%
• 4 – 76 -90%
• 5- 90-100%

 

Presentations

1. Biphasic stridor or wheezing
2. Respiratory distress within the first year of life.

Location of stenosis is divided into 5 regions

1. Upper 1/3 of the trachea
2. Middle 1/3
3. Lower 1/3
4. Right main bronchus
5. Left main bronchus

 

Diagnosis

Chest X-RAY : Signs of bronchial obstruction producing collapse/ atelectasis

ECG : r/o VASCULAR RING

• CT/MRI: access vascular anatomy and relationship to trachea.
• Contrast Bronchography: Depicts size of lumen
• Outline the trachea
• Depicts bronchus distal to stenosis

 

Endoscopy

• Gold standard
• Done with Ventilation & Bronchoscope

 

 

Treatment

• Mild cases with minimal symptoms : No intervention
• Very narrow, short segments: Excisions & end to end anastomosis
• Long stenosis : Endoscopy balloon dilatation  + Posterior Split of complete Rings +Stenting, Slide tracheoplasty/ Oblique anastomosis
• Alternative – use cadaveric tracheal homograft for the reconstruction.

Treatment options are:

1. Laser surgery to remove scars tissue
2. Airway stenting: tracheobronchial stenting
3. Tracheal dilation with small balloon/dilation
4. Full tracheal resection and reconstruction

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