Abstract
Benign airway stenoses are frequently seen by the interventional pulmonologist. The most common condition is postintubaticon stenosis that develops after prolonged endotracheal intubation following mechanical ventilation. Other etiologies are congenital, postinfectious, post-lung transplant, chemical damage, radiotherapy, and associated to systemic conditions or idiopathic. Symptoms vary according to the severity of the stenosis, being the most frequent different degrees of dyspnea, cough, and retained secretions.
Surgery is the treatment of choice for benign airway stenosis. However, when patients are inoperable due to extensive airway disease or the presence of comorbidities, many therapeutic interventions can be offered: balloon dilatation, rigid bronchoscopy dilatation, laser resection, and placement of airway stents are the most frequently applied.
Tracheobronchial stenoses can be difficult to treat, and patients benefit from a multidisciplinary approach; every case should be discussed in a team of dedicated physicians, including the pulmonary interventionist, otorhinolaryngologist, and surgeon, in order to offer the best available solution.
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References
Galluccio G, Lucantoni G, Battistoni P, Paone G, Batzella S, Lucifora V, Dello R. Interventional endoscopy in the management of benign tracheal stenosis: definitive treatment at long-term follow-up. Eur J Cardiothorac Surg. 2009;35:429–34.
Lorenz R. Adult laryngotracheal stenosis: etiology and surgical management. Curr Opin Otolaryngol Head Neck Surg. 2003;11:467–72.
Rea F, Callegaro D, Loy M, Zuin A, Surendra N, Gobbi T, Grapeggia M, Sartori F. Benign tracheal and laryngotracheal stenosis: surgical treatment and results. Eur J Cardiothorac Surg. 2002;22:352–6.
Ashiku S, Kuzucu A, Grillo H, Wright C, Wain J, Lo B, Mathisen D. Idiopathic laryngotracheal stenosis: effective definitive treatment with laryngotracheal resection. J Thorac Cardiovasc Surg. 2004;127(1):99–107.
Abbasidezfouli A, Akbarian E, Shadmehr MB, Arab M, Javaherzadeh M, Pejhan S, Abbasi-Dezfouli G, Farzanegan R. The etiological factors of recurrence alter tracheal resection and reconstruction in post-intubation stenosis. Interact Cardiovasc Thorac Surg. 2009;9(3):446–9.
Marulli G, Rizzardi G, Bortolotti L, Loy M, Breda C, Hamad AM, Sartori F, Rea F. Single-staged laryngotracheal resection and reconstruction for benign strictures in adults. Interact Cardiovasc Thorac Surg. 2008;7(2):227–30.
Grillo HC, Donahue DM, Mathisen DJ, Wain JC, Wright CD. Postintubaticon tracheal stenosis. Treatment and results. J Thorac Cardiovasc Surg. 1995;109(3):486–92.
Brichet A, Verkindre C, DuPont J, Carlier ML, Darras J, Wurtz A, Ramon P, Marquette CH. Multidisciplinary approach to management of postintubation tracheal stenosis. Eur Respir J. 1999;13:888–93.
Hartnick C, Hartley B, Lacy P, Liu J, Bean J, Willging P, Myer C, Cotton R. Topical mitomycin application after laryngotracheal reconstruction. A randomized, double-blind, placebo-controlled trial. Arch Otolaryngol Head Neck Surg. 2001;127:1260–4.
Smith M, Elstad M. Mitomycin C and the endoscopic treatment of laryngotracheal stenosis: are two applications better than one? Laryngoscope. 2009;119:272–83.
Cantrell JR, Guild H. Congenital stenosis of the trachea. Am J Surg. 1964;108:297–305.
Filler RM. Current approaches in tracheal surgery. Pediatr Pulmonol. 1999;18:105–8.
MacEwen W. Clinical observations on the introduction of tracheal tubes by the mouth instead of performing tracheotomy or laryngotomy. Br Med J. 1880;2:122–4.
Stauffer JL, Olson DE, Petty TL. Complications and consequences of endotracheal intubation and tracheotomy. A prospective study of 150 critically ill adult patients. Am J Med. 1981;70(1):65–76.
Dutau H. Tracheal stenosis endoscopic treatment. Proceedings of the 12th World Congress for Bronchology, Boston; Bologna:Monduzzi Editore; 2002; p. 83–8
Nouraei SA, Ma E, Patel A, Howard DJ, Sandhu GS. Estimating the population incidence of adult post-intubation laryngotracheal stenosis. Clin Otolaryngol. 2007;32(5):411–2.
Poetker DM, Ettema SL, Blumin JH, Toohill RJ, Merati AL. Association of airway abnormalities and risk factors in 37 subglottic stenosis patients. Otolaryngol Head Neck Surg. 2006;135(3):434–7.
Grillo HC. Management of neoplastic diseases of the trachea. In: Shields TW, LoCicero III J, Ponn RB, editors. General thoracic surgery, vol. 1. 5th ed. Philadelphia: Lippincott Williams & Wilkins; 2000. p. 885–97.
Anand VK, Alemar G, Warren ET. Surgical considerations in tracheal stenosis. Laryngoscope. 1992;102(3):237–43.
Sarper A, Ayten A, Eser I, Ozbudak O, Demircan A. Tracheal stenosis after tracheostomy or intubation: review with special regard to cause and management. Tex Heart Inst J. 2005;32(2):154–8.
Norwood S, Vallina VL, Short K, Saigusa M, Fernandez LG, McLarty JW. Incidence of tracheal stenosis and other late complications after percutaneous tracheostomy. Ann Surg. 2000;232(2):233–41.
Walz MK, Peitgen K, Thürauf N, et al. Percutaneous dilatational tracheostomy—early results and long-term outcome of 326 critically ill patients. Intensive Care Med. 1998;24:685–90.
VanHearn LWE, Goei R, dePloeg I, et al. Late complications of percutaneous dilatational tracheostomy. Chest. 1996;110:1572–6.
Hill BB, Zweng TN, Maley RH, et al. Percutaneous dilatational tracheostomy: report of 356 cases. J Trauma. 1996;40:238–44.
Kim YH, Kim HT, Lee KS, et al. Serial fiberoptic bronchoscopic observations of endobronchial tuberculosis before and early after antituberculosis chemotherapy. Chest. 1993;103:673–7.
McIndoe RB, Steele JD, Samsom PC, et al. Routine bronchoscopy in patients with active pulmonary tuberculosis. Am Rev Tuberc. 1939;39:617–28.
Hank JK, Im JG, Park JH, et al. Bronchial stenosis due to endobronchial tuberculosis: successful treatment with self-expanding metallic stent. Am J Roentgenol. 1992;159:971–2.
Grillo HC, Mark EJ, Mathisen DJ, Wain JC. Idiopathic laryngotracheal stenosis and its management. Ann Thorac Surg. 1993;56:80–7.
Perotin JM, Jeanfaivre T, Thibout Y, Jouneau S, Lena H, Dutau H, Ramon P, Lorut C, Noppen M, Vergnon JM, Vallerand H, Merol JC, Marquette CH, Lebargy F, Deslee G. Endoscopic management of idiopathic tracheal stenosis. Ann Thorac Surg. 2011;92(1):297–301.
Sonnett JR, Conte JV, Orens J, Krasna M. Removal and repositioning of “permanent” expandable wire stents in bronchial airway stenosis after lung transplantation. J Heart Lung Transplant. 1998;17:328–30.
Álvarez A, Algar J, Santos F, Lama R, Atanda JL, Baamonde C, et al. Airway complications after lung transplantation: a review of 151 anastomoses. Eur J Cardiothorac Surg. 2001;19:381–7.
Santacruz JF, Mehta AC. Airway complications and management after lung transplantation ischemia, dehiscence, and stenosis. Proc Am Thorac Soc. 2009;6(1):79–93.
Lee JH, Park SS, Lee DH, et al. Endobronchial tuberculosis: clinical and bronchoscopic features in 121 cases. Chest. 1992;102:990–4.
Chung HS, Lee JH. Bronchoscopic assessment of the evolution of endobronchial tuberculosis. Chest. 2000;117(2):385–92.
Chung MP, Lee KS, Han J, Kim H, Rhee CH, Han YC, Kwon OJ. Bronchial stenosis due to anthracofibrosis. Chest. 1998;113(2):344–50.
Gómez-Seco J, Pérez-Boal I, Guerrero-González J, Sáez-Noguero F, Fernández-Navamuel I, Rodríguez-Nieto MJ. Antracofibrosis o antracoestenosis. Arch Bronconeumol. 2012;48:133–6.
Kauczor HU, Wolcke B, Fischer B, Mildenberger P, Lorenz J, Thelen M. Three-dimensional helical CT of the tracheobronchial tree: evaluation of imaging protocols and assessment of suspected stenoses with bronchoscopic correlation. AJR Am J Roentgenol. 1996;167(2):419–24.
Speiser BL, Spratling L. Radiation bronchitis and stenosis secondary to high dose endobronchial irradiation. Int J Radiat Oncol Biol Phys. 1993;25:589–97.
Baugnée PE, Marquette CH, Ramon P, Darras J, Wurtz A. Endoscopic treatment of post-intubation tracheal stenosis. A propos of 58 cases. Rev Mal Respir. 1995;12(6):585–92.
Hollingsworth HM. Wheezing and stridor. Clin Chest Med. 1987;8:231–40.
Boiselle PM, Ernst A. Recent advances in central airway imaging. Chest. 2002;121:1651–60.
Naidich DP, Gruden JF, McGuinness G, et al. Volumetric (helical/spiral) CT (VCT) of the airways. J Thorac Imaging. 1997;12(1):11–28.
Amorico MG, Drago A, Vetruccio E, et al. Tracheobronchial stenosis: role of virtual endoscopy in diagnosis and follow up after therapy. Radiol Med. 2006;111:1064–77.
Vining DJ, Liu K, Choplin RH, et al. Virtual bronchoscopy: relationships of virtual reality endobronchial simulations to actual bronchoscopic findings. Chest. 1996;109:549–53.
Grenier PA, Beigelman-Aubry C, Fetita C, et al. New frontiers in CT imaging of airways disease. Eur Radiol. 2002;12:1022–44.
Hoppe H, Dinkel HP, Walder B, et al. Grading airway stenosis down to segmental level using virtual bronchoscopy. Chest. 2004;125:704–11.
Morshed K, Trojanowska A, Szymanski M, Trojanowski P, Szymanska A, Smolen A, Drop A. Evaluation of tracheal stenosis: comparison between computed tomography virtual tracheobronchoscopy with multiplanar reformatting, flexible tracheofiberoscopy and intra-operative findings. Eur Arch Otorhinolaryngol. 2011;268:591–7.
Polverosi R, Vigo M, Baron S, Rossi G. Evaluation of tracheobronchial lesions with spiral CT: comparison between virtual endoscopy and bronchoscopy. Radiol Med. 2001;102(5–6):313–9.
Herth F, Becker HD, Lo Cicero J, Ernst A. Endobronchial ultrasound in therapeutic bronchoscopy. Eur Respir J. 2002;20:118–21.
Hou R, Le T, Murgu SD, Chen Z, Brenner M. Recent advances in optical coherence tomography for the diagnoses of lung disorders. Expert Rev Respir Med. 2011;5(5):711–24.
Michel RG, Kinasawitz GT, Fung KM, Keddissi JI. Optical coherence tomography as an adjunct to flexible bronchoscopy in the diagnosis of lung cancer: a pilot study. Chest. 2010;138(4):984–8.
Williamson JP, McLaughlin RA, Phillips MJ, Armstrong JJ, Becker S, Walsh JH, Sampson DD, Hillman DR, Eastwood PR. Using optical coherence tomography to improve diagnostic and therapeutic bronchoscopy. Chest. 2009;136(1):272–6.
Finkelstein SE, Schrumps DS, Nguyen DM, et al. Comparative evaluation of super high-resolution CT scan and virtual bronchoscopy for the detection of tracheobronchial malignancies. Chest. 2003;124:1834–40.
Cotton RT. Pediatric laryngotracheal stenosis. J Pediatr Surg. 1984;19:699–704.
Moya J, Ramos R, Villalonga R, Morera R, Ferrer G, Díaz P. Tracheal and cricotracheal resection for laryngotracheal stenosis: experience in 54 consecutive cases. Eur J Cardiothorac Surg. 2006;29(1):35–9.
Freitag L, Ernst A, Unger M, Kovitz K, Marquette CH. A proposed classification system of central airway stenosis. Eur Respir J. 2007;30:7–12.
Dumon JF, Reboud E, Garbe L, Aucomte F, Meris B. Treatment of tracheobronchial lesions by laser photoresection. Chest. 1982;81:278–84.
Cavaliere S, Foccoli P, Farina PL. Nd:YAG laser bronchoscopy: a five year experience with 1,396 applications in 1000 patients. Chest. 1988;94:15–21.
Díaz Jiménez JP, Canela M, Maestre J, Balust M, Fontanals J, Balust J. Treatment of obstructive tracheobronchial disease with the Yag-Nd laser: 400 procedures in a 4-year experience. Med Clin. 1989;93(7):244–8.
Martinez-Ballarin JI, Díaz Jiménez JP, Castro MJ, Moya JA. Silicone stents in the management of benign tracheobronchial stenosis. Tolerance and early results in 63 patients. Chest. 1996;109(3):626–9.
Fernando HC, Dekeratry D, Downie G, Finley D, Sullivan V, Sarkar S, Rivas Jr R, Santos RS. Feasibility of spray cryotherapy and balloon dilation for non-malignant strictures of the airway. Eur J Cardiothorac Surg. 2011;40(5):1177–80.
Tremblay A, Marquette CH. Endobronchial electrocautery and argon plasma coagulation: a practical approach. Can Respir J. 2004;11:305–10.
Grund KE, Storek D, Farin G. Endoscopic argon plasma coagulation (APC) first clinical experiences in flexible endoscopy. Endosc Surg Allied Technol. 1994;2:42–6.
Maiwand MO, Zehr KJ, Dyke CM, et al. The role of cryotherapy for airway complications after lung and heart-lung transplantation. Eur J Cardiothorac Surg. 1997;12:549–54.
Montgomery W. T-tube tracheal stent. Arch Otolaryngol. 1965;82:320–1.
Dumon JF. A dedicated tracheobronchial stent. Chest. 1990;97:328–32.
Eisner MD, Gordon RL, Webb WR, Gold WM, Hilal SE, Edinburgh K, Golden JA. Pulmonary function improves after expandable metal stent placement for benign airway obstruction. Chest. 1999;115:1006–11.
Wood DE, Liu YH, Vallieres E, Karmy-Jones R, Mulligan MS. Airway stenting for malignant and benign tracheobronchial stenosis. Ann Thorac Surg. 2003;76:167–72.
Dumon JF, Cavaliere S, Diaz-Jimenez JP, et al. Seven years experience with de Dumon prosthesis. J Bronchol. 1996;3:6–10.
Rodríguez A, Díaz-Jiménez JP, Edell E. Silicone stents versus metal stents for tracheobronchial management of benign disease. With metal stents. Medical controversies. J Bronchol. 2000;7:184–7.
FDA public health notification: complications from metallic tracheal stents in patients with benign airway disorders. 2005. http://www.fda.org.
Ernst A, Silvestri G, Johnstone D. Interventional pulmonary procedures: guidelines from the American College of Chest Physicians. Chest. 2003;123(5):1693–717.
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Díaz-Jimenez, J.P., Lisbona, R.M.L. (2013). Benign Tracheal and Bronchial Stenosis. In: Díaz-Jimenez, J., Rodriguez, A. (eds) Interventions in Pulmonary Medicine. Springer, New York, NY. https://doi.org/10.1007/978-1-4614-6009-1_11
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