Skip to main content
SpringerLink
Log in

Benign Tracheal and Bronchial Stenosis

  • Chapter
  • First Online:
Book cover Interventions in Pulmonary Medicine

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.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 219.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. 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.

    Article  PubMed  Google Scholar 

  2. Lorenz R. Adult laryngotracheal stenosis: etiology and surgical management. Curr Opin Otolaryngol Head Neck Surg. 2003;11:467–72.

    Article  PubMed  Google Scholar 

  3. 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.

    Article  PubMed  Google Scholar 

  4. 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.

    Article  PubMed  Google Scholar 

  5. 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.

    Article  PubMed  Google Scholar 

  6. 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.

    Article  PubMed  Google Scholar 

  7. 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.

    Article  PubMed  CAS  Google Scholar 

  8. 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.

    Article  PubMed  CAS  Google Scholar 

  9. 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.

    PubMed  CAS  Google Scholar 

  10. Smith M, Elstad M. Mitomycin C and the endoscopic treatment of laryngotracheal stenosis: are two applications better than one? Laryngoscope. 2009;119:272–83.

    Article  PubMed  CAS  Google Scholar 

  11. Cantrell JR, Guild H. Congenital stenosis of the trachea. Am J Surg. 1964;108:297–305.

    Article  PubMed  CAS  Google Scholar 

  12. Filler RM. Current approaches in tracheal surgery. Pediatr Pulmonol. 1999;18:105–8.

    Article  CAS  Google Scholar 

  13. 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.

    Article  PubMed  CAS  Google Scholar 

  14. 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.

    Article  PubMed  CAS  Google Scholar 

  15. Dutau H. Tracheal stenosis endoscopic treatment. Proceedings of the 12th World Congress for Bronchology, Boston; Bologna:Monduzzi Editore; 2002; p. 83–8

    Google Scholar 

  16. 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.

    Article  PubMed  CAS  Google Scholar 

  17. 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.

    Article  PubMed  Google Scholar 

  18. 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.

    Google Scholar 

  19. Anand VK, Alemar G, Warren ET. Surgical considerations in tracheal stenosis. Laryngoscope. 1992;102(3):237–43.

    Article  PubMed  CAS  Google Scholar 

  20. 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.

    PubMed  Google Scholar 

  21. 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.

    Article  PubMed  CAS  Google Scholar 

  22. 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.

    Article  PubMed  CAS  Google Scholar 

  23. VanHearn LWE, Goei R, dePloeg I, et al. Late complications of percutaneous dilatational tracheostomy. Chest. 1996;110:1572–6.

    Article  Google Scholar 

  24. Hill BB, Zweng TN, Maley RH, et al. Percutaneous dilatational tracheostomy: report of 356 cases. J Trauma. 1996;40:238–44.

    Article  Google Scholar 

  25. 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.

    Article  PubMed  CAS  Google Scholar 

  26. McIndoe RB, Steele JD, Samsom PC, et al. Routine bronchoscopy in patients with active pulmonary tuberculosis. Am Rev Tuberc. 1939;39:617–28.

    Google Scholar 

  27. 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.

    Google Scholar 

  28. Grillo HC, Mark EJ, Mathisen DJ, Wain JC. Idiopathic laryngotracheal stenosis and its management. Ann Thorac Surg. 1993;56:80–7.

    Article  PubMed  CAS  Google Scholar 

  29. 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.

    Article  PubMed  Google Scholar 

  30. 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.

    Google Scholar 

  31. 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.

    Article  PubMed  Google Scholar 

  32. Santacruz JF, Mehta AC. Airway complications and management after lung transplantation ischemia, dehiscence, and stenosis. Proc Am Thorac Soc. 2009;6(1):79–93.

    Article  PubMed  Google Scholar 

  33. Lee JH, Park SS, Lee DH, et al. Endobronchial tuberculosis: clinical and bronchoscopic features in 121 cases. Chest. 1992;102:990–4.

    Article  PubMed  CAS  Google Scholar 

  34. Chung HS, Lee JH. Bronchoscopic assessment of the evolution of endobronchial tuberculosis. Chest. 2000;117(2):385–92.

    Article  PubMed  CAS  Google Scholar 

  35. 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.

    Article  PubMed  CAS  Google Scholar 

  36. 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.

    Article  PubMed  Google Scholar 

  37. 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.

    PubMed  CAS  Google Scholar 

  38. Speiser BL, Spratling L. Radiation bronchitis and stenosis secondary to high dose endobronchial irradiation. Int J Radiat Oncol Biol Phys. 1993;25:589–97.

    Article  PubMed  CAS  Google Scholar 

  39. 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.

    PubMed  Google Scholar 

  40. Hollingsworth HM. Wheezing and stridor. Clin Chest Med. 1987;8:231–40.

    PubMed  CAS  Google Scholar 

  41. Boiselle PM, Ernst A. Recent advances in central airway imaging. Chest. 2002;121:1651–60.

    Article  PubMed  Google Scholar 

  42. Naidich DP, Gruden JF, McGuinness G, et al. Volumetric (helical/spiral) CT (VCT) of the airways. J Thorac Imaging. 1997;12(1):11–28.

    Article  PubMed  CAS  Google Scholar 

  43. 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.

    Article  PubMed  CAS  Google Scholar 

  44. 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.

    Article  PubMed  CAS  Google Scholar 

  45. Grenier PA, Beigelman-Aubry C, Fetita C, et al. New frontiers in CT imaging of airways disease. Eur Radiol. 2002;12:1022–44.

    Article  PubMed  Google Scholar 

  46. Hoppe H, Dinkel HP, Walder B, et al. Grading airway stenosis down to segmental level using virtual bronchoscopy. Chest. 2004;125:704–11.

    Article  PubMed  Google Scholar 

  47. 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.

    Article  PubMed  Google Scholar 

  48. 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.

    PubMed  CAS  Google Scholar 

  49. Herth F, Becker HD, Lo Cicero J, Ernst A. Endobronchial ultrasound in therapeutic bronchoscopy. Eur Respir J. 2002;20:118–21.

    Article  PubMed  CAS  Google Scholar 

  50. 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.

    Article  PubMed  Google Scholar 

  51. 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.

    Article  PubMed  Google Scholar 

  52. 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.

    Article  PubMed  Google Scholar 

  53. 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.

    Article  PubMed  Google Scholar 

  54. Cotton RT. Pediatric laryngotracheal stenosis. J Pediatr Surg. 1984;19:699–704.

    Article  PubMed  CAS  Google Scholar 

  55. 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.

    Article  Google Scholar 

  56. 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.

    Article  PubMed  CAS  Google Scholar 

  57. Dumon JF, Reboud E, Garbe L, Aucomte F, Meris B. Treatment of tracheobronchial lesions by laser photoresection. Chest. 1982;81:278–84.

    Article  PubMed  CAS  Google Scholar 

  58. 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.

    Article  PubMed  CAS  Google Scholar 

  59. 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.

    Google Scholar 

  60. 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.

    Article  PubMed  CAS  Google Scholar 

  61. 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.

    PubMed  Google Scholar 

  62. Tremblay A, Marquette CH. Endobronchial electrocautery and argon plasma coagulation: a practical approach. Can Respir J. 2004;11:305–10.

    PubMed  Google Scholar 

  63. 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.

    PubMed  CAS  Google Scholar 

  64. 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.

    Article  PubMed  CAS  Google Scholar 

  65. Montgomery W. T-tube tracheal stent. Arch Otolaryngol. 1965;82:320–1.

    Article  PubMed  CAS  Google Scholar 

  66. Dumon JF. A dedicated tracheobronchial stent. Chest. 1990;97:328–32.

    Article  PubMed  CAS  Google Scholar 

  67. 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.

    Article  PubMed  CAS  Google Scholar 

  68. 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.

    Article  PubMed  Google Scholar 

  69. Dumon JF, Cavaliere S, Diaz-Jimenez JP, et al. Seven years experience with de Dumon prosthesis. J Bronchol. 1996;3:6–10.

    Article  Google Scholar 

  70. 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.

    Article  Google Scholar 

  71. FDA public health notification: complications from metallic tracheal stents in patients with benign airway disorders. 2005. http://www.fda.org.

  72. Ernst A, Silvestri G, Johnstone D. Interventional pulmonary procedures: guidelines from the American College of Chest Physicians. Chest. 2003;123(5):1693–717.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department Pulmonary Medicine, MD Anderson Cancer Center, Houston, TX, USA

    Jose Pablo Díaz-Jimenez M.D., Ph.D., F.C.C.P.

  2. Bellvitge University Hospital, Barcelona, Spain

    Jose Pablo Díaz-Jimenez M.D., Ph.D., F.C.C.P.

  3. Department of Pulmonology – Bronchoscopy, Hospital Universitari de Bellvitge, Sección de Broncoscopia – Neumología Feixa Llarga, Feixa Llarga, s/n, Barcelona, Catalonia, 08907, Spain

    Rosa M. López Lisbona M.D.

Authors
  1. Jose Pablo Díaz-Jimenez M.D., Ph.D., F.C.C.P.
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Rosa M. López Lisbona M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Rosa M. López Lisbona M.D. .

Editor information

Editors and Affiliations

  1. MD Anderson Cancer Center, Houston, TX, Department of Pulmonary Medicine, Bellvitge University Hospital, Barcelona, 08907, Spain

    Jose Pablo Díaz-Jimenez

  2. Clinica Y Maternidad Colon, Pulmonary Department, Mar Del Plata, Buenos Aires, 7600, Argentina

    Alicia N. Rodriguez

Rights and permissions

Reprints and permissions

Copyright information

© 2013 Springer Science+Business Media New York

About this chapter

Cite this chapter

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

Download citation

  • DOI: https://doi.org/10.1007/978-1-4614-6009-1_11

  • Published:

  • Publisher Name: Springer, New York, NY

  • Print ISBN: 978-1-4614-6008-4

  • Online ISBN: 978-1-4614-6009-1

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation