An Analytical study on the Presentation and Outcomes of Laryngotracheal Stenosis in Patients following Intubation & Tracheostomy

  • Vinod Kumar Singh
  • Rahul Singh Rai
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Vinod Kumar Singh and Rahul Singh Rai, “An Analytical study on the Presentation and Outcomes of Laryngotracheal Stenosis in Patients following Intubation & Tracheostomy ”, ijmhs, vol. 10, no. 07, Jul. 2020.
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Abstract

Introduction: Laryngotracheal stenosis (LTS) is a complex condition that results in a compromised airway, involving trachea and/or larynx. The etiology of LTS has changed over the years, the common cause now being iatrogenic; post-intubation and post-tracheostomy. The evolution of early injury into stenosis depends on local and systemic factors. Objective of this Study is to  analyze, the clinical presentation and outcomes, following  management of LTS.

Methods: This study was carried out as a Retrospective  study .Review and Reports  of 200 cases /patients, who were diagnosed as LTS and surgically managed by various Tertiary Medical Institutes and Hospitals  over a period of 1 year   were included in the study. Data relating to the types of intervention, complications, and outcome were documented, filled  and statistically analysed

Results : Main etiology of LTS was Endotracheal Intubation in 83 % ( 166 ) cases and rest were ( 17%) Post Tracheostomy. The predominant site of stenosis in endotracheal intubated patients is the Tracheal (75.3%) & Subglottic and Upper Tracheal (18%) followed by glottis  (6.6%). In Post Tracheostomy / Tracheostomized  Cases the Predominant site was Suprastomal. 105 patients (52.5%) underwent T-tube stenting with Montgomery T-tube (temporary and permanent). Following resection and anastomosis, 94% had successful outcomes.Cricotracheal resection and anastomosis had a 100% successful outcome.

93% of the patients with LTS were managed successfully with a good outcome, 5 cases (2.5%)  failed on tracheostomy, 2% failed on T-tube, and 2.5 % awaiting decannulation. The overall success is more with resection and anastomosis procedures. Long term review showed that the airway, voice, and laryngeal protective mechanisms were well preserved in above 89% of the patients with a satisfactory result.

 

Conclusion: Management of LTS is a challenge. The procedure of choice is tracheal resection and anastomosis for tracheal stenosis but when the glottis and/or the subglottis is involved this surgical approach may not be applicable also it may not be feasible due to the extent of stenosis, underlying disease and general health of the patient. . The progress of resuscitation with improving care for ventilated patients has led to a marked decrease in the incidence of tracheal stenosis compared to the previous years.

 

Key Word : Laryngotracheal Stenosis , Retrospective evaluation , Endotracheal Intubation , Tracheostomy

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“I certify that I have participated sufficiently in the conception and design of this work and the analysis of the data (wherever applicable), as well as the writing of the manuscript, to take public responsibility for it. I believe the manuscript represents valid work. I have reviewed the final version of the manuscript and approve it for publication. Neither has the manuscript nor one with substantially similar content under my authorship been published nor is being considered for publication elsewhere, except as described in an attachment. Furthermore I attest that I shall produce the data upon which the manuscript is based for examination by the editors or their assignees, if requested.”

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