Author(s): Himanshu Gupta1, Rahul Ashok Telang2, Samir Vinayak Joshi3, Cherry Anilkumar Roy4
BACKGROUND AND AIMS
Airway stenosis is a congenital or acquired narrowing that obstructs the passage of air to the lungs. Upper airway stenosis has a significant impact on the quality of life and sometimes on life itself. The most common cause of acquired airway stenosis is endotracheal intubation resulting in 90% of cases Grenier PA et .al.1 In prospective study at our centre (2012-2015,) we observe the clinical presentation of laryngotracheal stenosis at different levels and the efficacy of Montgomery silicone T-tube as treatment modality for laryngotracheal stenosis.
In a prospective observational study, 32 patients with laryngotracheal stenosis were managed with silicone T-tube. Their clinical profiles were studied in detail and present treatment modality i.e. silicone t- tube stent with laser excision of stenotic segment, dilatation and Mitomycin-C application was done. Repeat management in the form of tracheal resection and anastomosis and silicone T-tube stent insertion were needed in patients who had breathlessness and stridor after removal of silicone t- tube stent. Outcome were measured in terms of improvement in symptoms clinically and by radiological evaluation.
In our study, males (66%) (21/32) were more in number and organophosphorus poisoning (69%) was found to be the common cause for prolonged intubation as compared to western world where trauma is most common cause. Silicone t- tube removal was done after one year in 29 patients (n=32). Out of 29 patients, silicone t- tube stent removal at one year with no repeat management in 15 (47%) patients. Repeat T-tube insertion in 11(35%) patients. Tracheal resection and anastomosis in 3 (9%) patients. 13 (41%) patients who underwent Mitomycin-C + laser excision + dilatation + silicone – t –tube insertion did not require repeat stenting.
Primary treatment with scar incision/excision with tracheal stenting by T-tube has proved to be useful at our centre with a minimum stenting period of one year. The success rate was found around 50% and there were no significant complications due to the stent itself. The procedure itself is easy and safe in the hands of an average otolaryngologist as compared to the major surgery of resection and anastomosis. Mitomycin-C is a useful adjunct to incision/excision of the scar during stenting procedure. In general, the stenosis in intrathoracic portion is difficult to tackle, occurs due to uncared for tracheostomy and has a worse outcome than cervical stenosis.