Benign airways stenosis

Abstract

Tracheal or laryngotracheal stenosis and bronchial stenosis are non-specific terms implying the presence of airway compromise involving the larynx, trachea, or bronchi. This is usually the result of scar formation with associated morbidity depending on the location, extent, and thickness of the compromized tissue. The most common condition is post-intubation stenosis that develops after prolonged endotracheal intubation following mechanical ventilation. The sequence of events that leads to tracheal stenosis in adults involves inflammatory reactions with associated granulation tissue and ulceration of the mucosa and the cartilage. Other etiologies are congenital, postinfectious, post lung transplant, chemical damage, radiotherapy, 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 considered the treatment of choice for benign airway stenosis. However, in cases of concentric stenosis without cartilage destruction and 1 cm long, dilation with rigid bronchoscopy with or without laser obtaining a normal caliber could be definitive; in these cases surgery and thoracotomy becomes unnecessary. Other therapeutic interventions can be offered: balloon dilatation, rigid bronchoscopy dilatation, laser resection, and placement of airway stents are the most frequently applied. Tracheobronchial stenosis 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 interventionists, otorhinolaryngologists, and thoracic surgeons, in order to offer the best available solution. We believe that effective management of tracheal stenosis requires a multidisciplinary assessment of patient’s overall clinical status and medical history in addition to etiology and morphology of the stricture.