Laryngotracheal stenosis

Laryngotracheal stenosis
Classification and external resources
This condition can also be referred to as subglottic or tracheal stenosis.
ICD-10	Q31.1, Q32.1, J38.6, J39.8, J95.5
ICD-9	519.19, 748.3
MeSH	D014135

Laryngotracheal stenosis refers to abnormal narrowing of the central air passageways. This can occur at the level of the larynx, trachea, carina or main bronchi. In a small number of patients narrowing may be present in more than one anatomical location.

Nomenclature

Laryngotracheal stenosis (Laryngo-: Glottic Stenosis; Subglottic Stenosis; Tracheal: narrowings at different levels of the windpipe) is a more accurate description for this condition when compared, for example to subglottic stenosis which technically only refers to narrowing just below vocal folds or tracheal stenosis. In babies and young children however, the subglottis is the narrowest part of the airway and most stenoses do in fact occur at this level. Subglottic stenosis is often therefore used to describe central airway narrowing in children, and laryngotracheal stenosis is more often used in adults.

Causes

Laryngotracheal stenosis is an umbrella term for a wide and heterogeneous group of very rare conditions. The population incidence of adult post-intubation laryngotracheal stenosis which is the commonest benign sub-type of this condition is approximately 1 in 200,000 adults per year. The main causes of adult laryngotracheal stenosis are:

Main causes of adult laryngotracheal stenosis

	Benign causes	Malignant causes
Extrinsic compression	Thyroid goitre Thymoma Mediastinal lymphadenopathy (e.g. TB) Vascular anomalies	Thyroid cancer Lung cancer/lymphomas-related mediastinal lymphadenopathy
Intrinsic narrowing	At the level of the larynx (glottis) Bilateral vocal fold paralysis Blunt/sharp laryngeal trauma Foreign body inhalation Sarcoidosis Amyloidosis Bilateral vocal fold mobility impairment Crico-arytenoid joint fixation Rheumatoid arthritis Intubation-related joint fixation Inter-arytenoid scarring Intubation-related Infections (e.g. Diphtheria, epiglottitis) Respiratory papillomatosis Large ball-valving vocal polyps At the level of subglottis/trachea Intubation/tracheostomy-related (commonest cause) Wegener's Granulomatosis Idiopathic Progressive Subglottic Stenosis Amyloidosis Benign tumors (e.g. Carcinoid) Tracheal trauma / rupture At the level of carina or main bronchi Wegener's Granulomatosis Foreign body inhalation Tuberculosis Following Photodynamic Therapy	Head and neck (especially laryngeal or supraglottic) cancers Primary tracheal cancers Erosive thyroid cancer Erosive esophageal cancer Lung cancer causing central airway obstruction

Presentation

Symptoms can include, but are not limited to, dyspnea (shortness of breath) and stridor (wheezing). Several patients have reported being initially diagnosed with asthma.

Treatment

General treatment options include

1. Tracheal dilation using rigid bronchoscope
2. Laser surgery
3. Tracheal resection and reconstruction

Tracheal dilation is used to temporarily enlarge the airway. The effect of dilation typically lasts from few days to 6 months.

There are differing opinions on treating with laser surgery.

Tracheal resection is so far the best alternative to cure the stenosis completely. The narrowed part of the trachea will be cut off and the cut ends of the trachea sewn together with sutures. For stenosis of length greater than 5 cm a stent may be required to join the sections.

Late June or early July 2010, a new potential treatment was pioneered at Great Ormond Street Hospital in London, where Ciaran Finn-Lynch (aged 11) received a transplanted trachea which had been injected with stem cells harvested from his own bone marrow. The use of Ciaran's stem cells is hoped to prevent his immune system from rejecting the transplant.

See also

• Hermes Grillo pioneer in tracheal resection surgery

References

• Ongkasuwan, Julina (2006-02-09). "Tracheal Stenosis". Baylor College of Medicine. Archived from the original on 2007-02-20. http://web.archive.org/web/20070220085830/http://www.bcm.edu/oto/grand/02_09_06.htm. Retrieved 2007-03-17.