Annals of the National Academy of Medical Sciences (India) (Jul 2019)

Management of Laryngotracheal Stenosis: A 10-Year Study on the Role of Stents

  • Ravikumar Arunachalam,
  • Saravanam Prasanna Kumar

DOI
https://doi.org/10.1055/s-0039-3399405
Journal volume & issue
Vol. 55, no. 03
pp. 159 – 166

Abstract

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Introduction Laryngotracheal stenosis (LTS) is mostly due to road traffic accidents, prolonged intubation, and tracheostomy. Objectives This study focused on a 10-year experience on the role of stents in the management of LTS in a tertiary referral hospital. The aims of this study were to study the internal dimensions of the subglottis and upper trachea in the Indian adult population; to study the mucosal response to injury to the subglottis and the trachea; and to develop an ideal stent for use in LTS in a rabbit model. Materials and Methods The authors have been treating patients with LTS since 2000. The present study deals with the experience of 82 cases of LTS treated over the past 10 years using stents as well as surgical procedures such as Shiann Yann Lee tracheoplasty and tracheal resection and anastomosis. The work also involved a focused research on LTS using rabbits by inducing injury to the mucosa of the upper trachea and subglottis and histological study of the response to injury. The study led to the development of new indigenous stent for use in rabbits to prevent LTS. This stent has been patented. Statistical Analysis The study of the subglottis and upper tracheal discussion have been analyzed and proved that the dimension in the Indian adult population was smaller than in Caucasians. The mucosal inflammation following injury at the subglottis and upper trachea can be reversed by topical application of triamcinolone, which was better than Mitomycin on statistical analysis. Results The quality of life measured after treatment of LTS using stents and other methods of reconstructive surgery has given an overall benefit of 90% with no mortality. Conclusion LTS is a preventable disease. It can be prevented by proper care of patients in ICU and correct technique of endotracheal intubation and tracheostomy. Further, it can be avoided using medications during extubation and proper decannulation protocol. The silastic “T” tube stents are useful to improve the quality of life in these patients.

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