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Head & Neck Aug 2022The purpose of this review article is to summarize the existing literature surrounding wound healing mechanisms in laryngotracheal stenosis. (Review)
Review
BACKGROUND
The purpose of this review article is to summarize the existing literature surrounding wound healing mechanisms in laryngotracheal stenosis.
METHODS
A review of general wound healing pathophysiology, followed by a focused review of iatrogenic laryngotracheal stenosis (iLTS) and idiopathic subglottic stenosis (iSGS) as conditions of aberrant wound healing.
RESULTS
iLTS is the scarring of the laryngotracheal complex, coming secondary to injury from prolonged intubation. iSGS is a chronic fibroinflammatory scarring and narrowing of the subglottic airway in the absence of any obvious preceding injury or trauma. They are both thought to result from a prolonged and dysregulated wound healing response that promotes the deposition of pathologic scar in the airway.
CONCLUSIONS
Understanding the mechanisms that underlie wound healing will help identify and intervene on the process early in its development and discover future therapies that target individual wound healing mechanisms limiting the incidence of this recalcitrant disease process.
Topics: Cicatrix; Constriction, Pathologic; Humans; Laryngostenosis; Tracheal Stenosis
PubMed: 35488503
DOI: 10.1002/hed.27079 -
Tuberkuloz Ve Toraks Sep 2018Postintubation tracheal stenosis (PITS) is an iatrogenic complication seen increasingly often as the number of intensive care unit (ICU) bed multiply, the indications... (Review)
Review
Postintubation tracheal stenosis (PITS) is an iatrogenic complication seen increasingly often as the number of intensive care unit (ICU) bed multiply, the indications for endotracheal intubation expand and disease awareness rises. PITS has a clinical severity spectrum ranging from asymptomatic cases to patients requiring urgent interventional procedures. It should therefore always be considered in the differential diagnosis in patients with a history of intubation who present with the complaint of difficult breathing. The golden standart for diagnosis is fiberoptic/rigid bronchoscopy. Even though tracheal resection and end-to-end anastomosis (TRA) is the preferred traetment, in some selected cases and in the patients who are not candidates for surgery, bronchoscopic interventions can be life saving, temporizing until surgery is possible and even be curative.
Topics: Adult; Bronchoscopy; Diagnosis, Differential; Dyspnea; Female; Humans; Intensive Care Units; Intubation, Intratracheal; Male; Severity of Illness Index; Tracheal Stenosis
PubMed: 30479232
DOI: 10.5578/tt.67108 -
International Journal of Molecular... Feb 2022Laryngotracheal stenosis (LTS) is a complex and heterogeneous disease whose pathogenesis remains unclear. LTS is considered to be the result of aberrant wound-healing... (Review)
Review
Laryngotracheal stenosis (LTS) is a complex and heterogeneous disease whose pathogenesis remains unclear. LTS is considered to be the result of aberrant wound-healing process that leads to fibrotic scarring, originating from different aetiology. Although iatrogenic aetiology is the main cause of subglottic or tracheal stenosis, also autoimmune and infectious diseases may be involved in causing LTS. Furthermore, fibrotic obstruction in the anatomic region under the glottis can also be diagnosed without apparent aetiology after a comprehensive workup; in this case, the pathological process is called idiopathic subglottic stenosis (iSGS). So far, the laryngotracheal scar resulting from airway injury due to different diseases was considered as inert tissue requiring surgical removal to restore airway patency. However, this assumption has recently been revised by regarding the tracheal scarring process as a fibroinflammatory event due to immunological alteration, similar to other fibrotic diseases. Recent acquisitions suggest that different factors, such as growth factors, cytokines, altered fibroblast function and genetic susceptibility, can all interact in a complex way leading to aberrant and fibrotic wound healing after an insult that acts as a trigger. However, also physiological derangement due to LTS could play a role in promoting dysregulated response to laryngo-tracheal mucosal injury, through biomechanical stress and mechanotransduction activation. The aim of this narrative review is to present the state-of-the-art knowledge regarding molecular mechanisms, as well as mechanical and physio-pathological features behind LTS.
Topics: Biomarkers; Biomechanical Phenomena; Cytokines; Genetic Predisposition to Disease; Humans; Intercellular Signaling Peptides and Proteins; Laryngostenosis; Mechanotransduction, Cellular; Tracheal Stenosis
PubMed: 35269565
DOI: 10.3390/ijms23052421 -
Swiss Medical Weekly Dec 2020Tracheal or cricotracheal resection is the standard of care for definitive treatment of tracheal stenosis. However, the incidence is low, the management is complex, and...
BACKGROUND
Tracheal or cricotracheal resection is the standard of care for definitive treatment of tracheal stenosis. However, the incidence is low, the management is complex, and only a few centres have reported their experience. Therefore, more clinical reports on this topic are needed.
METHODS
We performed a retrospective analysis of all patients who underwent tracheal or cricotracheal resection for malignant or benign tracheal stenosis in our institution between 2001 and 2016. Fisher’s exact test was used for analysis of complications and recurrence. P-value <0.05 was considered statistically significant.
RESULTS
37 patients, aged 19–74, underwent tracheal (n = 21, 56.8%) or cricotracheal (n = 16, 43.2%) resection for idiopathic (n = 15, 40.5%), neoplasm-related (n = 11, 29.7%), postintubation/-tracheotomy (n = 10, 27%), and congenital (n = 1, 2.7%) stenosis. Cervical incision was applied in 28 patients (75.7%), and an extended access (5 thoracotomy, 3 hemiclamshell, 1 partial-sternotomy) was required in 9 patients (24.3%). Mediastinal lymphadenectomy was done in 7 patients (18.9%), all with neoplasm-related stenosis. Median resection length was 2.8 cm (range 1.0–6.0), and longer than 4.0 cm in 6 cases (16.2%). Release manoeuvre was performed in 7 patients (18.9%). All patients were extubated immediately after surgery and median hospital stay was 5 days (range 3–15). Median follow-up was 6 months (range, 1-93). There was no 30-day mortality, and no dehiscence or fistula occurred at the suture line. Complications were seen in 11 patients (29.7%), significantly correlating to malignant stenosis (p = 0.011) and surgical procedure, meaning extended access (p = 0.011), mediastinal lymphadenectomy (p = 0.016), and release manoeuvres (p = 0.016). Temporary hoarseness was the most common complication (n = 5, 13.5%), but remained persistent in only one patient (n = 1, 2.7%). Recurrence was seen only in patients with idiopathic stenosis (n = 5, 13.5%).
CONCLUSIONS
Our results confirm good efficacy for surgical resection of tracheal stenosis. The complication rate is relatively low in comparison to the literature, suggesting the importance of managing tracheal stenosis in a tertiary referral centre.
Topics: Anastomosis, Surgical; Humans; Postoperative Complications; Retrospective Studies; Trachea; Tracheal Stenosis; Treatment Outcome
PubMed: 33378546
DOI: 10.4414/smw.2020.20383 -
Journal of Cardiothoracic and Vascular... Aug 2022The authors aimed to evaluate the characteristics and management outcomes of patients who developed tracheal stenosis after invasive mechanical ventilation (IMV) due to...
OBJECTIVES
The authors aimed to evaluate the characteristics and management outcomes of patients who developed tracheal stenosis after invasive mechanical ventilation (IMV) due to COVID-19.
DESIGN, SETTING, AND PARTICIPANTS
The data of 7 patients with tracheal stenosis and 201 patients without tracheal stenosis after IMV due to COVID-19 between March 2020 and October 2021 were retrospectively analyzed.
INTERVENTIONS
Flexible bronchoscopy was performed for the diagnosis of tracheal stenosis and the evaluation of the treatment's effectiveness, and rigid bronchoscopy was applied for the dilatation of tracheal stenosis.
MEASUREMENTS AND MAIN RESULTS
In the follow-up period, tracheal stenosis was observed in 7 of 208 patients (2 women, 5 men; 3.3%). The patients were divided into 2 groups as patients with tracheal stenosis (n = 7) and patients without tracheal stenosis (n = 201). There were no statistically significant differences between the 2 groups in terms of age, sex, body mass index, and comorbidities (p > 0.05). The mean duration of IMV of the patients with tracheal stenosis was longer than patients without tracheal stenosis (27.9 ± 13 v 11.2 ± 9 days, p < 0.0001, respectively). Three (43%) of the stenoses were web-like and 4 (57%) of them were complex-type stenosis. The mean length of the stenoses was 1.81 ± 0.82 cm. Three of the patients were treated successfully with bronchoscopic dilatation, and 4 of them were treated with tracheal resection.
CONCLUSIONS
Tracheal stenosis developed in 7 of 208 (3.3%) patients with COVID-19 who were treated with IMV. The most important characteristic of patients with tracheal stenosis was prolonged IMV support.
Topics: Bronchoscopy; COVID-19; Constriction, Pathologic; Female; Humans; Intubation, Intratracheal; Male; Retrospective Studies; Tracheal Stenosis
PubMed: 35283040
DOI: 10.1053/j.jvca.2022.02.009 -
Pediatric Pulmonology May 2021Airway anomalies are accountable for a substantial part of morbidity and mortality in children with Down syndrome (DS). Although tracheal anomalies occur more often in... (Review)
Review
INTRODUCTION
Airway anomalies are accountable for a substantial part of morbidity and mortality in children with Down syndrome (DS). Although tracheal anomalies occur more often in DS children, a structured overview on the topic is lacking. We systematically reviewed the characteristics of tracheal anomalies in DS children.
METHODS
A MEDLINE and EMBASE search for DS and tracheal anomalies was performed. Tracheal anomalies included tracheal stenosis, complete tracheal ring deformity (CTRD), tracheal bronchus, tracheomalacia, tracheal web, tracheal agenesis or atresia, laryngotracheoesophageal cleft type 3 or 4, trachea sleeve, and absent tracheal rings.
RESULTS
Fifty-nine articles were included. The trachea of DS children is significantly smaller than non-DS children. Tracheomalacia and tracheal bronchus are seen significantly more often in DS children. Furthermore, tracheal stenosis, CTRD, and tracheal compression by vascular structures are seen regularly in children with DS. These findings are reflected by the significantly higher frequency of tracheostomy and tracheoplasty performed in DS children.
CONCLUSION
In children with DS, tracheal anomalies occur more frequently and tracheal surgery is performed more frequently than in non-DS children. When complaints indicative of tracheal airway obstruction like biphasic stridor, dyspnea, or wheezing are present in children with DS, diagnostic rigid laryngotracheobronchoscopy with special attention to the trachea is indicated. Furthermore, imaging studies (computed tomography, magnetic resonance imaging, and ultrasound) play an important role in the workup of DS children with airway symptoms. Management depends on the type, number, and extent of tracheal anomalies. Surgical treatment seems to be the mainstay in severe cases.
Topics: Child; Down Syndrome; Humans; Infant; Larynx; Trachea; Tracheal Diseases; Tracheal Stenosis
PubMed: 33434377
DOI: 10.1002/ppul.25203 -
Ear, Nose, & Throat Journal Feb 2022Tracheal stenosis is defined as a narrowing of the airway distal to the lower edge of the cricoid cartilage. It is initially diagnosed based on clinical presentation and...
OBJECTIVES
Tracheal stenosis is defined as a narrowing of the airway distal to the lower edge of the cricoid cartilage. It is initially diagnosed based on clinical presentation and then confirmed using direct laryngobronchoscopy. Other adjunctive diagnostic methods, including spirometry, have been proposed. This study aimed to evaluate the relationship between tracheal stenosis severity and pre- and post-balloon dilatation spirometry parameters in order to assess for significant changes in spirometry values and to evaluate for the effects of stenosis-associated factors on post-dilation spirometry values, including vertical length and grade of the stenosis, as well as the role of wound-modifying agents.
METHODS
This retrospective study included adults (>18 years of age) with isolated tracheal stenosis who underwent endoscopic balloon dilations at King Saud University Medical City from June 2015 to May 2019, with detailed documentation of operative findings and valid spirometry measurements pre- and post-balloon dilation. Basic demographic data and operative note details, including information about the percentage of tracheal stenosis, distance of tracheal stenosis from vocal cords, vertical length of stenotic segment, and use of wound-modifying agents (topical mitomycin C or triamcinolone injections), were extracted.
RESULTS
Fourteen patients with spirometry measurements obtained on 50 occasions (25 pre-balloon dilation and 25 post-balloon dilation) were included. Each 1-unit increase in the vertical length of the stenosis showed a statistically significant negative relationship (-1.47 L/s) with pre-balloon dilation peak expiratory flow (PEF; = .034). Post-balloon dilation spirometric values showed statistically significant improvements for most variables.
CONCLUSIONS
The vertical length of an isolated tracheal stenosis can be predicted before surgical interventions using PEF values and may be a significant indicator of anticipated post-balloon dilation surgical success. Our study suggested that spirometry is a very useful technique for evaluating patients with tracheal stenosis due to its noninvasiveness, cost-effectiveness, with a good clinical value.
Topics: Adult; Dilatation; Female; Humans; Male; Retrospective Studies; Spirometry; Tracheal Stenosis
PubMed: 32692288
DOI: 10.1177/0145561320936968 -
In Vivo (Athens, Greece) 2021Tracheal stenosis can cause respiratory problems in mature, small-breed dogs. This study aimed to evaluate the placement of an intratracheal titanium alloy stent to...
BACKGROUND/AIM
Tracheal stenosis can cause respiratory problems in mature, small-breed dogs. This study aimed to evaluate the placement of an intratracheal titanium alloy stent to prevent tracheal stenosis in canine tracheal anastomosis.
MATERIALS AND METHODS
The self-expandable intratracheal stent was an alloy of nickel and titanium, at the same atomic ratio. Vital signs and respiratory patterns, C-reactive protein, radiography, computed tomography, and endoscopy results after intraluminal stenting were assessed for 3-5 months.
RESULTS
No dogs showed evidence of intraluminal tracheal stenosis or tracheitis in the region of stent insertion on tracheoscopy and computed tomography after tracheal stent placement. After 1-2 weeks of tracheal stent placement, all dogs resolved coughing and dyspnea signs and resumed normal activities.
CONCLUSION
The intratracheal stent showed no movement or deformation in the trachea, and had flexibility and an appropriate radial force. Therefore, titanium alloy tracheal stents are useful in stenotic operations for tracheal reconstruction.
Topics: Alloys; Anastomosis, Surgical; Animals; Dogs; Stents; Titanium; Trachea; Tracheal Stenosis
PubMed: 34697148
DOI: 10.21873/invivo.12612 -
Asian Journal of Surgery Jul 2023
Topics: Humans; Tracheal Stenosis; Intubation, Intratracheal; Bronchoscopy; Attention
PubMed: 36805721
DOI: 10.1016/j.asjsur.2023.01.106 -
Post-COVID-19 airway stenosis treated by tracheal resection and anastomosis: a bicentric experience.Acta Otorhinolaryngologica Italica :... Apr 2022The COVID-19 pandemic was an extraordinary challenge for the global healthcare system not only for the number of patients affected by pulmonary disease, but also for the...
OBJECTIVE
The COVID-19 pandemic was an extraordinary challenge for the global healthcare system not only for the number of patients affected by pulmonary disease, but also for the incidence of long-term sequalae. In this regard, laryngo-tracheal stenosis (LTS) represents one of the most common complications of invasive ventilation.
METHODS
A case series of patients who underwent tracheal resection and anastomosis (TRA) for post-COVID-19 LTS was collected from June 2020 to September 2021.
RESULTS
Among 14 patients included, 50% had diabetes and 64.3% were obese. During intensive care unit stay, mean duration of orotracheal intubation (OTI) was 15.2 days and 10 patients (71.4%) underwent tracheostomy, which was maintained in 7 for an average of 31 days. According to the European Laryngological Society classification, 13 patients (92.9%) had a grade IIIa LTS and one a grade IIIa+. All patients underwent Type A TRA, according to the authors' classification. No major perioperative complications were reported and at the last follow-up all patients were asymptomatic.
CONCLUSIONS
With the appropriate indications, TRA represents an effective treatment in post-COVID-19 LTS patients. Short OTI times and careful tracheostomy are required in order to reduce the incidence of airway injury.
Topics: Anastomosis, Surgical; COVID-19; Constriction, Pathologic; Humans; Intubation, Intratracheal; Pandemics; Retrospective Studies; Tracheal Stenosis; Tracheostomy; Treatment Outcome
PubMed: 35612502
DOI: 10.14639/0392-100X-N1952