THE MANAGEMENT OF LARYNGEAL AND TRACHEAL STENOSIS. ENDOSCOPIC TREATMENT BY LASER VERSUS EXTERNAL TECHNIQUES

Abstract

The management of laryngotracheal stenosis represents a challenging problem

for most of head and neck surgeons. Cicatricial laryngotracheal stenosis is defined as progressive and permanent diminution of the laryngotracheal lumen with replacement of the normal tissue of the walls by new tissue usually fibrous in nature. This definition excludes stenosis secondary to external compression, edema, tumors and laryngeal paralysis i.e. non-cicatricial stenosis.

Laryngotracheal stenosis could be classified as congenital or acquired. Congenital laryngotracheal stenosis is secondary to inadequate re-canalization of the laryngeal lumen after completion of normal epithelial fusion at the end of the 3" month of gestation. It could be in the form of laryngeal atresia, congenital web, congenital subglottic stenosis, tracheal agenesis and congenital tracheal stenosis.

Acquired laryngotracheal stenosis is classified into primary (idiopathic) and secondary stenosis. Idiopathic stenosis is a rare, slowly progressive inflammatory process of unknown cause, limited to the subglottic region and first tracheal arch. It is , more common in females. It has good response to corticosteroid therapy. In chronic

cases endoscopic laser therapy has good results.

The most common causes of 2 acquired laryngotracheal stenosis are PITS (postintubation tracheal stenosis) and external trauma including tracheotomy. The etiology of cicatricial stenosis could be classified into: 1- Direct causes where the stenosis is directly related to the pathology presented by the patient as in external trauma, bums and infection of the larynx, and 2- Indirect causes where the stenosis occurs as a consequence of treatment as in PITS, following arytenoidectomy or vocal fold surgery, and following treatment of malignant tumors of the larynx.