الفهرس 
AnatomyOnly 14 pages are availabe for public view
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Abstract
SUMMARY
Benign tracheal stenosis is an acquired inflammatory
lesion which is mostly due to prolonged intubation and
tracheostomy. Considering high prevalence of road
accidents and head injuries, necessity of prolonged
intubation associated with prolonged ICU stay has been
increased, and as a result, these patients usually undergo
tracheostomy. In case of lack of supervision in these
patients, long and segmental tracheal stenosis occurs that
complicates the treatment.
Tracheal stenosis can present very insidiously or as a
catastrophic near death episode requiring cardiopulmonary
resuscitation. In many cases the condition is precipitated by
an acute respiratory infection. Worsening of dyspnea
following recumbency may also result. Dyspnoea on
exertion appears when about 50% of the airway is
narrowed. Dyspnoea at rest occurs when 75% of the airway
is stenosed. Typically, in adults, exertional dyspnea occurs
when the airway diameter is reduced to about 8 mm; resting
dyspnea occurs at a diameter of 5 mm, at which point
stridor also occurs.
Important data should be collected for each patient
for the proper assessement of the stenotic segment, its
clinical impact and the best management policy.
Various diagnostic techniques must be used to gather
this basic information. These include endoscopy, radiology.
The presence of additional comorbidities should also be
explored especially cardiac or neurological diseases.
Pre-operative assessment is the first step to success
in tracheal surgery, because the best opportunity to correct
the tracheal lesion is at the initial operation.
Clinical pre-operative evaluation includes a detailed
patient history and physical examination. Previous
treatment (successive dilatation, laser, tracheostomy, stents,
previous surgery) may have transformed the initial problem
into a different entity, most often becoming increasingly
difficult to correct.
Chest multi-detector computer tomography with
sagittal and coronal reconstructions reveals essential
information about the stenosis, including length, location
and vocal cords involvement.
Flexible bronchoscopy is probably the most
important component of the pre-operative work-up.
Bronchoscopy may show the need of initial
therapeutic procedures, such as dilatation or granulation
tissue removal. Essential information about tracheal
mucosa, the vocal cords (paralysis, cords fixation, glottis
stenosis) and their distance from the stenosis , and location,
length and assessment of the stomas is considered a key
aspect of surgery planning.
The wide variety of surgical and non-surgical options
available for the management of tracheal stenosis is an
indicator not only of the complexity of the problem but
also of the shortcomings of different approaches. The final
goal of any reconstructive technique is to have a stable,
mucosa lined flexible structure that can transmit the air
flow in and out of the lungs from a competent, patent
larynx. The chosen techniques(s) must also provide long
term patency and should be easily supplemented or
amended in case of restenosis.
Available options include:
1. Prevention
2. Conservative treatment
3. Endoscopic management
4. Open surgical techniques
In experienced hands tracheal reconstruction (end-toend
anastomosis with or without laryngotracheal temporary
stent to prevent airway collapse) achieves excellent results
and remains the gold standard treatment suitable for 99% of
patients.