Clinical Analysis Of The Laryngotracheal Stenosis

Objective: To analyze the etiology,means of diagnosis and surgical approaches for the treatment of larygotracheal stenosis(LTS),and to evaluate their effects on the outcome of surgical management of LTS.Materials and Methods: 22 cases of LTS treated in the Department of Otorhinolaryngology, Head and Neck Surgery, First Clinical Hospital of Jilin University from January 2000 ~ January 2010 were reviewed. Choosing surgical approaches according on the condition of larynx and trachea, laryngotracheal split and plasticity implantation with T-tube 11 cases, with laryngeal dilator 4 cases and endoscopic removal of the obstruction with CO2 laser 7 cases. The prognosis of the patients is analyzed according to different causes, narrow scope and degree and surgical method. Prognosis index including respiration, voice and swallowing function, and whether the complications and operation.Results: 22 cases of LTS, excluding 1 case was lost of fallow-up,the overall success was achieved in 15 of 22 patients(68.2%). 4 cases failed in decannulation within 3 months to 10 years followed-up. Post–operation of larynx 3cases (3 / 9), ectopic thyroid 1 case(1 / 1).There were 17 cases of isolated stenosis with a succussful rate of 70.6% (12/17), all of the 4 subglottic stenosis cases succeed to decannulation, there were 2 patients without dyspnea after decannulation in three cases of supraglottic stenosis, the successful rates were 5/8 in glottic stenosis, 2 cases of trachea stenosis,1 case of which succeed to decanulation. There were 5 cases of multiple stenosis with a succussful rate of 60% (3/5) . Supraglottic–glottic stenosis 2 cases were successful; glottic - subglottic stenosis 2 case, one of which succeed to decannulation, the other was lost of fallow-up; Cross-glottic stenosis 1 case failed to decannulation. According to the Myer-Cotton grading system of LTS: there were 5 cases of GradeⅠwith a successful rate of 80% (4 / 5) and 17 cases of GradeⅡ~Ⅲwith a successful rate of 64.7% (11/17).There were 8 neck injury cases with a successful rate of 75% (6 / 8), 5 cases succeed to decannulation; 1 case obtained improved hoarseness and wide rima vocalis after laryngoscopic approcah. 1 case still had dyspnea after decannulation, who was done by supporting laryngoscopic CO2 laser surgery again, follow up 3 months without dyspnea; 1 case was lost of fallow-up. There were 9 cases of post-operation of larynx with a successful rate of 66.7% (6/9), there were 5 malignant cases, 2 of which succeed to decannulation,1 of which ease dyspnea;there were 4 benign cases, 2 of which succeed to decannulation,1 of which has improved hoarseness and wide rima vocalis.Among the 11 T-tube cases, 1 case was lost of fallow-up, 7 cases succeed to decannulation within 1 to 10 years followed-up, the overall successful rate was 63.6% (7/11).3 surgical falures, 1 case because of sputum obstruction had to emergency decannulation, 1 case because of cervical fistula fail to decannulation, 1 case had dyspnea again after decannulation. Among the 4 cases of laryngeal dilator implantation, 2 cases succeed to decannulation without dyspnea.2 cases fialed to decannulation: 1 case of ectopic thyroid failed to decannulation; 1 case of granulomas recurrenced after 1 month, who had the second operation, supplemented by small doses of radiation therapy after surgery, follow-up 3 months found no growth of granulation. There are 7 cases of laryngoscope laser treatment with a successful rate of 85.7% (6 / 7). 1 failing case was laryngeal contact grauloma.The complications rate is 22.7% (5 / 22), there are four cases of LTS, and 1 case is cervical fistula .Conclusion: 1. It is necessary to evaluate the laryngotracheal framework defect,the degree and extension of stenosis systematically before operation for surgical planning. 2.Grade I isolated stenosis preferred supportting laryngoscope laser surgery. 3. For more than II degree of LTS,we should make full use of the surrounding tissue flap for functional reconstruction, and select the appropriate support dilator; For the subglottic and tracheal limited stenosis, we should first choose scar resection, end-to-end anastomosis. 4. Recurrent episodes of inflammatory granulomas can obtain satisfactory results ,if it was supplied with small doses of radiation therapy,.