A Contemporary Review of Surgical Options in Laryngotracheal Stenosis

Upper airway stenosis is a potentially life-threatening condition that can occur at the level of the larynx, trachea, or multiple sites. It compromises breathing, coughing up secretions or voice production. To date, a wide range of endoscopic and open procedures have been described. Different techniques involve variable decannulation times, recurrence rates or complications. Improved breathing is a major concern for each method. However, other laryngeal functions should also be maintained with optimal voice quality and swallowing function. All these features create a constant challenge for stenosis surgery and, consequently, the need to verify and improve existing methods. A literature review was performed to provide an overview of the different treatment methods utilized in particular localizations. Supraglottic stenosis has a high rate of recurrence; nevertheless, it has a better prognosis than glottic or subglottic stenosis does. In this location, endoscopic surgery is preferable because of its decreased morbidity and optimal wound healing. Glottic stenosis includes bilateral vocal fold palsy (BVFP) and anterior and posterior glottic stenosis. Endoscopic resection combined with readhesion-reducing treatment is recommended for less advanced scars. Endoscopic laterofixation is a safe and easy method to perform for BVFP when there is potential for functional recurrence. Posterior cordotomy with partial arytenoidectomy is selected for patients with persistent disease. Subglottic stenosis is graded according to the Cotton-Myer classification, and open surgical procedures are more successful than endoscopic procedures in terms of decannulation rates and disease-free recurrence periods. The current guidelines concerning the treatment of LTS are still heterogeneous and cover a wide spectrum of procedures. Consequently, the therapy should be tailored individually to the patient, and the operator should be familiar with advantages related to different approaches. Future protocol development requires the standardization of qualification criteria and the verification of respiratory, voice and swallowing results.