Tracheal stenosis after tracheostomy or intubation - Review with special regard to cause and management

To investigate the management outcomes of patients who developed tracheal stenosis after tracheostomy or intubation, we reviewed the courses of 45 patients who had experienced tracheal stenosis at a single institution, over 19 years from February 1985 through January 2004. There were 38 tracheal and 7 infraglottic stenoses. Twenty-nine stenoses were associated with the stoma, 12 with the cuff and 2 with the endotracheal tube resulting in infraglottic lesions; the remaining 2 were double stenoses. Eleven patients were treated by bronchoscopic surgery, and 34 patients were treated by tracheal or laryngotracheal resection. The overall success rate was 93%. The complication rate was 18%. A 2nd operation was required in 3 patients, and 1 of the 3 died of sepsis. Our management strategy of treating tracheal stenosis with resection and end-to-end anastomosis has been associated with good outcomes. Management of infraglottic stenosis is difficult, particularly when there is a large laryngeal defect or when there have been previous surgical attempts at the same site.