Tracheal stenosis

See also Tracheal stenosis information

The trachea is an airway tube connecting the larynx and lungs. It is composed of 16-22 incomplete D-shape cartilage rings.

Congenital tracheal stenosis would include either a weakened tracheal segment (tracheomalacia) or when tracheal rings are complete or O-shape. Tracheal stenosis can be short or long segment depending on the number of pathologic tracheal rings. Acquired tracheal stenosis can be due to prolonged intubation, neck trauma, tracheostomy (neck tube/canula) and burns.

A patient with tracheal stenosis presents with shortness of breath either at rest or on activity or exercise. Patients have increased nasal flaring, chest retractions and noisy breathing or stridor. The voice is not affected as the narrowing is away from the vocal cords, unless the narrowing is very severe or a tracheostomy has been done. Sometimes, the tracheotomy itself can be a cause of this narrowing.

Loss of cartilage support of the trachea causes a collapse or tracheomalacia. This can occur along with stenosis or tracheostomy.

The treatment of tracheal stenosis depends on the length and degree of severity of the stenotic segment. It can be done either endoscopically or by open surgery.

Mild forms with very few symptoms can be corrected only by dilatation. Partial limited CO2 laser excision and an endoscopic stent placement for temporary duration can be done in select cases.

Stenosis affecting the upper trachea is corrected through a neck incision. Lower tracheal narrowing may need a sternotomy (opening of the thorax) for repair. Surgical treatment includes expansion of the airway using rib cartilage grafts or excision of the stenotic segment (tracheal resection and anastomosis).