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  • Title: Non-intubation traumatic laryngotracheal stenosis: management policies and results.
    Author: Mostafa BE, El Fiky L, El Sharnoubi M.
    Journal: Eur Arch Otorhinolaryngol; 2006 Jul; 263(7):632-6. PubMed ID: 16633824.
    Abstract:
    Traumatic laryngotracheal stenosis (LTS) is increasing in clinical practice. Causes include external trauma, post-intubation, and iatrogenic injuries. It is a complex problem and many patients undergo multiple procedures to achieve a stable and well-protected airway with adequate voice. We present our experience at Ain-Shams University Hospitals on 15 patients followed-up for 7 years. All patients had traumatic LTS excluding post-intubation injuries. Patients were aged 4-58 years. Nine were the victims of road traffic accidents; five were occupational trauma victims; and one tried to commit suicide by strangulation. The patients underwent a total of 53 procedures (mean 3.5 per patient). A total of seven laryngotracheal reconstruction, six partial cricotracheal resection, and four laser recanalization with stenting were performed. Six patients have mean follow-up of 26.5 months (3-60 months). Six patients had normal speech (GRBAS 0-5), three had a moderate degree of voice disturbance (GRBAS 5-10), and five had severe dysphonia (GRBAS > 10). As regards tolerance for daily activities, we used a modification of the McMaster University asthma quality of life questionnaire [Rea et al. Eur J Cardiothorac Surg 22(3):352, 2002] (using the activities and emotional scores total 112). Four patients could perform above the 90th percentile; all the remaining patients were above the 50th percentile. No patient was totally handicapped as a result of their airway problem and they could tend for their basic activities. The aim of this work is to demonstrate that non-intubation traumatic LTS is a complex problem that usually needs a longer time for reconstruction and a different way of approach. However, most of the patients can be finally rehabilitated with a stable, protected airway and adequate voice albeit at the price of a prolonged series of interventions and a long follow-up.
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