POSTINTUBATION TRACHEAL STENOSIS - TREATMENT AND RESULTS

A total of 503 patients underwent 521 tracheal resections and reconstr uctions for postintubation stenosis from 1965 through 1992. Fifty-thre e had had prior attempts at surgical resection, 51 others had undergon e various forms of tracheal or laryngeal repair, and 45 had had laser treatment. There were 251 cuff lesions, 178 stomal lesions, 38 at both levels, and 36 of indeterminate origin. Sixty-two patients with major laryngeal injuries required complete resection of anterior cricoid ca rtilage and anastomosis of trachea to thyroid cartilage, and 117 had t racheal anastomosis to the cricoid. A cervical approach was used in 35 0, cervicomediastinal in 145, and transthoracic in 8. Length of resect ion was 1.0 to 7.5 cm. Forty-nine had laryngeal release to reduce anas tomotic tension. A total of 471 patients (93.7%) had good (87.5%) or s atisfactory (6.2%) results. Eighteen of 37 whose operation failed unde rwent a second reconstruction. Eighteen required postoperative tracheo stomy or T-tube insertion for extensive or multilevel disease. Twelve died (2.4%). The most common complication, suture line granulations (9 .7%), has almost vanished with the use of absorbable sutures. Wound in fection occurred in 15 (3%) and glottic dysfunction in 11 (2.2%). Five had postoperative innominate artery hemorrhage. Resection and reconst ruction offer optimal treatment for postintubation tracheal stenosis.