SURGICAL-TREATMENT OF NONTUMORAL STENOSES OF THE UPPER AIRWAY

Background. After 1970, the widespread use of nasotracheal intubation, avoiding tracheostomy and its pitfalls, resulted in more frequent lar yngeal or laryngotracheal stenoses, which required more complex and so metimes multistaged procedures. Methods. A series of 217 nontumoral st enoses of the upper airway were treated following the same therapeutic principles in the period 1978 to 1992. Two hundred one of them were i atrogenic postintubation strictures (92%); the others were posttraumat ic (7), idiopathic (5), and various (4). Results. One hundred twenty ( 55%) were tracheal stenoses and treated by resection and primary end-t o-end anastomosis with 117 excellent or good results and three deaths. Length of the stenosis, old age, neuropsychological sequelae, and ove rall poor respiratory status of the patients made up the remaining dif ficulties in the treatment. Ninety-seven (45%) were laryngotracheal st enoses with much more complex surgical indications: 57 patients underw ent tracheal and subglottic resection and anastomosis with 56 successe s and one death,:7 had laryngotracheal resection and anastomosis with total cricoidectomy and consequently laryngeal stenting fair 3 to 6 mo nths (six successes, one death), 3 had supraglottic resection and anas tomosis (three successes), 12 patients with glottic opening difficulti es and short laryngeal stenosis underwent a laryngeal enlargement over a T tube without resection (11 successes, one death), and 18 were sub jected to a complex combination of resection and modeling with 16 succ esses, 2 failures, and 1 death. Final results were successful in 208 e ases (96%) with seven deaths and two failures. Mild phonetic sequelae were observed after laryngeal modeling. A minimal follow-up of 1 year has shown long-term stability of most repairs. Conclusions. Despite ac ceptable results, the therapeutic approach remains difficult for laryn gotracheal stenoses involving the glottic and the supraglottic level a s well as for those that have not responded to previous attempts at re pair. In a few cases, despite a meticulous preoperative assessment, th e surgical strategy can only be adopted intraoperatively. The key to s urgical success is undoubtedly a careful preoperative treatment of inf ection and inflammation as well as a meticulous muco-mucosal approxima tion of healthy margins at the anastomosis.