IATROGENIC STENOSES OF THE AIRWAYS - SURG ICAL INDICATIONS IN A SERIES OF 217 CASES

The authors report a series of 217 non-neoplastic stenoses of the uppe r airways operated in die period 1978-1991. One hundred and twenty pat ients with tracheal stenoses underwent tracheal resection and end-to-e nd anastomosis, with 117 excellent results and 3 deaths. The treatment of 97 patients with laryngotracheal stenoses was much more complex an d difficult to manage : - Fifty-nine underwent tracheal and subglottic resection-anastomosis with 58 successes and 1 death - Seven had resec tion-anastomosis with total cricoidectomy and stenting. They were 6 su ccesses and 1 death - Three had supraglottic resection-anastomosis wit h 3 successes - Twelve underwent laryngeal enlargement over a T-tube w ith successes in 11 cases and failure in 1 case. - Sixteen had complex combinations of resection and modeling with 13 successes, 2 failures, and 1 death. In this series under the same therapeutic options, the r esults were successful in 96 % of cases, with 4 % of failures (7 % of them resulting in death). The anatomical type, tracheal or laryngotrac heal, length of the stenosis, neuropsychological sequelae, and overal poor respiratory status of the patients must be taken into account bef ore deciding the therapeutic strategy. Old age is not a contraindicati on to tracheal resection, but is certainly a risk factor for morbidity and mortality. The key to success is undoubtedly careful preoperative preparation, treatment of local infection and inflammation, as well a s meticulous mucomucosal approximation of healthy margins at the anast omosis.