eMedicine Specialties > Radiology > Chest

Trachea, Stenosis: Follow-up

Author: Salomon Waizel, MD, Associate Professor of Otolaryngology, Anahuac University; Consulting Surgeon, Department of Otolaryngology, Hospital De Especialidades, National Medical Center SXXI, IMSS
Coauthor(s): Anil Khosla, MBBS, Assistant Professor, Department of Radiology, Section of Neuroradiology, Mallinckrodt Institute of Radiology, Washington University School of Medicine, Veterans Affairs Medical Center of St Louis
Contributor Information and Disclosures

Updated: Jun 13, 2007

Intervention

Medical therapy for tracheal stenosis includes prevention, precise airway management, appropriate treatment of patients who require prolonged intubation, intubation by experienced personnel, continuous monitoring of the endotracheal tube-cuff pressure, intermittent endotracheal tube aspiration, and efficient management of gastroesophageal reflux and infections. Medical supportive therapy includes oxygen administration, heliox therapy, humidification, and antibiotic or steroid therapy.

Surgical management depends on the exact location and extent of the stenosis. The priority is to secure the airway. The following 3 modalities are available:

  • Endoscopic management (direct resection, laser resection, or stent use)
  • Percutaneous dilatation therapy
  • Open surgery procedures (eg, widening, anterior cricotracheal splitting, laryngofissure creation with anterior lumen augmentation, resection, or end-to-end anastomosis)

Medicolegal Pitfalls

  • The principal medicolegal pitfall is the failure to diagnose tracheal stenosis. The key to diagnosis is to have a high index of suspicion. Tracheal stenosis is a frequent condition in large hospitals, in head and neck surgical departments, and in intensive care units, but it is rare in outpatient settings.
  • Some researchers do not consider the laryngotracheal lesions that are induced by prolonged endotracheal intubation to be a part of the disease; rather, the lesions are considered to be iatrogenic entities.
  • In the experience of the authors of this article, the majority of cases are provided by 2 large facilities: major trauma centers and cardiovascular intensive care units. Therefore, we strongly recommend discussing with the patient's family the possibility of tracheal lesions secondary to intubation.
  • In cases of tracheal stenosis caused by blunt or penetrating neck trauma, it is essential to document the condition at the first contact with the patient or as soon as the condition is detected. Also important are taking the appropriate legal action in cases where there are complications and protecting the medical staff against actions that may arise from any preexisting lesions the patient may have.

Special Concerns

  • Technologic advances in CT scanning and MRI have greatly improved radiologists' ability to image the upper airway. SpiralCT scanning and fast MRI techniques allow the use of rapid acquisition speeds that decrease degradation motion artifacts caused by patients breathing and swallowing and carotid artery pulsations. SpiralCT scanners rapidly, in less than 10 seconds, acquire the complete data set through the larynx, limiting the time during which the patient needs to remain motionless. Images can then be reconstructed to create overlapping sections, and coronal, sagittal, and even 3-D images can be generated from the same data set.
  • Helical CT scanning with 3-D reconstruction and virtual endoscopy in neonates and infants can prevent additional diagnostic tracheobronchoscopy in a high percentage of such patients who have tracheobronchial lesions.
 


More on Trachea, Stenosis

Overview: Trachea, Stenosis
Imaging: Trachea, Stenosis
Follow-up: Trachea, Stenosis
Multimedia: Trachea, Stenosis
References
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References

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Further Reading

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Keywords

upper airway stenosis, stenotic trachea, tracheal trauma, laryngotracheal stenosis, narrow airway

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Contributor Information and Disclosures

Author

Salomon Waizel, MD, Associate Professor of Otolaryngology, Anahuac University; Consulting Surgeon, Department of Otolaryngology, Hospital De Especialidades, National Medical Center SXXI, IMSS
Disclosure: Nothing to disclose.

Coauthor(s)

Anil Khosla, MBBS, Assistant Professor, Department of Radiology, Section of Neuroradiology, Mallinckrodt Institute of Radiology, Washington University School of Medicine, Veterans Affairs Medical Center of St Louis
Anil Khosla, MBBS is a member of the following medical societies: American College of Radiology, American Roentgen Ray Society, American Society of Neuroradiology, North American Spine Society, and Radiological Society of North America
Disclosure: Nothing to disclose.

Medical Editor

Satinder P Singh, MD, Associate Professor of Radiology, Chief of Cardiopulmonary Radiology, Director of Cardiac CT, Director of Combined Cardiopulmonary and Abdominal Radiology, Department of Radiology, University of Alabama at Birmingham
Disclosure: Nothing to disclose.

Pharmacy Editor

Bernard D Coombs, MB, ChB, PhD, Consulting Staff, Department of Specialist Rehabilitation Services, Hutt Valley District Health Board, New Zealand
Disclosure: Nothing to disclose.

Managing Editor

W Richard Webb, MD, Chief of Thoracic Imaging, Professor, Department of Radiology, University of California at San Francisco
Disclosure: Nothing to disclose.

CME Editor

Robert M Krasny, MD, Consulting Staff, Department of Radiology, The Angeles Clinic and Research Institute
Robert M Krasny, MD is a member of the following medical societies: American Roentgen Ray Society and Radiological Society of North America
Disclosure: Nothing to disclose.

Chief Editor

Eugene C Lin, MD, Consulting Radiologist, Virginia Mason Medical Center; Clinical Assistant Professor of Radiology, University of Washington School of Medicine
Eugene C Lin, MD is a member of the following medical societies: American College of Nuclear Medicine, American College of Radiology, Radiological Society of North America, and Society of Nuclear Medicine
Disclosure: Nothing to disclose.

 
 
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