Sunday, January 31, 2010

Tracheal stenosis management dilema

Tracheal stenosis is a difficult condition to manage.  Often a patient is doomed with a permanent tracheostomy to save his / her breath at the cost of voice.  Adding to the difficulty is the large number of vital structures that course through the neck.

Case report:
I am reporting a case of tracheal stenosis and how it was managed.
20 years old male patient was admitted with tracheostomy tube.  He was not able to vocalize.  This was due to the fact that there was absolute stenosis of trachea just below the level of vocal cords (Cotton's type IV).

MRI scan taken showed:

1. Stenotic segment measuring 4 mm just below the level of vocal folds

2. Cricoid cartilage (the only complete cartilagenous ring in the respiratory pathway) was anatomically normal


MRI scan showing stenosis above the level of tracheostome


This patient was managed by resection of the stenosed segment and end to end anastomosis of the trachea.  In order to compensate for the stenosed length which was resected laryngeal drop was resorted to in order to lengthen the trachea.  Anastomosis was performed without any strain at the level of anastomosis.

Interesting read:

I am giving below a link for the E book titled "Tracheal stenosis and its management"