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THORACIC & CERVICAL TRACHEA SURGERY

INTRODUCTION

The trachea as an organ located between the larynx and the bronchi is placed in the neck and chest wall. As causes of stenosis; long-term intubation, benign and malign tumors, congenital causes, laryngotracheal trauma, chronic inflammatory diseases and collagen tissue diseases are the diseases that can be included. The rate of tracheal stenosis due to long-term intubation is between 0.6% and 21% despite of the technological improvements and increased intensive care facilities.

The preferred method of surgical treatment of tracheal stenosis is the circular extraction of the affected tracheal area and end-to-end anastomosis of the remaining tracheal ends. In these cases, an anaesthetic approach and the patency of the airways are essential. A secure airway can be provided by placing the tube in the trachea distal of the removed site.

The causes of stenosis include long-term intubation, malignant and benign tumors, laryngotracheal trauma, chronic inflammatory diseases, congenital conditions and collagen tissue diseases.

Resection and end-to-end anastomosis in tracheal stenosis can be performed with high success rates such as 71-97%. The tension on the anastomoses is the biggest cause of restenosis after tracheal resection and many release techniques are used to prevent these kind of complications.

Another reason for restenosis is the formation of granulation tissue in the anastomotic region due to the use of unabsorbed suture material.

TECHNICAL

As endoscopic and open techniques; two main treatment modalities are used in the treatment of tracheal stenosis. Bronchoscopic dilatation, laser therapy and stenting are recommended to be used in benign tracheal stenosis. However, Gaissert and his colleagues have reported that postentubation tracheal stenosis played a role in 10 0f 15 stent-implanted cases due to benign airway stenosis, air way obstruction findings were observed and granulation and stenosis were found in bronchoscopies at the end of 8-month follow-up period. In 13 of the cases, the stent has partially or completely been removed, the resection has been applied to the suitable ones and the T or tracheastomy tube has been placed in the non-resectable cases and the stents have not been superior in surgical repair.

In cases with operable tumor, 80% of the patients have gone through end-to-end anastomosis, 10% of the patients have been supported with prosthesis and the T-tube stent have been placed into 10% of the patients.

The cases of damaged trachea caused by tumors and traumas are caused by circular resection of tracheal area affected by the surgical procedure and end-to-end anastomosis of the remaining tracheal ends.

Şahin and his colleagues have found that tracheal stenosis was caused by tracheostomoy (n = 6), prolonged intubation (n=5) and malignancy (n=4) and among 7 of those cases underwent through resection and end-to-end anastomosis and 6 of the cases underwent through tracheal stenting. Postoperative recurrence in 3 cases and mortality in 3 cases were detected. Bayram and his colleagues have performed cervical incision in 8, cervical and partial sternotomy in 3 and right thoracotomy in 2 of 12 patients who underwent through segmental tracheal or laryngotracheal resection due to tracheal stenosis after 13 intubations.

REFERENCES

  • Gaebler C, Mueller M, Schramm W, et al. Tracheobronchial ruptures in children. Am J Emerg Med 1996;14:279-84.
  • Grillo HC, Donahue DM, Mathisen DJ, Wain JC, Wright CD. Postintubation tracheal stenosis. Treatment and results. J Thorac Cardiovasc Surg 1995;109:486-92.
  • Grillo HC, Suen HC, Mathisen DJ, Wain JC. Resectional management of thyroid carcinoma invading the airway. Ann Thorac Surg. 1992;54:3-9.
  • Hadi U, Hamdan AL. Diagnosis and management of tra- cheal stenosis. J Med Liban 2004;52:131-5.
  • Cordos I, Bolca C, Paleru C, Posea R, Stoica R. Sixty tra- cheal resections-single center experience. Interact Cardio- vasc Thorac Surg 2009;8:62-5.

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