Modalities of treatment for laryngotracheal stenosis: the EVMS experience.
OBJECTIVES/HYPOTHESIS
The aims of the study were to identify trends in surgical management of laryngotracheal stenosis (LTS) based on lesion location, as well as to recognize factors associated with recurrence and repeat surgical intervention.


STUDY DESIGN
The study is a retrospective review of all adult patients cared for at a tertiary care laryngology practice with a diagnosis of laryngotracheal stenosis between October 2001 and July 2010, following Institutional Review Board approval.


METHODS
This study collectively measured demographics, comorbidities, etiologies, sites of stenoses, treatment modalities, and recurrences.


RESULTS
Incisions made with the carbon dioxide (CO2) laser were the most common modality of treatment; patients with multilevel tracheal stenosis were most likely to have undergone at least one operation in which the CO2 laser was used to make incisions (78.7%). Balloon dilation was most commonly employed in patients with multilevel tracheal stenosis (66.0%). Lowest rates of decannulation were identified in patients with a pure tracheal stenosis (23.1%). Patients presenting with multilevel tracheal stenosis underwent the most procedures (6.7). Supraglottic, glottic, and multilevel laryngeal stenosis recurred at the lowest rates. Patients suffering from diabetes mellitus recurred in an average period of 3.9 months, a shorter time frame than those without diabetes, who recurred every 10.5 months.


CONCLUSIONS
Laser incision and/or balloon dilation are most effective in treatment of pure glottic, subglottic, and tracheal stenosis. Multilevel tracheal stenosis warrants closer follow-up, and is more likely to require multiple procedures. Worsening stenosis despite endoscopic management warrants an open procedure. Diabetes is associated with an earlier recurrence of stenosis.
['Sinacori|John T|JT|', 'Taliercio|Sal J|SJ|', 'Duong|Elizabeth|E|', 'Benson|Chris|C|']
D000293:Adolescent D000328:Adult D000368:Aged D000369:Aged, 80 and over D004106:Dilatation D004724:Endoscopy D005260:Female D005500:Follow-Up Studies D006801:Humans D007829:Laryngostenosis D053685:Laser Therapy D054020:Lasers, Gas D008297:Male D008875:Middle Aged D012189:Retrospective Studies D014135:Tracheal Stenosis D016896:Treatment Outcome D055815:Young Adult
decannulation Airway stenosis tracheostomy