68 Surgical Management of Upper Airway Stenosis Flashcards
Most common cause of laryngotracheal stenosis:
Prolonged endotracheal intubation
How does ET intubation cause stenosis?
Pressure necrosis > mucosal ulceration in presence of bacterial infection > perichondritis and chondritis, with cartilage resorption
Healing by secondary intention > submucosal fibrosis, scar contraction > chronic stenosis
Myer Cotton classification;
I 0-50 % obstruction
II 51 - 70%
III 71 - 99%
IV no detectable lumen
McCaffrey classification
I: subglottic or tracheal lesions <1 cm long
II: subglottic lesions > 1 cm long
III: subglottic/tracheal lesions that do not involve the glottis
IV: glottic lesions
Stenosis that can be treated endoscopically:
Myer - Cotton Gr I and II
Considerations in repair of laryngotracheal stenosis
Establishment of intact, reasonably shaped skeletal framework to provide a scaffold for the airway
Establishment of a completely epithelialized lumen of reasonably normal size and shape
What is the disadvantage of epidermal grafts in laryngotracheal reconstruction?
Why?
Larynx not ideal to accept free epidermal grafts
Larynx is in constant motion, wound bed us potentially contaminated when a tracheostomy is present
MC cause of posterior glottic stenosis
ET intubation
Clinical finding suggestive of interarytenoid scar
Passive medial movement of contralateral arytenoid when ipsilateral arytenoid is displaced laterally suggests IA scar
Usual cause of complete glottic stenosis
Mainstay of management
Unrecognized severe extralaryngeal trauma
Mgmt: open laryngofissure approach
Complete tracheal stenosis:
Approximatelyx % of trachea (____ - ______ cm) can be safely resected and anastomosed primarily, with appropriate mobilization techniques.
50%, 5-7 cm
Average length of adult trachea:
(and range)
of tracheal rings
1 1 cm - 1 1 looks like a trachea
(10-13 cm)
Tracheal rings: 14- 20
