Chronic subglottic and tracheal stenosis: endoscopic management vs. surgical reconstruction

Abstract

Laryngotracheal stenosis has been and remains one of the most vexing problems in the field of head and neck surgery. Two treatment modalities prevail, endoscopic and external. The indication for each modality is not yet clearly defined. This undefined situation motivated our current work, and we decided to assess laser-assisted endoscopy (with or without stenting) vs. open surgery for treating chronic laryngotracheal stenosis. Our study included 28 cases of chronic laryngotracheal stenosis that were classified according to treatment in two main groups: group I included 13 patients who were endoscopically treated and group II included 15 patients with surgical reconstruction. The mean follow-up period was 12.58 months for group I and 27.43 months for group II. Respiratory function tests (RFT) were carried out preoperatively, 1-month postoperatively and on completion of follow-up. Except for age, which was significantly higher in group I (P<0.001), there was no significant difference between both groups. Although the incidence of complications was higher in group I (69%) than in group II (47%), it was nonsignificant. The postoperative RFT improved significantly in both groups. Although the improvement was higher in group I than group II, the difference was nonsignificant. The correlation between preoperative stridor and all other variables demonstrated that preoperative stridor correlated with the diameter of the stenosed segment (rs=-0.631, P<0.001) and the peak expiratory flow rate (PEFR) (rs=-0.488, P=0.030). Our results indicate that open surgery is the treatment of choice. Compared with endoscopic treatment, it provides a higher success rate and better functional results, especially long term. However, if contraindications to open surgery exist, whether local or general, laser-assisted endoscopy with stenting can offer good palliative results.