A historical overview of the aetiology and treatment of laryngeal stenosis

Abstract

A review of over a century of publication on laryngeal stenosis reveals much about the aetiology and treatment. The earlier aetiologies of infection and in particular diphtheria of the early part of the twentieth century have given way to more complex and insidious causes. Trauma, particularly from intubation by endotracheal, tracheal or nasogastric tubes, is now the primary cause of simple and complex laryngeal stenosis. The treatments over the past century have been varied and ingenious, ranging from simple dilatation and intubation of the 1800s to galvanocautery, endoscopic scar incision and heated bougienage of the early twentieth century. By the 1930s and 1940s the concept of laryngofissure, scar excision, stenting and skin grafting was the accepted approach to laryngeal stenosis. More recently endoscopic approaches, local flap placement and laser surgery have been advocated. The open approach, however, has stood the test of time. This review presents a comprehensive bibliography and from the reading of these texts a method of classification is presented. This classification is coupled to available modern treatments as described in the literature and so gives the surgeon the available options for the stenosis encountered. The choice remains with the surgeon; however, as in most complex clinical problems there is usually a safe, reliable, dependable procedure, and it is the author's opinion, from this literature review, that the open laryngofissure procedure fulfils these criteria.