Clinical implications of differentiating between types of post-tracheostomy tracheal stenosis

Abstract

Background: Post-tracheostomy tracheal stenosis (PTTS) can be divided into four types according to stenosis mechanism and site: subglottic, stoma, cuff, and tip granuloma. However, there is little information available regarding clinical differences among types of PTTS; therefore, we evaluated the clinical differences between these types.

Methods: We retrospectively evaluated 99 PTTS patients who underwent interventional bronchoscopy between 2004 and 2014. Patients were divided into two groups according to pathophysiological similarities as follows: subglottic or stoma type (n=59) and cuff or tip type (n=40).

Results: There were no differences in baseline characteristics between groups. However, silicone stents were more frequently needed in patients with subglottic or stoma type stenosis (76%) than those with cuff or tip type stenosis (55%, P=0.031) to maintain airway patency. On the contrary, permanent tracheostomy was more frequently performed in patients with cuff or tip type stenosis (50%) than those with subglottic or stoma type stenosis (19%, P=0.002). Finally, successful removal of the tracheostomy tube without surgery and procedure- or disease-related mortality were more frequently achieved in patients with subglottic or stoma type stenosis (71%) than those with cuff or tip type stenosis (45%, P=0.012).

Conclusions: Although there were no significant differences in baseline characteristics between PTTS types, patients with subglottic or stoma type stenosis had more favorable outcomes than those with cuff or tip type stenosis. Therefore, it could be important to distinguish between types of PTTS when assessing prognosis.

Keywords: Post-tracheostomy tracheal stenosis (PTTS); airway stent; interventional bronchoscopy; treatment outcome.

Figure 1

CT and bronchoscopic findings according to PTTS type. (A) Subglottic type. Subglottic area was completely obstructed by fibrotic stricture (arrow and circle); (B) stoma type. Upper trachea at the tracheostomy stoma was narrowed by cartilage fracture and fibrosis (arrow). Tracheal stenosis of triangular shape was observed during the bronchoscopy (dotted triangle); (C) cuff type. Mid-trachea at the cuff level was narrowed by fibrotic bands (dotted square); (D) tip granuloma type. Distal trachea just above the carina was narrowed by fibrosis (long solid arrow: fibrotic band; short dotted arrow: carina). CT, computed tomography; PTTS, post-tracheostomy tracheal stenosis.

Figure 2

Clinical course of patients with PTTS. (A) Patients with subglottic or stoma type stenosis; (B) patients with cuff or tip type stenosis. ^#, these patients underwent tracheostomy because of poor expectoration and/or underlying neurological problems. PTTS, post-tracheostomy tracheal stenosis.