"We were already there where the narrow path …" Benign tracheal stenosis treatment: narrative review on the state of the art and future direction

Abstract

Acquired benign tracheal stenosis represents a challenging condition characterized by narrowing of the tracheal lumen, with post-intubation and post-tracheostomy stenosis accounting for approximately 90% of acquired cases. This comprehensive review examines current treatment strategies, from conservative management to surgical reconstruction, highlighting their indications, limitations, and outcomes based on recent clinical evidence. Conservative management, including humidification, corticosteroid therapy, and treatment of underlying conditions, plays a crucial role in selected cases with mild stenosis. Endoscopic techniques, such as dilation, laser treatment, and airway stenting, offer minimally invasive options with success rates varying from 40 to 80%, depending on patient selection. Surgical approaches, including tracheal resection with primary anastomosis and laryngotracheal reconstruction, remain the gold standard for definitive treatment, with success rates exceeding 90% in specialized centers. The choice of treatment modality depends on various factors, including stenosis length, location, severity, and patient characteristics. Emerging treatments, including tracheal replacement, bioengineered tracheal replacements, three-dimensional printing technology, and cell therapy approaches, show promise in addressing the limitations of traditional techniques, though long-term data remains limited. The integration of various biotechnology approaches has led to the development of hybrid solutions, combining 3D-printed scaffolds with cellular components and growth factors. However, significant challenges remain in the translation of these technologies to clinical practice, including issues of vascularization, immune response, and long-term stability. This review provides an up-to-date analysis of available treatment options and future directions in tracheal stenosis management.

Keywords: Airway reconstruction; Bioengineered airways; Endoscopic treatment; Laryngotracheal surgery; Tracheal stenosis.