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Tracheal Stenosis – Tracheal Stent

Tracheal stenosis is the narrowing of the trachea due to the formation of scar tissue or malformation of the cartilage in the trachea. Mild narrowing of the trachea may not cause complaints. When the narrowing is more than 50 percent of the airway, serious complaints can cause serious complications.The three most common causes of tracheal stenosis are:

  • Prolonged insertion of an endotracheal tube (breathing tube) or tracheostomy
  • Compression of tumors and masses adjacent to the trachea
  • Goiter and Thyroid cancers

Other known causes include:

  • Congenital malformations (congenital disability)
  • Trauma
  • Inhalation burns
  • Radiation therapy
  • Tracheal infections
  • Inflammatory diseases (sarcoidosis or amyloidosis)
  • Cancer

In cancer and congenital malformations, the airway is compressed by narrowing the trachea or malformed cartilage.
Other causes of tracheal stenosis usually begin with ulceration of the trachea. The ulcer results from inflammation. The additional scar tissue narrows the space in the trachea.

What are the Causes of Tracheal Stenosis?

The incidence of tracheal stenosis depends on the cause of the tracheal narrowing. Airway damage is a common complication of intubation; However, the risk of symptomatic stenosis is low. The following risk factors increase the risk of getting post-intubation or tracheostomy-related tracheal stenosis:

  • Female gender
  • Obesity
  • Diabetes
  • Hypertension
  • Heart disease
  • Smoking

Figure 1: A. Bronchoscopic view of tracheal stenosis. The trachea is very narrow, and the patient cannot breathe adequately. B. With rigid bronchoscopy, we see the tracheal opening after dilation, and the patient breathes easily.
Post-intubation or post-tracheostomy risk is prevented if we apply the following in the ICU:

  • Endotracheal or tracheostomy balloon pressure is between 20 and 30 cm of water pressure.
  • Preventing infection by practicing good oral care to avoid infection or mucus accumulation
  • Rotating the breathing tube outside the mouth to relieve pressure
  • Maintaining sufficient depth of the breathing tube
  • Prevent complications with breathing tubes during insertion and avoid accidental removal if there is a narrow airway.

Tracheal stenosis may be one of the first manifestations of granulomatosis with polyangiitis. Stenosis can occur about 20 percent of the time. There is not much data on the prevalence of other causes of tracheal stenosis.

Tracheal Stenosis Symptoms

In congenital tracheal stenosis, mild stenosis can present as asthma or recurrent bronchitis. In mild tracheal stenosis, the patient may not identify symptoms until later childhood or early adolescence. In more severe cases of congenital tracheal stenosis, we may see the following symptoms:

  • Stridor (high-pitched breathing sound)
  • Cyanosis, with prominent blue lips
  • Wheezing
  • Shortness of breath (dyspnea)

In other cases of acquired tracheal stenosis, symptoms appear several weeks after the injury. Difficulty breathing is the typical first symptom. Stridor, wheezing, or shortness of breath on exertion are common.

Diagnosing Tracheal Stenosis

Various methods help us diagnose tracheal stenosis. Bronchoscopy is considered the "Gold Standard" for diagnosing tracheal stenosis because it directly visualizes the trachea.

However, there are some risks because a scope further obstructs your airway, affecting oxygenation levels. Remember to discuss your risk factors associated with bronchoscopy with your doctor.

Other methods include X-ray, Thoracic CT scan, ultrasound, MRI, and pulmonary function testing.

A CT scan determines tracheal stenosis. However, it is challenging to identify soft tissue diseases of the trachea. Some techniques are used to create a "virtual endoscopy" to minimize the need for bronchoscopy. However, CT scanning is not an excellent method for determining less severe stenosis.

Ultrasound can be helpful in determining the amount of air space in the trachea.

How Is Tracheal Stenosis Treated?

Tracheal stenosis, including subglottic stenosis, is a narrowing of the trachea that causes breathing problems. It forms scar tissue in the trachea due to prolonged intubation -- when a breathing tube is inserted into the trachea to maintain breathing during a medical procedure -- or from a tracheostomy, which is an operation to create an opening in the neck. The stenosis may require surgery. The type of procedure depends on the exact location and degree of stenosis.

The most common treatment options are:

Tracheal Resection and Reconstruction: During tracheal resection, our surgeons remove the narrowed section of the trachea and then reattach it to the upper and lower areas. It is a very successful treatment for stenosis with excellent long-term results.

Bronchoscopic Tracheal Dilatation: Enlargement of the trachea with surgical instruments called balloons or tracheal dilators provides temporary relief of symptoms and allows our specialists to determine the severity of stenosis. During the dilation procedure, we can diagnose the cause of the stenosis.

Laser Bronchoscopy: In some cases, surgeons use lasers to remove the scar tissue causing the stenosis. Laser surgery offers good short-term results and temporary relief but is not usually a long-term solution. In some cases, laser surgery can worsen the stenosis. For these reasons, it is essential to consider the underlying disorder before laser surgery.

Tracheobronchial Airway Stent: A tracheal stent is a tube made of metal or silicone inserted into the airway to keep it open. Stents are used as both short-term and long-term therapy for stenosis.

Stent Indications

Tracheobronchial stents;

  • Maintain central airway patency
  • Cleans Endobronchial/endoluminal growing tumors Endoscopically/bronchoscopically treatment with laser, argon plasma coagulation, electrocautery, and cryotherapy
  • The stent can be inserted after bronchoscopic treatment if the airway patency is below 50% or if the lumen diameter is above 50% but the tumor is overgrowing.

The primary treatment method in tumor-related airway stenosis is surgical removal. However, in most malignant cases, the stenosis in the airway is inoperable. In these patients, stent placement improves the patient's respiratory distress and quality of life and saves time for other treatment methods.
A stent can be placed in the airway where there is external pressure to the trachea from surrounding tissue tumors or benign lesions if other treatment methods fail to provide adequate airway patency.

Benign stenoses often occur due to disruption of blood flow in the tracheal wall due to mucosal damage from inadequate nutrition. Postintubation tracheal stenosis due to high balloon pressure is the most common type of benign stenosis. Segmental tracheal resection with surgery and end-to-end anastomosis is still the gold standard in these cases. A stent is recommended if symptomatic and severe respiratory distress occurs.
If the stenosis is located close to the vocal cords and is not suitable for surgery, the Montgomery T-tube may be a safe alternative to surgery.
It is used in supporting cartilage dynamics in tracheobronchomalacia and leak repair also.

Tracheal Stenosis – Frequently Asked Questions About Tracheal Stent

Tracheal stenosis is the undulation of the windpipe that occurs after radiation therapy, prolonged use of the breathing tube, or other procedures. Show details. Tracheal stenosis, including subglottic stenosis, is tracheal undulation that causes breathing problems.

In addition to feeling tired or a general malaise (malaise), symptoms of tracheal stenosis typically include: Wheezing, coughing or shortness of breath, including difficulty breathing. A high-pitched wheezing that comes from your lungs when inhaled.

A tracheostomy usually takes 20 to 45 minutes. The surgeon or other healthcare professional will cut the lower front part of your neck and then cut into your windpipe. Clamped track tubes can be used

Chest X-ray: A plain X-ray can tell if the trachea has deviated to either side of the chest.