This disease is usually acquired and is caused by intubation or tracheotomy. Inflammation and pressure necrosis of the tracheal mucosa most commonly occur in the stomach of the tracheotomy or at the level of the tubular balloon.
Acute post-intubation stenosis results from mucosal edema or granulation tissue.
The stenosis is typically 1.5-2.5 cm in length. In patients with chronic stenosis, tracheomalacia may result from weakness of the tracheal cartilage and may be a cause of dyspnea .
The trachea is the airway between the diaphragm and the lungs. When this airway narrows or contracts, the condition is known as tracheal stenosis, which restricts the ability to breathe normally.
Tracheal stenosis, including subglottic stenosis, is a narrowing of the trachea that causes respiratory problems.
It can develop when scar tissue forms in a person’s windpipe due to prolonged intubation – when a breathing tube is inserted into the windpipe to help maintain breathing during a medical procedure – or a tracheostomy, which is a surgery to create an opening in the neck to access the trachea.
Doctors usually treat any underlying medical condition before treating the stricture. If the stricture itself requires treatment, doctors usually perform the surgery. The type of procedure depends on the exact location and extent of the stenosis.
There are two forms of this condition:
- Acquired – caused by an injury or illness after birth.
- Congenital – present from birth
Most cases of tracheal stenosis develop as a result of prolonged ventilatory support known as intubation or a surgical tracheotomy.
The symptoms of tracheal stenosis are similar to those of other conditions so it is important to consult the doctor, particularly if the patient has suffered a sore throat. In addition to a feeling of fatigue or a general feeling of discomfort, the symptoms of tracheal stenosis are usually:
- Wheezing, coughing or difficulty breathing.
- A shrill scream from the lungs when inhaled.
- Frequent episodes of pneumonia or upper respiratory infections.
- Asthma that does not respond well to treatment
- Congestion in the chest.
- Pauses in breathing (apnea).
- A blue color on the skin or mucous membrane of the mouth or nose.
Causes and risk factors for Tracheal Stenosis
Although rare, tracheal stenosis may be present at birth. More commonly, the condition is the result of an injury or illness, such as:
- An external injury to the throat or chest.
- Infections of a viral or bacterial nature, including tuberculosis.
- An autoimmune disorder such as sarcoidosis, papillomatosis, Wegener’s granulomatosis and amyloidosis.
- Benign or malignant tumors that can press on the trachea, thus restricting the flow of air.
- Occasionally, tracheal stenosis may develop after radiotherapy in the neck or thorax.
Tracheal stenosis is usually suspected in individuals with risk factors that show signs and symptoms of stenosis of the respiratory tract.
The condition can be further suspected on the basis of spirometry with a flow volume flow and computed tomography of the neck and chest, but fiber optic bronchoscopy is generally necessary to confirm the presence and severity of tracheal stenosis.
Treatment of Tracheal Stenosis
The most common treatment options for tracheal stenosis include:
- Tracheal resection and reconstruction – During a tracheal resection, surgeons remove the narrow section of the trachea and then gather the upper and lower sections. This is usually a very successful treatment for stenosis, with excellent long-term results.
- Bronchoscopic tracheal dilatation – The lengthening of the trachea, either with a balloon or surgical instruments called tracheal dilators, provides temporary relief of symptoms and allows experts to determine how much of the trachea is affected by the stenosis. During the dilatation procedure, the cause of the stenosis can also be diagnosed if it is not yet known.
- Laser bronchoscopy – In some cases, surgeons use lasers to remove the scar tissue that is causing the stenosis. Laser surgery offers good short-term results and provides temporary relief, but is generally not a long-term solution. In some situations, laser surgery can make the stenosis worse. For these reasons, it is important to consider the underlying disorder before using laser surgery to treat tracheal stenosis.
- Tracheobronchial Airway Stent – A tracheal stent is a tube made of metal or silicone that is placed in the airway to help keep it open. Stents are used as short-term and long-term treatments for stenosis.
There are several treatment options that can be used for tracheal stenosis and the type of treatment used will depend on the cause, location and severity of the tracheal narrowing. Surgeons use minimally invasive techniques whenever possible, although even these procedures require general anesthesia and hospital stay.
Some treatment options may provide immediate relief, but are considered temporary solutions, while others may provide a better long-term solution.
Short-term treatment options for the condition include laser surgery and enlargement of the trachea. Laser surgery can remove the scar tissue that is causing tracheal stenosis.
This treatment option may provide short-term relief, but it is usually not considered a permanent solution. For some patients, laser surgery can make the condition worse, so it is important that patients see a well-informed specialist when evaluating for treatment.
For some patients, the trachea can be widened using a small balloon or dilator to expand the airway. This may also not be a long-term solution.
Treatment options that are generally considered for long-term work include stents and tracheal reconstruction. The stent includes inserting a small metal tube or high density polyethylene or polypropylene mesh into the trachea. This tube keeps the airway open and allows the patient to breathe more easily.
Reconstruction of the trachea is an option when only a small portion of the trachea is involved. During the procedure, the surgeon removes the damaged portion and attaches the remaining ends.