Endoscopically Introduced Expandable Stents in Laryngotracheal Stenosis: The Jury is Still Out

Abstract

A new technique using endoscopically introduced, expandable stents for the management of upper airway stenosis is presented. Evaluation of this technique in the canine model forms the basis of this pilot study. Stenosis was surgically induced in a controlled fashion by resection of cartilage from the anterior cricoid arch and tracheal wall to reduce the airway diameter by approximately 50%. A period of 8 weeks was allowed for complete healing and maturation of the surgical stenosis. This was followed by endoscopic introduction of expandable titanium-mesh stents. The stents were then balloon-inflated to dilate the stenotic region. Airway patency was assessed clinically, radiologically, and endoscopically, before expansion and at 4 and 8 weeks after expansion. This assessment was followed by euthanasia of the animals and gross examination of the expanded stenotic segments. In general, the stents were well tolerated with adequate expansion of the airway. In some instances granulation tissue formation was noted around the stents. This was less pronounced when stents coated with Tecoflex (Advanced Surgical Intervention Co., San Clemente, Calif.) were used. This is probably because of their “inert” nature, which induces less tissue reaction. A literature review of the subject is presented. The significance of this endoscopic modality for management of upper airway stenosis is discussed, and the indications, alternatives, potential pitfalls, and complications are depicted.