Recalcitrant Airway Stenosis in Patients with Abnormal Scars

Abstract

Objective: 1) Identify factors that lead to failures in laryngotracheal reconstruction. 2) Substantiate the clinical suspicion that patients with aberrant wound healing are more likely to fail initial reconstruction surgery, requiring multiple procedures. 3) Consider this population for research in the genetics of subglottic and tracheal stenosis.

Method: A retrospective chart review of patients who failed initial laryngotracheal reconstruction surgery and required additional procedures. The main outcome measure was decannulation. We evaluated demographic data, cause of stenosis, Cotton-Myer grade, surgical techniques, medications employed, and whether patients presented evidence of aberrant wound healing in other anatomic sites.

Results: Six records were identified. Five of these (83%) demonstrated hypertrophic scarring on physical examination. The cause of stenosis in every patient was mechanical ventilation ranging from 5 to 20 days. All patients presented with Cotton grades 3 or 4. Although surgical technique did not vary among patients, all underwent a minimum of three interventions over a 2-year period, despite the regular use of steroids and anti-reflux medications. Mitomycin C was used in only 1 patient and she is currently tolerating capping. Two patients have been deccanulated, but continue to exhibit dyspnea on exertion. Three are still tracheotomy dependant.

Conclusion: We have observed a high incidence of scarring in patients failing initial laryngotracheal reconstruction. Although multiple causes for failure have been identified in the literature, this correlation has not been reviewed. Our results suggest there may be a genetic predisposition to develop airway stenosis in this group of patients.