Etiology of laryngotracheal cicatricial stenosis and its prevention and treatment

Abstract Objective To investigate the causes of laryngotracheal cicatricial stenosis and to search out the best way to prevent and treat it. Methods 241 cases of laryngotracheal cicatricial stenosis in our hospital from 1976 to 1996 were reviewed and analyzed. Results In 241 cases (male 144, female 97, age ranged from 10 months to 71 years), the pathogenic causes were as follows: 135 cases of injury, including traffic accident in 78 cases (accounting for the most part of the injury), neck incised wound in 27, crush injury in 22, strangulation in 7, gunshot wound in 1; 37 caused by postoperative stenosis of laryngotracheal tumor; 28 caused by tracheotomy; 12 by tracheal cannula; 5 by congenital developmental anomaly of larynx; 12 by chemical burn and 1 by electric burn; 11 by other causes (unknown causes and special infections). The regions of stenosis: 141 at laryngeal part, 49 at cervical part of trachea, 38 at both laryngeal and cervical parts of trachea, 4 at laryngohypopharynx, 5 at both cervical and thoracic parts of trachea, 4 at thoracic part of trachea. Conclusions The etiological analysis showed that the major factors causing stenosis are performing tracheotomy alone and neglecting the management of wound or handling improperly in the emergency management of laryngotracheal injury. The airway stenosis caused by tracheotomy and tracheal cannula is mainly due to small incision or large tracheal tube or improper incision position and pulling out endotracheal intubation too late. For the burn in esophagus simultaneously with airway, failing to treat the airway injury properly may develop tracheal or laryngeal stenosis. For the large defect of cartilage and mucosa after tumor resection of larynx and trachea, placing silicon T tube can effectively prevent the laryngotracheal stenosis caused by the operation.