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Laryngotracheoplasty for Laryngotracheal Stenosis Post Intubation and Post Tracheostomy : A Case of Stenting with Airway Exchange Catheter

Objective: To report a case of Laryngotracheoplasty with costal cartilage augmentation and stenting with airway exchange catheter. Case report: We received a 27 year-old man with past medical history of asthma and cerebral malaria managed by intubation and tracheostomy for assisted ventilation. The lung specialist for suspicion of laryngotracheal stenosis referred him. At presentation, he was complaining of noisy breathing with respiratory difficulty mistaken for asthma. Computed tomography found laryngotracheal stenosis of 19 mm long and 6 mm thick with a distored cricoid cartilage with partial erosion Flexible laryngoscopy showed normal mobility of vocal folds and a grade III subglottic stenosis. Emergency tracheostomy was performed for moderate to severe dyspnea. Posterior cricoid split with costal cartilage augmentation and stenting was performed. Because Montgomery T-tubes were not available, we used a fashioned airway exchange catheter as a stent. Post recoveries were marked by infection and mucus plugging in tracheal cannula. Stent removal was done 2 months later with decannulation the same day. Follow-up was achieved for 18 months without re-stenosis. Discussion: Prolonged intubation and high tracheostomy may cause laryngotracheal stenosis. In this case, both mechanisms were involved. Symptoms like stridor and wheezing can led to misdiagnose laryngotracheal stenosis as asthma. Abnormal pulmonary function tests and absence of improvement through asthma treatment raised suspicion of obstruction. Laryngoscopies (indirect and direct) give the diagnosis and assess the grading of stenosis. Only CT scan can show other stenosis. This case associated subglottic and tracheal stenosis. Laryngotracheal reconstruction with free costal cartilage graft was our surgical option with using of airway exchange catheter as a stent. Decannulation was successfully achieved. Conclusion: Laryngotracheal stenosis is a complex issue with difficulty in management. Various surgical options are available. Proper selection of surgical technique in each clinical setting is the key for successful outcome.

Auteur(s) : Deguenonvo REA, Diouf Ba MS, Ndiaye C, Thiam A, Diop A, Seye M, Hawili H, Sonhaye K, Ahmed H, Seydou A, Owono AS, Lokossou AD, Faysal N, Thiam NF, Mai
Année de publication : 2016
Revue : La Prensa Medica Argentina
N° de volume : 102:2
Type : Article
Mise en ligne par : DEGUENONVO Richard Edouard Alain