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
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