Tracheal stenosis is a narrowing or constriction of the trachea that causes breathing difficulties. Tracheal stenosis may occur in several locations in the windpipe. When it occurs below the vocal cords and voice box, it is known as subglottic stenosis. The two primary types of tracheal stenosis are congenital, resulting from a birth defect, and acquired, resulting from a trauma. Of the two, acquired stenosis is by far the more common type.
Causes of Acquired Tracheal Stenosis
Damage to the trachea typically occurs after prolonged intubation or a tracheostomy. During intubation, a tube is inserted into the nose or mouth to provide a temporary protected airway, usually for a patient being ventilated with a respirator. Long-term intubation may lead to a tracheostomy, a procedure during which a hole is made directly into the trachea to enable a patient to breathe more easily. In either of these cases, tracheal stenosis results from scar tissue building up around the inserted device.
Other causes of tracheal stenosis include accidents, chemical exposure, chronic inflammatory disease, neoplasm (a benign or malignant tumor), and Wegener's granulomatosis, a rare disorder which results in inflammation of the blood vessels.
Symptoms of Tracheal Stenosis
Symptoms of tracheal stenosis are not only extremely uncomfortable, but may be life-threatening. These symptoms may include:
- Shortness of breath
- Stridor, a high-pitched sound made upon inhalation
- Extreme fatigue
- Chest congestion
- Recurring pneumonia
- Cyanosis, a blue coloration of the skin
Treatment of Tracheal Stenosis
It is important that the condition underlying the tracheal stenosis be diagnosed and treated. Treatment of the tracheal stenosis itself requires surgery. The type of procedure performed is dependent upon the location and extent of the tracheal narrowing. The surgical procedures for tracheal stenosis include the following:
Tracheal Resection and Reconstruction
During a tracheal resection the surgeon removes the constricted section of the trachea and reattaches the unaffected upper and lower sections. Tracheal resection and reconstruction is usually successful with excellent long-term results.
Bronchoscopic Tracheal Dilation
Bronchoscopic tracheal dilation is performed one of two ways: either by stretching the trachea with an inserted balloon, or through the use of tracheal dilators, surgical devices designed to widen the passage. Tracheal dilatation may serve as a diagnostic tool, as well as a means of relieving symptoms. This is because the physician may be able to determine the precise location of the problem, and detect the cause of the stenosis with the use of a broncoscope. The relief provided by this procedure, however, may be only temporary.
Direct Bronchoscopy with CO2 Laser
Under magnification of a microscope, CO2 laser energy is used to incise scar tissue of stenosis. This is usually followed by balloon dilation. In many patients, endoscopic procedures themselves lead to durable symptom relief. Other patients require either tracheal resection and reanastomosis or a permanent tracheostomy.
Tracheobronchial Airway Stent
A tracheobronchial stent is a metal or silicone tube inserted into the airways to help keep them open. Stents may be used for long-term as well as short-term treatment of the condition.
Diagnosis of Tracheal Stenosis
Tracheal stenosis is diagnosed through the use of several diagnostic tests which may include:
- X-rays, MRI or CT scans
- Endoscopy of the upper digestive tract
The scopes investigating the throat and bronchial tubes are helpful in distinguishing other lesions which may be responsible for the patient's symptoms and can also assist in determining the degree of tracheal narrowing. The gastrointestinal scope can uncover or rule out another illness which may affect the surgical outcome.
Recovery from Tracheal Stenosis Surgery
There are several issues which must be addressed postsurgically in patients who have been operated on for tracheal stenosis. In order to recover properly, patients usually require several rehabilitative therapies, including respiratory, speech, hearing or swallowing therapy to restore normal functioning and quality of life. For patients who have been smokers, a smoking cessation program will also be necessary.