Clinical classification and surgical treatment stratification of benign subglottic laryngotracheal stenosis

Objective To discuss the clinical classification of benign subglottic laryngotracheal stenosis (SLTS) and stratified surgical strategy. Methods Thirty cases of benign SLTS treated between Jan 2010 to Aug 2014 were reviewed, among whom 21 were males with an average age was 47. Three cases were combined with trachoesophageal fistula. According to the upper edge location, the lesions were divided into 4 types: type Ⅰ- high tracheal stenosis but not reach lower boarder of cricoid cartilage, type Ⅱ-anterior portion of cricoid cartilage involvement, type Ⅲ-circumferential invasion of the cricoid cartilage, type Ⅳ- reach the glottis or less than 1cm away. Results In all patients, type Ⅰ was in 6 cases, type Ⅱ in 10, type Ⅲ in 13, type Ⅳ in 1. The treatments included one conservative endoscopic therapy, 3 tracheotomy, 11 Montgomery T tube insertion, and 15 airway stenosis resection and primary end-to-end anastomosis. In the 15 patients undergoing resection and reconstruction, type Ⅰ was in 5 cases, type Ⅱ in 4, type Ⅲ in 5 and type Ⅳ in 1. Restenosis occurred in one case with type Ⅱ lesion, salvage treatment with T tube was performed and decannulation succeeded 6 months later. Two failures happened in one type Ⅲ and one type Ⅳ, respectively. Tracheostomy and T tube insertion were done to release the restenosis. The overall rate of decannulation was 86.7%(13/15). The results of T tube insertion were satisfactory. No death happened. Conclusions Single-staged laryngotracheal stenosis resection and reconstruction can cure type Ⅰ to type Ⅲ benign SLTS. Montgomery T tube is a good temporary or permanent modality for patients who are not available for one-stage surgical resection. Key words: Laryngostenosis; Tracheal stenosis; Clinical classification; Surgical treatment