Tracheal Stenosis is narrowing of the trachea. It can arise from a diverse range of underlying mechanisms. Some common causes include tumors, airway trauma (tracheostomy or tracheal intubation), inflammatory diseases of the airway (Wegener’s granulomatosis or Granulomatosis with polyangiitis) and infections. There is a high rate of recurrence and patients may often need repeat therapies. Treatments include the following:
- Endoscopic treatment is the preferred treatment especially for long regions of narrowing or diffuse disease. A small video camera (endoscope) is inserted to visualize the trachea and the region of disease. The excess tissue causing narrowing can be destroyed using thermal modalities such as laser photocoagulation, electrocautery and photodynamic therapy. There is concern, however that the excess heat may cause recurrent stenosis due to scar tissue formation. Spray cryotherapy is an alternative to thermal treatments. In cryotherapy, liquid nitrogen is delivered to cause tissue ablation by flash freezing. It has been corroborated by multiple studies as a safe and effective treatment for tracheal stenosis.
- Airway stenting is the introduction of a cylindrical, hollow prosthesis called stents to maintain airway luminal patency. They are commonly used for malignant obstruction of the trachea and bronchi but may be employed temporarily for benign disease as well in select cases. Broadly these stents are classified into silicone and metallic stents. Metallic stents are employed in malignant central airway obstruction whereas in benign disease silicone stents are mainly used.