Laryngotracheal stenosis

Laryngotracheal stenosis (LTS) is a medical condition characterized by a narrowing of the upper airway, specifically the larynx (voice box) and trachea (windpipe). This condition can lead to significant breathing difficulties and may be congenital (present at birth) or acquired later in life due to various causes such as prolonged intubation, trauma, infection, or systemic diseases like Wegener's granulomatosis.

Causes

Laryngotracheal stenosis can arise from a variety of causes, which are generally classified into congenital and acquired. Congenital LTS is less common and may be associated with genetic syndromes or anomalies in fetal development. Acquired LTS, on the other hand, is more prevalent and can result from:

• Prolonged intubation or tracheostomy, leading to scar formation
• External trauma to the neck
• Inhalation injuries
• Infections causing inflammation and subsequent scarring
• Autoimmune conditions, such as Wegener's granulomatosis or Relapsing Polychondritis
• Idiopathic, where the cause remains unknown

Symptoms

The symptoms of laryngotracheal stenosis vary depending on the severity and location of the narrowing but may include:

• Difficulty breathing (dyspnea), especially during physical exertion
• Stridor (a high-pitched wheezing sound during breathing)
• Frequent bouts of pneumonia or other respiratory infections
• Changes in voice quality
• Coughing
• Difficulty swallowing (dysphagia)

Diagnosis

Diagnosis of LTS involves a thorough medical history and physical examination, followed by more specific tests such as:

• Laryngoscopy and tracheoscopy, which allow direct visualization of the larynx and trachea
• Computed Tomography (CT) scan or Magnetic Resonance Imaging (MRI) for detailed imaging
• Pulmonary function tests to assess the impact on breathing

Treatment

Treatment of laryngotracheal stenosis depends on the cause, severity, and location of the stenosis. Options include:

• Monitoring mild cases without immediate intervention
• Surgical procedures to remove the stenotic segment and reconstruct the airway. Techniques include laryngotracheal reconstruction, cricotracheal resection, and tracheal resection with primary anastomosis.
• Balloon dilation, where a balloon is inserted and inflated to widen the narrowed area
• Stenting, placing a tube to keep the airway open
• Administration of corticosteroids to reduce inflammation

Prognosis

The prognosis for individuals with laryngotracheal stenosis varies widely and depends on the underlying cause, the extent of the stenosis, and the response to treatment. Early diagnosis and appropriate management are crucial for improving outcomes and quality of life.

See also

• Tracheostomy
• Airway obstruction
• Pulmonary fibrosis