Abstract:
Little was known about idiopathic laryngotracheal stenosis when it was
first described. We have operated on 73 patients with idiopathic laryngotracheal
stenosis, have confirmed its mode of presentation and response to surgical therapy,
and have established long-term follow-up.
Methods: Charts of 73 patients treated surgically for idiopathic laryngotracheal
stenosis between 1971 and 2002 were retrospectively reviewed.
Results: All patients were treated with a single-staged laryngotracheal resection,
with (36/73) and without (37/73) a posterior membranous tracheal wall flap. Nearly
all were women (71/73), with a mean age of 46 years (range, 13-74 years).
Twenty-eight (38%) of 73 had undergone a previous procedure with laser, dilation,
tracheostomy, T-tube, or laryngotracheal operations. After laryngotracheal resection,
the majority of patients (67/73) were extubated in the operating room, and 7
required temporary tracheostomies, only 1 of whom was among the last 30 patients.
All were successfully decannulated. There was no perioperative mortality. Principal
morbidity was alteration of voice quality, which was mild and tended to improve
with time. Sixty-seven (91%) of 73 patients had good to excellent long-term results
with voice and breathing quality and do not require further intervention for their
idiopathic laryngotracheal stenosis.
Conclusion: Idiopathic laryngotracheal stenosis is an entity that occurs almost
exclusively in women and is without a known cause. It is not a progressive process,
but the timing of the operation is crucial. Single-staged laryngotracheal resection is
successful in restoring the airway while preserving voice quality in more than 90%
of patients. Protective tracheostomy is now rarely required (1/30). Long-term
follow-up shows a stable airway and improvement in voice quality
