EXPIRATORY STENOSIS OF THE

TRACHEA

BY

DR. INNOCENT KINGSLEY ASOGWA

ML - 608

DEFINITION• The trachea, commonly called

the windpipe, is the airway between your larynx (voice box) and your lungs.

• Tracheal stenosis is a narrowing of this airway, which restricts your ability to breathe normally.

ETIOLOGY AND PATHOPHYSIOLOGY• Though rare, tracheal stenosis may be present at birth.

More commonly, the condition is the result of an injury or illness, such as

• Intubation/tracheostomy-related (most common cause)• An external injury to the throat or chest• Infections of a viral or bacterial nature,

including tuberculosis• An autoimmune disorder such as sarcoidosis,

papillomatosis, Wegener's granulomatosis and amyloidosis

• Tracheopathia osteoplastica• Tumors, benign or malignant, which may press against

the trachea, thereby restricting air flow• Occasionally, tracheal stenosis may develop

after radiation therapy to the neck or chest

ETIOLOGY AND PATHOPHYSIOLOGY• Tracheomalacia

– Expiratory Dynamic Airway Collapse (EDAC)

– Tracheobronchomalacia

• Relapsing polychondritis

• Tracheal ring damage due to COPD

• Tracheal ring weakness

• Congenital tracheal anomalies

–Complete tracheal rings

–Congenital Tracheal webs

– tracheal cysts

The linear tomogram shows the larynx (red line), stenotic trachea (blue line), ventricular

bands (blue arrow), laryngeal ventricles

(green arrow), true vocal cords (red arrow), and

tracheostomy site (black arrow).

This linear tomogram was obtained from a patient

with a respiratory scleroma and tracheal stenosis in the cervical

trachea (double-headed red arrow). The green

arrow indicates the pyriform sinus, and the double-headed black

arrow indicates the larynx.

CLASSIFICATION• Structural stenosis includes stenosis due to all

types of exophytic intraluminal malignant or benign tumors and granulation tissue; extrinsic compression; narrowing due to airway distortion, kinking, bending, or buckling; and shrinking or scarring (eg, postintubation stenosis).

• Dynamic (functional) stenosis includes triangular-shaped or tent-shaped airway, in which cartilage is damaged, as well as inward bulging of the floppy posterior membrane

DEGREE OF STENOSIS• 0 None

• 1 < 25%

• 2 26–50%

• 3 51-75%

• 4 76-90%

• 5 90-100% (complete stenosis)

LOCATION OF THE STENOSIS IS DIVIDED INTO 5 REGIONS:

• Upper one third of the trachea

• Middle one third of the trachea

• Lower one third of the trachea

• Right main bronchus

• Left main bronchus

PRESENTATIONS• the symptoms of tracheal stenosis typically are:

• Wheezing, coughing or shortness of breath, including difficulty breathing

• A high-pitched squeal coming from your lungs when you inhale

• Frequent bouts of pneumonia or upper respiratory infections

• Asthma that doesn’t respond well to treatment

• A blue color in the skin or mucous membrane of the mouth or nose

DIAGNOSIS• Lung function tests to measure respiratory function and

determine blockages.

• A computed tomography (CT) scan of both your neck and chest.

• A chest X-ray, which will show the windpipe and your chest.

• An endoscopic procedure, in which a tiny camera is inserted in your airway, to see inside the hollow cavity:– Bronchoscopy, which is used to examine airways for

abnormalities such as tumors, bleeding and inflammation.

• Laryngoscopy, which is used to view the vocal cords.

• A biopsy to check on the malignancy of any tumors or lumps.

TREATMENTS• The surgical techniques include:

• Laser surgery, which can remove scar tissue, if that is what’s causing the stenosis. This provides short term relief but usually isn’t a long term solution.

• Airway stenting, called tracheobronchial stenting, where a mesh like tube keeps the airway open.

• Widening of the trachea, or tracheal dilation, where a small balloon or dilator is used to expand the airway. This also may not be a long term solution.

• Full tracheal resection and reconstruction, which may provide long term relief. The damaged section of the trachea, windpipe, is removed and the remaining ends are joined.