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Staged laryngotracheoplasty in adult laryngotracheal stenosis: predictors of long-term decannulation.

  • Author(s): Liu, Isabelle Y
  • Mendelsohn, Abie H
  • Ching, Harry
  • Long, Jennifer
  • Chhetri, Dinesh K
  • Berke, Gerald S
  • et al.
Abstract

IMPORTANCE: This study reviews a single center's experience of performing staged laryngotracheoplasty (LTP) for the treatment of laryngotracheal stenosis with the ultimate goal of attaining long-term airway patency without restenosis. OBJECTIVE: To identify staged LTP as an efficacious surgical treatment option for laryngotracheal stenosis. DESIGN, SETTING, AND PARTICIPANTS: From January 2000 to January 2012, patients at a tertiary care academic institution presenting with diagnoses of laryngeal or laryngotracheal stenosis were retrospectively identified. Medical records from adult patients were inspected, and patient demographics, clinical data, and clinical outcomes were recorded. All patients undergoing staged LTP were initially included. Patients with history of head and neck malignant neoplasm were excluded. INTERVENTIONS: Staged LTP. MAIN OUTCOMES AND MEASURES: The primary outcome was long-term decannulation, defined as decannulation for duration of at least 6 months. RESULTS: Sixty-one patients were included in this study. The mean (SD) patient age was 47.1 (16.7) at the time of first-stage LTP and had a mean (range) follow-up of 5.32 (0.5-17.3) years from the first-stage reconstruction. Etiology of stenosis included prolonged intubation in 27 patients (44%), autoimmune disease in 9 (15%), idiopathic causes in 11 (18%), blunt laryngeal trauma in 10 (16%), and other causes in 4 (7%). Forty-nine patients (80%) were successfully decannulated, while to date 12 (20%) remain tracheostomy or tympanostomy tube dependent. Univariate analyses showed no significant association between decannulation and age (P = .35), sex (P = .52), history of intubation (P = .22), surgeon (P = .20), etiology of stenosis (P = .91), or length of stenosis (P = .31). Multivariate logistic regression analysis showed a significant inverse relationship between grade of stenosis and probability of decannulation (P = .01). CONCLUSIONS AND RELEVANCE: Staged LTP is an option for the reconstruction laryngotracheal stenosis. Our experience shows excellent decannulation rates in the selected patients with stenosis, many of whom have failed treatment with other surgical modalities.

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