Endotracheal intubation injury is the most common cause of acquired laryngotracheal stenosis in the developed world. The incidence is uncertain but estimated at 200 new cases per year in the United Kingdom. Prospective studies have shown some sort of intubation injury in up to 40% of patients who have been ventilated on an Intensive Care Unit. Although the risk of significant airway injury correlates with duration of intubation, there does not appear to be a safe limit and significant injuries have been observed after only 8 hours of intubation in adults and 1 week in children. The incidence of airway stenosis following prolonged ventilation is estimated at 6-10%.
Symptoms related to airway stenosis can be subtle or cause severe shortness of breath. Subtle symptoms may be mistaken for asthma. Some patients may require surgery to insert a tracheostomy tube in the neck to allow them to breath.
The majority of airway stenoses in the paediatric population are in the subglottis. Most are managed with augmentation using rib grafts. The most severe cases require tracheal or cricotracheal resection and anastamosis. Resection has in the past been the ‘Gold Standard’ in adults as rib grafts have poor survival rates. If this technique is applied to all cases of airway stenosis it has a variable success rate.
Airway injuries differ considerably in pathophysiology and degree and in our series more than 70% have been managed with endoscopic procedures alone. In adults having endoscopic airway surgery, in an appropriate centre, the complication rates and hospital stay are much reduced when compared with resection. Patients not suitable for an endoscopic approach are managed with augmentation techniques and resection is used as a last resort.
