Filauro et al reported an algorithm for the management of laryngotracheal stenosis. This can help to decide between endoscopic and open surgical approaches. The authors are from IRCCS Ospedale Policlinico San Martino (Genoa), University of Genoa, and University of Brescia in Italy.
Patient selection: laryngotracheal stenosis
Parameters:
(1) grade of stenosis
(2) symptom status
(3) cranio-caudal extension
(4) selected patients
Grade
Symptom Status
Cranio-Caudal Extension
Selected
Approach
I or II (mild)
asymptomatic
NA
NA
wait and see
I or II
symptomatic
< 1.5 cm
NA
endoscopic
I or II
symptomatic
>= 1.5 cm
NA
open neck
III or IV
NA
< 1.5
yes
endoscopic
III or IV
NA
>= 1.5 cm
yes
open neck
III or IV
NA
NA
no
open neck
If the patient is initially managed by wait and see, then the patient is reassessed if the patient becomes symptomatic.
The type of open neck procedure to perform depends on inflammatory status, age, weight, comorbidities, and presence of a tracheotomy. Options:
(1) stenting
(2) single vs double stage
(3) laryngotracheal reconstruction
(4) partial cricotracheal resection and anastomosis
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