Cardiothoracic Surgery |

Management of Upper Airway Stenosis After Inhalation Injury FREE TO VIEW

Fernando Abdala*, MD; Oscar Abdala, MD
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Sanatorio de Los Arcos, Buenos Aires, Argentina

Chest. 2012;142(4_MeetingAbstracts):52A. doi:10.1378/chest.1388899
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SESSION TYPE: Thoracic Surgery Posters I

PRESENTED ON: Wednesday, October 24, 2012 at 01:30 PM - 02:30 PM

PURPOSE: The pathogenesis of upper airway stenosis (UAS) in burned patients combines the effects of inhaled gases, heat and usually intubation. The persistence of inflammatory signs, length and complexity of these lesions seems to be greater than other benign stenosis. The aim of this study was to describe the presentation,treatment and results of a group of patients evaluated for UAS after inhalation injury.

METHODS: All patients with UAS after inhalation injury evaluated by the authors from January 2006 to January 2011 were included. All the surgical centers were approved by national or provincial health department to perform this kind of procedures. The demographics,lesion description, initial and definitive management and surgical results were prospectively recorded.

RESULTS: A total of 10 patients were included (males 5, females 5). Mean age was 31 years (18 to 41 years). Mean follow-up: 41 months (12 to 72 months).Seven patients had combined laryngeal and tracheal lesions. There were 8 Laryngeal (1 unilateral vocal cord paralysis, 1 aritenoid fixation and 6 subglottic stenosis), 8 proximal and mid tracheal and 1 lower tracheal lesions. Phonation was impaired in 5 patients. Initial management was tracheostomy in 4 patients, tracheal stent placement in 3 ,surgical resection in 2 and rigid bronchoscopic dilation in 1. Definitive laryngotracheal resections were performed in 9 patients. The other one had a permanent tracheal stent. Time from inhalation injury to surgery was 12,6 months (6 to 24 months). Mean Length of resection was 4 cm (3 to 6 cm). One patient presented an anastomotic granuloma (resolved with laser resection) and other a restenosis (treated with stent placement). Both of them were operated before one year of the airway injury. There were not other complications nor deaths.

CONCLUSIONS: Most of the UAS observed were extense and almost all involved the larynx and trachea (7 cases). The results of surgical treatment were excellent when postponed until endoscopic signs of inflammation succeeded and large tracheal resections could be performed without significant complications. All the patients with phonation impairment recovered vocal communication.

CLINICAL IMPLICATIONS: Laryngotracheal resection should be the main therapeutic option in the management of this complex group of patient. Although it is important to have other tools that allow the patient to be safe when waiting for the perfect surgical spot.

DISCLOSURE: The following authors have nothing to disclose: Fernando Abdala, Oscar Abdala

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Sanatorio de Los Arcos, Buenos Aires, Argentina




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