What is tracheal stenosis?

Tracheal stenosis is a narrowing of the trachea (windpipe) that is caused by an injury or a birth defect. There are two different types of tracheal stenosis:

• Acquired tracheal stenosis (narrowing from injury) is a reaction to repeated irritation or injury. Causes can include ongoing irritation from a breathing tube, reaction to tissue injury due to pressure from a breathing tube cuff, or reaction to injury from external factors such as inhalational injury from fire.
• Congenital tracheal stenosis (narrowing due to a birth defect) is a rare condition in which the cartilage support structure of the trachea can cause a narrowing of the airway. A normal tracheal cartilage is C-shaped with a softer, posterior membrane which consists of muscle. Abnormalities of this cartilage can include tracheal cartilaginous sleeves, prone to obstruction and crusting, and complete tracheal rings, in which the trachea consists of several or more complete rings of cartilage with a narrowed diameter.

Treatment for tracheal stenosis

Treatment for tracheal stenosis depends on the nature and severity of the condition. There are a wide range of treatment options including:

Observation

Milder forms of tracheal stenosis which do not significantly affect the patient may be monitored with close observation and regular doctor visits. As the child and the airway grows, the condition may improve over time.

Surgery

Balloon dilation

In less severe cases of tracheal stenosis, scar tissue may be divided with a sickle knife and then dilated with an angioplasty-like balloon during an endoscopic, non-surgical procedure. The formation of new scarring can be avoided by injecting the tissue with a steroid during the time of balloon dilation.

Tracheal resection and primary anastomosis

More severe cases may require open surgical intervention with reconstruction. For severe narrowing involving a few tracheal rings, tracheal resection and anastomosis may be performed. This involves surgically removing the defective tracheal segment and then repairing the airway by suturing the remaining ends back together.

Slide tracheoplasty

In long-segment tracheal stenosis, a slide tracheoplasty is required. In this surgery, the narrow part of the trachea is cut horizontally. Then a vertical incision is made in the back part of one segment and the front part of the other tracheal segment. Finally, the two sections are slid together and sutured so that they overlap, providing a wider tracheal airway.

The total length of the hospital stay will depend upon your child’s healing process, and can approximately be three weeks in the intensive care unit (ICU).