Obstructive Lesions of the Trachea

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Abstract
Over 100 patients with obstructing lesions of the trachea have undergone resection and end-to-end reconstruction in the past decade. Eighty-four of these had lesions of inflammatory origin and 16 were neoplastic. Their symptoms were primarily airway obstruction. Postintubation lesions of the trachea occur most commonly at the level of inflatable cuffs used to obtain a seal during ventilatory therapy and next most commonly at the level of tracheal stomas in similar patients. Their etiology is chiefly cicatrization following deep ulceration due to pressure necrosis at one of the two sites. Additional lesions may also occur at other levels. The most common primary neoplasm of the trachea was squamous cell carcinoma; the second most common was adenoid cystic carcinoma. Autopsy studies indicated that approximately one-half of the trachea might be resected and primary reconstruction done if certain principles of anatomic mobilization were followed, dependent on the level of the lesion and its extent. Upper tracheal lesions are approached clinically anteriorly through a cervicomediastinal approach with or without division of the upper sternum. In all but extreme cases direct approximation can be done. On a rare occasion, a laryngeal release procedure will provide additional mobility. Tumors of the lower half of the trachea are approached through a high transthoracic incision with appropriate hilar mobilization in addition to cervical flexion for devolvement of the cervical trachea into the mediastinum. In the first 100 consecutive cases, 73 of the 84 patients with benign stricture had a good or excellent result on morphologic and clinical grounds. Four were satisfactory, four represented failures or poor results and there were three deaths. Only one-third of 29 patients with primary neoplasms of the trachea were reconstructable when first seen. Others were suitable for radiation treatment only, no treatment or laryngotrachiectomy. Eleven patients underwent end-to-end reconstruction. There was one operative death, one late recurrence and the other nine are living without known disease from 1 to 11 years postoperatively.