Tracheal stenosis Management dilema

History:

20 years old male patient came with tracheostomy seeking decannulation.
Trachestomy was performed 4 years back following tracheal stenosis.
He gave history of attempted suicide (organo phosphorous poisoning) following which he was on prolonged ventilatory support.
He developed tracheal stenosis as a sequele to prolonged ventilatory support.

On examination:

The patient was on Fuller's tracheostomy tube. Otherwise he was healthy.

Video laryngoscopic examination showed:

1. Normal vocal cords

2. Total stenosis below the level of vocal cords

Imaging:

MRI scan taken showed:

Total stenosis below the level of cricoid cartilage. Cricoid was anatomically normal.

sub_sten.jpg

Management:

This patient was taken up for surgery. Under general anesthesia administered via the tracheostome
the stenotic segment of trachea was exposed. The same was resected and lengthening of trachea
was performed by Laryngeal drop method. End to end anastomosis of trachea was performed and
Montgomery T tube was used as a stent.

Surgical video:

An interesting read:

[http://www.scribd.com/doc/23648138/Tracheal-Stenosis-and-Its-Management#stats
E book on tracheal stenosis and its management]

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