OBJECTIVETo analyze the etiology, means of diagnosis and surgical approaches for the treatment of laryngotracheal stenosis (LTS), and to evaluate their effects on the outcome of surgical management of LTS.

METHODSFifty-three patients with benign LTS were retrospectively studied for the clinical trial in Peking University, First Hospital, ENT Head & Neck Department between April 1989 and April 2005. The follow-up ranged from 1 to 16 years. The surgical approaches included endoscopic removal of the obstruction with or without CO(2) Laser and open surgical techniques. Open surgical techniques included scar resection, arytenoidectomy, laryngoplasty with hyoid bone and end-to-end anastomosis. A number of grafts (cartilage, hyoid bone) and intraluminal stents were used. Statistical analysis was performed by the chi(2) test.

RESULTSThe overall success was achieved in 38 of 53 patients (71.7%). Three cases were lost of follow-up and 12 cases were lived with endotracheal tube in place. As for the surgical approach, 19 cases (35.8%) were done by open surgical technique and 34 cases (64.2%) by endoscopic approach. The successful rates were 73.7% (14/19) and 70.6% (24/34) respectively. There were 31 cases of isolated stenosis with a successful rate of 87.1% (27/31) and 22 cases of multiple sites with a successful rate of 50.0% (11/22). Isolated stenosis had a statistically better result than multiple stenosis through the chi(2) test (chi(2) = 8.727, P = 0.003). As for the length of stenosis, 47 cases were less than 3 cm with a successful rate of 80.8% (38/47), 6 cases were longer than 3 cm with no success. The stenosis of less than 3 cm had a statistically better result than longer stenosis through the chi(2) test (chi(2) = 17.140, P = 0.000). According to the Cotton grading system of LTS, there were 28 cases of Grade I with a successful rate of 96.4% (27/28) and 25 cases of Grade II - IV with a successful rate of 44.0% (11/25). Grade I stenosis according to Cotton grading system of LTS had better prognosis than Grade II - IV (chi(2) = 17.891, P = 0.000). As for the stents, finger cot usage of one case was successful, while laryngeal stents had a successful rate of 72.2% (13/18) and T tube of 25.0% (1/4). Six cases of hyoid graft with sternohyoid muscle flap were suess.

CONCLUSIONSSurgical approaches of LTS should be chosen according to the site, length and diameter of stenosis. The operative efficacy ranged from case to case, while shorter stenosis and isolated stenosis might be easier to handle than multiple stenosis. The use of stents and interposition grafts were also helpful in some cases.