Tracheal stenosis is a narrowing of the trachea or windpipe. This may lead to shortness of breath, especially when exercising. Breathing may become noisy on deep inspiration and may feel constricted. This noisy breathing is called stridor. In tracheal stenosis stridor occurs most significantly during breathing in, but breathing during exhale can be obstructed in severe tracheal stenosis. This is most significantly due to difficulty in expelling mucous through the narrowed windpipe. Additional symptoms of tracheal stenosis include fatigue and labored cough. Tracheal stenosis may be misdiagnosed as asthma or COPD (chronic obstructive pulmonary disease).
Tracheal stenosis may be acquired through an illness or injury. It may be congenital (present at birth), but it most commonly occurs after being intubated for surgery or illness. It may also occur after Tracheostomy.
Inflammatory diseases such as Wegener’s granulomatosis (a disease that results in blood vessel inflammation) can cause tracheal stenosis along. These diseases are less frequent causes, but must be diagnosed and treated for successful management of tracheal stenosis.
Most ttracheal stenosis cases require surgical intervention. Surgery may be conservative with endoscopic treatment such as laser surgery or balloon dilation, but more severe cases or those that recur may require resection of the narrowed windpipe or possible tracheostomy which is usually temporary but may become permanent.
Subglottic stenosis is when the airway narrows immediately below the vocal cords but above the trachea. In some cases, it can damage the vocal cords as well. This adds another level of difficulty in management and may require resection of part of the voice box cartilage (cricotracheal resection, CTR) and/or laryngotracheal reconstruction (LTR) with additional cartilage such as rib.
There are four grades of severity. Grades 1 and 2 are mild and may improve over time without any treatment. Other times an endoscopic surgery is performed with balloon dilation or laser techniques. Grades 3 and 4 are considered severe subglottic stenosis and will require more intense surgeries, usually either a laryngotracheal reconstruction surgery or cricotracheal resection.
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