Sandhu, G.S.; (2011) Management of adult benign laryngotracheal stenosis. Doctoral thesis , UCL (University College London).

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Abstract

Upper airway stenosis has a significant impact on the quality of life and sometimes on life itself. The incidence of this condition is likely to be increasing as survival rates following periods of ventilation on Intensive Care Units (ICUs) improve (1, 2). Paediatric laryngotracheal stenosis is a well researched discipline and treatment includes airway augmentation with rib grafts and tracheal or cricotracheal resection with end-to-end anastomosis. At the start of my research, in 2005, adult laryngotracheal stenosis was poorly researched and the treatment options were tracheostomy, tracheal resection or cricotracheal resection, each with associated morbidity and mortality. This thesis investigates the aetiology, incidence, screening and alternative treatment options, which include endoscopic techniques, for the management of acquired adult benign laryngotracheal stenosis. The commonest causes for this condition are ventilation on intensive care units and inflammatory disorders such as Wegener's granulomatosis, idiopathic subglottic stenosis and sarcoidosis. In January 2004 a prospective database was set up in the busiest airway reconstruction unit in the United Kingdom. Data was collected on all new adult patients with upper airways stenosis. At the completion of this research in January 2010, 400 patients had been entered on this database. Due to the rarity of this condition, it was not possible to design randomised trials to compare different treatment options. This thesis is an integrated series of prospective cohort studies, with the aim of developing a greater understanding of adult airway stenosis, with a particular emphasis on minimally invasive endoscopic techniques. This research has shown that 72% of patients with post-intubation airway stenosis can be treated with these minimally invasive endoscopic techniques. Effective new treatments have been devised for the management of inflammatory stenoses when the results of previous treatments had not been effective. New tools for assessing the airway and outcome measures have also been proposed.

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