الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
Tracheal stenosis is considered a potentially life-threatening condition. Tracheostomy and endotracheal intubation remain the commonest causes of benign tracheal stenosis, tracheal stenosis is caused by regional ischemic necrosis of the tracheal wall. The lesions characteristically occur at the cuff and stomal site, presenting with symptoms and signs of airway obstruction. Surgical reconstruction is the gold standard in the management of benign tracheal stenosis. The use of balloon dilatation and metallic self- expandable stents to relieve airway obstruction in inoperable airway lesions was previously reported.
Other etiologies of acquired tracheal stenosis are tumors and external compression. Tracheal neoplasms account for less than 1% of all malignancies, they may be primary or more commonly tumor infiltrating the trachea from nearby structures. In cases of airway compromise and unresectable disease, the airway may be maintained by repeated bronchoscopic debulkings, the use of CO2 laser, silicone Montgomery T-tube and tracheal stents. The use of metallic expandable stents to relieve airway obstruction in advanced tracheal tumors was previously reported.
Balloon dilatation is used in short segment mild degree tracheal stenosis. It may be used in combination with other techniques such as laser and tracheal stents and can be repeated as necessary.
Our aim was to evaluate the use of balloon dilatation and metallic self- expandable tracheal stents in the management of airway obstruction secondary to different tracheal pathologies in patients who presented to the Otolaryngology Head and Neck Surgery at the Main Alexandria University Hospital, Egypt. The study was conducted as a retrospective group from October 2010 to October 2015 and a prospective group from November 2015 to November 2016. After endoscopic and radiological evaluation, balloon dilatation and expandable metallic tracheal stents (Ultraflex tracheal stent) were inserted under general anesthesia to relieve airway obstruction.
Postoperative follow-up with regard to improvement of respiration, tolerability of the stent and reporting of complications was done. Forty patient were included in the study. Two groups were made, a benign group for patients with benign causes of tracheal stenosis and a malignant group were the cause was malignant cause either primary tracheal tumor or secondary tumor infiltrating and/or compressing the trachea.
Twenty five patients were in the benign group, fifteen males and ten females. All had been subjected to previous procedures before tracheal stenting e.g balloon dilatation (9 patients), bronchoscopic dilatation (24 patients), tracheoplasty (4 patients) and T-tube insertion (1 patient).The causes of tracheal stenting were being unfit for surgery (18 patients), long stenotic segment with intrathoracic segment (5 patients), and tracheal stenosis at two levels (1 patient).
Fifteen patients were in the malignant group, eleven males and four females. Four patients (26.7%) had primary tracheal tumors and eleven (73.3%) suffered from tumors infiltrating the trachea from nearby structures.
The stent was easily inserted in all patients with no significant intraoperative complications.
Postoperatively, the stents were well tolerated and all patients experienced good respiration. Complications occurred were obstructive granuloma which was statistically more significant in the benign group than malignant group, while intraoperative bleeding was statistically more in the malignant group than benign one. Other complications reported were surgical neck emphysema, transient cough, retention of secretions, migration of stent and infection.
We concluded that balloon dilatation could be considered as a therapeutic option for mild degree short segment tracheal stenosis and Ultraflex self-expandable stent could be considered as a therapeutic option for inoperable airway lesions, especially in patients with medical co-morbidities, as well as in cases of long stenotic segment with intrathoracic extension or failed surgery. Also Ultraflex metallic self-expandable stent is a good alternative for palliation of airway obstruction in cases of inoperable malignant tracheal tumors. Strict follow-up is mandatory for early detection and management of expected complications.