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Clinical Note |

Slide Tracheoplasty for Long-Segment Tracheal Stenosis

Michael J. Cunningham, MD; Roland D. Eavey, MD; Gus J. Vlahakes, MD; Hermes C. Grillo, MD
Arch Otolaryngol Head Neck Surg. 1998;124(1):98-103. doi:10.1001/archotol.124.1.98.
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Objective  To introduce a novel surgical technique for the repair of congenital long-segment tracheal stenosis.

Design  Retrospective case series.

Setting  Tertiary-care hospital.

Patients  Three children ranging in age from 3 months to 3 years, all with complete tracheal rings, the stenotic segments representing between 36% and 49% of the total tracheal length. One patient had an anomalous right upper lobe bronchus and an associated pulmonary artery sling.

Intervention  Slide tracheoplasty reconstruction.

Main Outcome Measure(s)  Postoperative clinical status as evidenced by day and site of extubation, duration of hospitalization, number of bronchoscopic examinations performed before discharge, and subsequent need for urgent bronchoscopic examinations, which reflects the adequacy of the reconstructed airway.

Results  Two patients were extubated on the day of surgery, 1 intraoperatively; the child with the pulmonary artery sling required 3 days of elective intubation for postoperative ventilatory support. The duration of hospitalization ranged from 8 to 10 days. All patients underwent elective bronchoscopy once before discharge; none had granuloma formation. Follow-up ranged from 1 to 4½ years. One patient required a single urgent bronchoscopic examination in addition to planned surveillance endoscopy. Growth of the reconstructed hemitracheal rings is demonstrable.

Conclusions  Slide tracheoplasty achieves successful tracheal reconstruction using the patient's own tracheal tissues. Advantages of this method include the potential avoidance of cardiopulmonary bypass, immediate or early postoperative extubation, and the near-complete absence of granulation tissue formation. The latter obviates the need for multiple postoperative bronchoscopic examinations, as has been reported in tracheoplasty procedures using either costal cartilage or pericardium.

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Figures

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Figure 1.

Laryngotracheal diagrams demonstrating the extent of stenosis and associated anomalies in each of the 3 patients. Note the anomalous right upper lobe bronchus and associated pulmonary artery sling in patient 2 (adapted in part from Grillo23).

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Figure 2.

Technique of slide tracheoplasty. A, The extent of stenosis is identified precisely. The stenotic segment is divided transversely at its midpoint after circumferential dissection at that locus only. The upper stenotic segment is incised vertically posteriorly and the lower segment anteriorly for the full length of the stenosis. B, The right-angled corners produced by these divisions are trimmed above and below. A stay suture near the tip of the superior flap is helpful, as are traction sutures at the tracheobronchial angles or within the mainstem bronchi below. The 2 ends are slid together (C) after placement of individual anastomotic sutures around the entire oblique circumference of the tracheoplasty site (D and E). The reconstructed tracheal circumference is doubled, resulting in quadrupled cross-sectional area (from Grillo23).

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Figure 3.

Anteroposterior plain radiograph (A) and sagittal magnetic resonance image (B) demonstrating narrowing (arrows) of the distal third of the trachea in patient 3. Sequential cross-sectional magnetic resonance images demonstrate progression from normal C-shaped cartilages of the cervical trachea (C) to O-shaped cartilages of the intrathoracic trachea (D) with significant lumen compromise of the distal trachea (E) within 1.0 cm of the carina.

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Figure 4.

A, Coronal computed tomographic scan showing the complex tracheobronchial anatomy of patient 2, including tracheal narrowing proximal to takeoff of anomalous right upper lobe (RUL) bronchus, severe distal tracheal stenosis between pseudocarina and true carina (arrowhead), and the almost horizontal position of the right bronchus intermedius (BRONCH INTER) and the left mainstem bronchus (LMSB). Note comparative width of bronchi relative to smaller tracheal lumen dimensions. B, Enhanced axial computed tomographic scans showing right (RT PA) and left (LT PA) pulmonary arteries and the posterior position of the left pulmonary artery sling relative to the stenotic distal trachea.

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Figure 5.

Preoperative (A) and postoperative (B) computed tomographic scans demonstrate the cross-sectional area enlargement and resultant bilobate shape of the tracheal lumen as determined by the postreconstruction configuration of the splayed anterior and posterior tracheal walls.

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