García-Buenrostro N, González-Palafox MA

Language: Spanish
References: 32
Page: 65-80
PDF size: 124.96 Kb.

ABSTRACT

Introduction: Laringotracheal stenosis is a narrowing of the airway that may be congenital or acquired, that may affect the glottis, subglottis and trachea. The three-dimensional computed tomography (CT 3D) reconstruction and the virtual bronchoscopy (VB) are complementary diagnostic methods. They are non invasive and permit the measurement of the extent of the stenosis. They produce internal views of the airways simulating those achieved with fiber optic endoscopy.
Objective: To compare the characteristics of the lesions obtained by the CT 3D and the VB, with those obtained by surgery or bronchoscopy.
Materials and methods: This study was preformed in the Surgical Ward of a pediatric hospital between 2002 and 2003. It was an observational, descriptive, transversal, prospective and retrospective study. The population selected for this study was from 3 months to 15 years of age at the moment of this study. The patients that were selected had the following inclusion criteria: patients in which laringotracheal stenosis was clinically suspected, or that had problems to decanulate. These patients had three-dimensional computed tomography reconstruction and the virtual bronchoscopy made. Operated patients and those who did not complete this study were not included.
Results: The population of this study consists of a total of 12 patients with the diagnosis of laringotracheal stenosis or in witch it was suspected. Seven patients (58.3%) were male and 5 (41.7%) were female. The age ranged from 3 months to 15 years and one month, mean age of 4 years and 8 months. Nine of the patients (75%) required intubation for more than 15 days. Three patients had been intubated for less than 15 days (25%). The number of days intubated ranged from 1 day to 26 days, with a mean of 15 days. None of the three patients that were intubated for less than 15 days had evidence of laringotracheal stenosis. We found laringotracheal stenosis in 8 patients by virtual bronchoscopy and no evidence of stenosis in 4 patients was found. By bronchoscopy laringotracheal stenosis was found in 9 of the patients and was not found in 3 patients. The CT 3D and VB failed to demonstrate the presence of laringotracheal stenosis in one of the patients.
Conclusions: Intubation was the most significant factor in the development of laringotracheal stenosis. All of the patients that had laringotracheal stenosis had been intubeted for a period of more than 15 days. All of the patients that had laringotracheal stenosis had acquired causes. CT 3D and VB failed to demonstrate a posterior wall granuloma. The CT 3D and VB can display the level of obstruction, the degree of the narrowing and the extent to which the obstruction narrows the airway. This information can be used for the planning of the reconstructive surgery.

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