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Expiratory stenosis of the trachea by dr. innocent kingsley asogwa
DR. INNOCENT KINGSLEY ASOGWA
ML - 608
• The trachea, commonly called
the windpipe, is the airway
between your larynx (voice box)
and your lungs.
• Tracheal stenosis is a narrowing
of this airway, which restricts
your ability to breathe normally.
ETIOLOGY AND PATHOPHYSIOLOGY
• Though rare, tracheal stenosis may be present at birth.
More commonly, the condition is the result of an injury
or illness, such as
• Intubation/tracheostomy-related (most common cause)
• An external injury to the throat or chest
• Infections of a viral or bacterial nature,
• An autoimmune disorder such as sarcoidosis,
granulomatosis and amyloidosis
• Tracheopathia osteoplastica
• Tumors, benign or malignant, which may press against
the trachea, thereby restricting air flow
• Occasionally, tracheal stenosis may develop
after radiation therapy to the neck or chest
ETIOLOGY AND PATHOPHYSIOLOGY
–Expiratory Dynamic Airway Collapse (EDAC)
• Relapsing polychondritis
• Tracheal ring damage due to COPD
• Tracheal ring weakness
• Congenital tracheal anomalies
–Complete tracheal rings
–Congenital Tracheal webs
The linear tomogram
shows the larynx (red
line), stenotic trachea
(blue line), ventricular
bands (blue arrow),
(green arrow), true vocal
cords (red arrow), and
tracheostomy site (black
This linear tomogram was
obtained from a patient
with a respiratory
scleroma and tracheal
stenosis in the cervical
red arrow). The green
arrow indicates the
pyriform sinus, and the
arrow indicates the larynx.
• Structural stenosis includes stenosis due to all
types of exophytic intraluminal malignant or
benign tumors and granulation tissue;
extrinsic compression; narrowing due to
airway distortion, kinking, bending, or
buckling; and shrinking or scarring (eg,
• Dynamic (functional) stenosis includes
triangular-shaped or tent-shaped airway, in
which cartilage is damaged, as well as inward
bulging of the floppy posterior membrane
LOCATION OF THE STENOSIS IS DIVIDED
INTO 5 REGIONS:
• Upper one third of the trachea
• Middle one third of the trachea
• Lower one third of the trachea
• Right main bronchus
• Left main bronchus
• the symptoms of tracheal stenosis typically are:
• Wheezing, coughing or shortness of breath,
including difficulty breathing
• A high-pitched squeal coming from your lungs when
• Frequent bouts of pneumonia or upper respiratory
• Asthma that doesn’t respond well to treatment
• A blue color in the skin or mucous membrane of the
mouth or nose
• Lung function tests to measure respiratory function and
• A computed tomography (CT) scan of both your neck
• A chest X-ray, which will show the windpipe and your
• An endoscopic procedure, in which a tiny camera is
inserted in your airway, to see inside the hollow cavity:
– Bronchoscopy, which is used to examine airways for
abnormalities such as tumors, bleeding and inflammation.
• Laryngoscopy, which is used to view the vocal cords.
• A biopsy to check on the malignancy of any tumors or
• The surgical techniques include:
• Laser surgery, which can remove scar tissue, if that is
what’s causing the stenosis. This provides short term
relief but usually isn’t a long term solution.
• Airway stenting, called tracheobronchial stenting,
where a mesh like tube keeps the airway open.
• Widening of the trachea, or tracheal dilation, where a
small balloon or dilator is used to expand the airway.
This also may not be a long term solution.
• Full tracheal resection and reconstruction, which may
provide long term relief. The damaged section of the
trachea, windpipe, is removed and the remaining ends