الفهرس 
1- IntroductionOnly 14 pages are availabe for public view
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Abstract
LTS is a challenging condition for the otolaryngologist –head and neck surgeon.
Laryngotracheal stenosis (LTS) is a sequalae to laryngotracheal trauma. Depending upon the site of injury it can present as supraglottic or glottic stenosis but the commonest is subglottic stenosis. The subglottic stenosis can be caused by disruption of the supporting skeleton of the cricoid cartilage and tracheal rings,
failed treatment, nonrecognition of the acute trauma and prolonged intubation.
Acquired laryngotracheal stenosis in adult and children is usually a complication of prolonged intubation or due to external trauma. The incidence of laryngotracheal stenosis following intubation ranges from 2 to 12%. Ninety percent of cases of subglottic stenosis in children are secondary to endolaryngeal intubation. Laryngotracheal stenosis (LTS) is a relatively rare disease, caused usually by iatrogenic reasons (intubation, tracheotomy, radiotherapy and surgery of the larynx and trachea) or by trauma. However they may be caused by another rare diseases effecting the wall of the larynx and trachea (primary stenosis) or by compression of pathological process near by (secondary stenosis). Among the primary stenosis except iatrogenic and posttraumatic there are also: congenital, postinfective(tuberculosis, syphilis, scleroma, diphtheria, histoplasmosis and the other), in connective tissue diseases (Wegener’s granulomatosis, relapsing polychondritis), in blister diseases (pemphigoid cicarticans, epidermolysis bullosa hereditaria), in amyloidosis, in sarcoidosis and tracheobronchopathia osteochonDROPlastica.
Secondary stenosis may be effected by thyroid diseases, diseases of the big blood vessels of the thorax, hypertrophic thymus, enlargement of the lymph nodes near by the trachea, tumors and cysts of the neck and mediastinium, retrotracheal abscess and cold abscess in vertebral column tuberculosis. If the reason of stenosis is unknown, the stenosis is called idiopathic. Numerous methods have been developed to assess the degree of LTS: direct and indirect endoscopy, by flexible or rigid instruments of the airways, are still regarded as the gold standard in the diagnosis of stenoses; several classiffication systems of LTS are based on it.
Imaging modalities comprise conventional radiography, tomography or spiral computer tomography (S-CT), magnetic resonance tomography (MRT), as well as new approaches such as CT-based imaging techniques, e.g. virtual bronchoscopy.
Management of laryngotracheal stenosis (LTS) is a challenging problem that demands a multidisciplinary approach performed by surgical teams well trained in this field. The various forms of treatment described for LTS include endoscopic ( laser, repeated endoscopic dilatations, cryosurgery, prolonged stenting) and open surgery( laryngotracheal reconstruction, PCTR, slide tracheoplasty and segmental resection with end-to-end anastomosis). Procedures that do not remove the diseased segment of the subglottis or trachea are associated with variable outcomes. The ideal treatment option should be individualized based on patient characteristics, as each procedure has its own advantages and disadvantages.
Knowledge of the predisposing factors will help establish reliable guidelines for prevention. When endoscopic procedures were the initial treatment, there was a trend that patients with grades I/II subglottic stenosis were more likely to achieve success (i.e. resolution of symptoms, decannulation, and avoidance of a subsequent open procedure) than patients with grades III/IV, with rates of 82% vs. 45%,
respectively. However, in patients undergoing endoscopic management subsequent to laryngotracheoplasty, success rates of endoscopic management were similar when grade I/II patients were compared to grade III patients. Patients should be counseled that the endoscopic approach to management may require more than one surgical intervention with general anesthesia. Endoscopic approaches for treatment of grade III and grade IV subglottic stenosis may be used as a primary treatment,
however lower success rates may be expected.