Dorothy FarrarTracheal stenosis
Tracheal stenosis is the narrowing of the trachea. It can be congenital or caused by injuries, tumors or medical interventions on the trachea.
What is tracheal stenosis?
The trachea, i.e. the trachea, is a tubular organ. It connects the larynx with the bronchi and is therefore an important part of the respiratory tract. The trachea is about 9-13 centimeters long, begins at the level of the annular cartilage and ends at the so-called bifurcatio tracheae, the bifurcation where it divides into the two main bronchi. In its wall, the trachea contains numerous cartilage braces that strengthen the wall and prevent the trachea from collapsing. With stenosis, the trachea is narrowed. A distinction is made between rigid and soft constrictions. Due to the stenosis, the air can no longer flow properly.
Causes
The narrowing of the trachea may be congenital. Congenital tracheal stenosis is often based on malformations of the cartilage braces. The other causes of tracheal stenosis are manifold. For example, a narrowing can be caused by an enlargement of the thyroid gland. The tissue of the enlarged organ presses on the cartilage rings and thus causes pressure atrophy, i.e. tissue loss.
The result is a lack of stability of the tracheal wall. Chronic compression of the cartilage braces can also lead to a connective tissue reconstruction. In tracheomalacia, the cartilage braces in the trachea are too soft, which then leads to a narrowing of the trachea. Other causes of tracheal stenosis are long-term intubations, tracheotomy, injuries or tumor diseases in the neck area. Radiotherapeutic treatments as part of cancer therapy can also result in tracheal stenosis.
Symptoms and course
Typical symptoms of tracheal stenosis:
Clinically relevant are tracheal stenoses with a reduction of 50% of the diameter of the trachea. Depending on the cause, symptoms may appear suddenly or creep in slowly. The narrowing of the trachea causes air emergency attacks in those affected. This shortness of breath is usually accompanied by a whistling sound when inhaled. This is also referred to as an inspiratory stridor. It may also lead to coughing or the formation of viscous mucus. This can only be coughed up badly due to the narrowing and thus intensifies the shortness of breath even more.
Diagnosis
The diagnosis of tracheal stenosis is made, among other things, on the basis of a pulmonary function test. With the pulmonary function test (LUFU), the functional state of the airways, including the trachea, can be recorded quite accurately. In addition to this examination, X-ray and CT images of the lungs are also taken to better assess the extent of the narrowing. The most important diagnostic tool is pulmonary endoscopy, also known as bronchoscopy. An endoscope is passed through the mouth or nose through the trachea into the lungs. Thus, the localization and the extent of the narrowing can be diagnosed.
Treatment and therapy
In some cases, tracheal stenosis can be eliminated directly with bronchoscopy. Foreign tissue is removed with a laser and a stent is also inserted to support the trachea. In addition, concomitant cortisone therapy is often used here. This is intended to achieve a continuous widening of the narrowing. However, the success rate with this type of treatment is rather low. Recurrences often occur and the trachea narrows again.
In tracheopexy, a surgical method, a so-called reining of the trachea takes place. A kind of support scaffold is built into the trachea. Short and rigid stenosis is treated with tracheal transverse resection. In this procedure, the affected part of the trachea is surgically removed and the remaining pieces are reconnected with end-to-end anastomosis. This technique is suitable for stenoses that are no longer than four centimeters.
With a modified technique, developed by doctors Dedo and Fishman, defects of five to six centimeters can also be treated in this way. In a tracheostomy, the trachea is opened surgically. Subsequently, the skin of the neck is sutured with the now exposed mucous membrane of the trachea. The result is a so-called open channel. This is stretched with placeholders until a sufficient trachea diameter is reached. Then the placeholder is removed and the open gutter is sewn.
The treatment is quite complex and lengthy and is therefore carried out today only rarely or in a closed variant. In the closed variant, patients can usually leave the hospital after two to three weeks.
Prevention
Tracheal stenosis cannot usually be prevented. Congenital tracheal stenosis is usually recognized in childhood. In the case of breathing difficulties, especially with a slight whistling noise when inhaling, a tracheal stenosis should be considered as the cause. A medical examination should always be carried out so that any necessary therapy can be started as early as possible.
In small children, tracheal stenosis can also be triggered by swallowing and getting stuck with a foreign body. Children who clear their throat or cough more often should be taken to the doctor. This is the only way to ensure that the symptoms do not represent tracheal stenosis. Chronic diseases, especially of the thyroid gland, also require regular medical checks to prevent tracheal stenosis.
Hello and welcome to my Health Guide & Encyclopedia! My name is Dorothy Farrar, and I'm the founder and main author of this platform.
My passion for health and wellness started at a young age when I became interested in the connection between the food we eat and the way we feel. This fascination led me to study nutrition and dietetics in college, where I learned about the importance of a balanced diet and the impact of various nutrients on the body.