expiratory stenosis of the trachea by dr. innocent kingsley asogwa
TRANSCRIPT
![Page 1: Expiratory stenosis of the trachea by dr. innocent kingsley asogwa](https://reader031.vdocument.in/reader031/viewer/2022020307/55a70b001a28ab210b8b4808/html5/thumbnails/1.jpg)
EXPIRATORY STENOSIS OF THE
TRACHEA
BY
DR. INNOCENT KINGSLEY ASOGWA
ML - 608
![Page 2: Expiratory stenosis of the trachea by dr. innocent kingsley asogwa](https://reader031.vdocument.in/reader031/viewer/2022020307/55a70b001a28ab210b8b4808/html5/thumbnails/2.jpg)
DEFINITION• 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.
![Page 3: Expiratory stenosis of the trachea by dr. innocent kingsley asogwa](https://reader031.vdocument.in/reader031/viewer/2022020307/55a70b001a28ab210b8b4808/html5/thumbnails/3.jpg)
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,
including tuberculosis• An autoimmune disorder such as sarcoidosis,
papillomatosis, Wegener's 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
![Page 4: Expiratory stenosis of the trachea by dr. innocent kingsley asogwa](https://reader031.vdocument.in/reader031/viewer/2022020307/55a70b001a28ab210b8b4808/html5/thumbnails/4.jpg)
ETIOLOGY AND PATHOPHYSIOLOGY• Tracheomalacia
– Expiratory Dynamic Airway Collapse (EDAC)
– Tracheobronchomalacia
• Relapsing polychondritis
• Tracheal ring damage due to COPD
• Tracheal ring weakness
• Congenital tracheal anomalies
–Complete tracheal rings
–Congenital Tracheal webs
– tracheal cysts
![Page 5: Expiratory stenosis of the trachea by dr. innocent kingsley asogwa](https://reader031.vdocument.in/reader031/viewer/2022020307/55a70b001a28ab210b8b4808/html5/thumbnails/5.jpg)
The linear tomogram shows the larynx (red line), stenotic trachea (blue line), ventricular
bands (blue arrow), laryngeal ventricles
(green arrow), true vocal cords (red arrow), and
tracheostomy site (black arrow).
![Page 6: Expiratory stenosis of the trachea by dr. innocent kingsley asogwa](https://reader031.vdocument.in/reader031/viewer/2022020307/55a70b001a28ab210b8b4808/html5/thumbnails/6.jpg)
This linear tomogram was obtained from a patient
with a respiratory scleroma and tracheal stenosis in the cervical
trachea (double-headed red arrow). The green
arrow indicates the pyriform sinus, and the double-headed black
arrow indicates the larynx.
![Page 7: Expiratory stenosis of the trachea by dr. innocent kingsley asogwa](https://reader031.vdocument.in/reader031/viewer/2022020307/55a70b001a28ab210b8b4808/html5/thumbnails/7.jpg)
CLASSIFICATION• 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, postintubation stenosis).
• 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
![Page 8: Expiratory stenosis of the trachea by dr. innocent kingsley asogwa](https://reader031.vdocument.in/reader031/viewer/2022020307/55a70b001a28ab210b8b4808/html5/thumbnails/8.jpg)
DEGREE OF STENOSIS• 0 None
• 1 < 25%
• 2 26–50%
• 3 51-75%
• 4 76-90%
• 5 90-100% (complete stenosis)
![Page 9: Expiratory stenosis of the trachea by dr. innocent kingsley asogwa](https://reader031.vdocument.in/reader031/viewer/2022020307/55a70b001a28ab210b8b4808/html5/thumbnails/9.jpg)
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
![Page 10: Expiratory stenosis of the trachea by dr. innocent kingsley asogwa](https://reader031.vdocument.in/reader031/viewer/2022020307/55a70b001a28ab210b8b4808/html5/thumbnails/10.jpg)
PRESENTATIONS• 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 you inhale
• Frequent bouts of pneumonia or upper respiratory infections
• Asthma that doesn’t respond well to treatment
• A blue color in the skin or mucous membrane of the mouth or nose
![Page 11: Expiratory stenosis of the trachea by dr. innocent kingsley asogwa](https://reader031.vdocument.in/reader031/viewer/2022020307/55a70b001a28ab210b8b4808/html5/thumbnails/11.jpg)
DIAGNOSIS• Lung function tests to measure respiratory function and
determine blockages.
• A computed tomography (CT) scan of both your neck and chest.
• A chest X-ray, which will show the windpipe and your chest.
• 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 lumps.
![Page 12: Expiratory stenosis of the trachea by dr. innocent kingsley asogwa](https://reader031.vdocument.in/reader031/viewer/2022020307/55a70b001a28ab210b8b4808/html5/thumbnails/12.jpg)
TREATMENTS• 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 are joined.
![Page 13: Expiratory stenosis of the trachea by dr. innocent kingsley asogwa](https://reader031.vdocument.in/reader031/viewer/2022020307/55a70b001a28ab210b8b4808/html5/thumbnails/13.jpg)