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Benign Complete Tracheal Stenosis

BENIGN COMPLETE TRACHEAL STENOSIS (SILICONE STENT PLACEMENT): A 24-year-old lady came to us for difficult decanulation of tracheostomy tube. She was ventilated for 10 days for viral encephalitis and was tracheostomized during the icu stay. Later, she was diagnosed with a post tracheostomy tracheal stenosis and underwent 3 sessions of tracheal dilation at a peripheral center.. At presentation, CT chest showed a complete cut off of the trachea above the site of tracheostomy. Bronchoscopy also revealed a near complete complex tracheal stenosis 5 cm below the vocal cords.. She was given the option of surgical reconstruction versus bronchoscopic management and opted for the latter. On careful examination of the anatomy of stenosis, there was a band like adhesion connecting the anterior and posterior walls of trachea in the midline and a narrow tracheal lumen laterally which was occluded by granulation tissue. The granulation was removed with forceps. By careful use of cautery knife, the adhesion was released creating a complete tracheal lumen in the centre. The neotracheal lumen was dilated using CRE balloons and a rigid bronchoscope. A silicone stent (13mm x 7 cm) was then deployed and repositioned to the site of stenosis. Following the procedure, she was able to phonate well and was discharged with a plan to follow up and remove the stent after 1 to 2 years.