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Treatment

By Michael Zervos, M.D.

Airway diseases can require a variety of surgical and therapeutic treatments, including:

Stenting for Airway Obstruction

This procedure is used to treat the symptoms of airway obstruction and can involve either metal or silicone stents. Metal stents are made of self-expanding nitinol (memory metal) and can be covered or uncovered. Silicone stents are fully covered and used in the airway with rigid bronchoscopy. Advantages and disadvantages of each should be discussed with your surgeon.

Tracheal Resection

The amount of trachea removed will depend on the type of resection performed. The type of incision will depend on the area of involvement and the planned surgical approach.

  • Benign Disease: Most resection procedures are done through a neck incision and may include a sternotomy. Thoracotomy is rarely required.

  • Cancer: Generally requires the removal of a more extensive area of trachea to ensure that the tissue around the removed section is free of cancer (negative margins). Depending on the location, a neck incision with a sternotomy (opening the breastbone) or a thoracotomy , as well as radiation therapy, may be necessary.

  • Carinal Resection: The carina is the point where the trachea divides and can be removed if compromised by cancer. The procedure is performed through either a thoracotomy or sternotomy (opening the breastbone), and can be either isolated or done in addition to lung removal.

Fistula Surgery

Fistula surgery is performed with resection of the involved segments of the trachea and either the esophagus or innominate artery, sometimes with a muscle flap interposed between both structures.

  • Tracheoesophageal: Related to cuff injury from prolonged intubation, this surgery is not an option if cancer is present.

  • Tracheoinnominate: This life-threatening emergency is a communication between the innominate artery and the trachea and requires immediate attention. Surgery is conducted through the breastbone (sternotomy) and involves first tying off or stapling the artery, then closing the hole in the trachea. If the hole cannot be closed directly, then a muscle flap is used to close it and keep the artery away from the repaired area.