Management of acute and chronic disorders of the trachea and subglottis.

During a 14 year period, 22 patients with stricture, acute laryngeal injury, and cancer were treated. Nine patients had postintubation tracheal stenosis and underwent tracheal resection with good to excellent results. Six patients had strictures after tracheostomy. In one patient, stenosis occurred after repair and repeated dilatation was necessary. He subsequently had to undergo repeat tracheostomy, but the tube was later removed and his symptoms disappeared. Our current preference for suture is either 3-0 polypropylene or polyglycolic acid. Acute separation of the trachea can occur with trauma to the neck, either by garrotting or direct blunt force. The diagnosis is suspected when endotracheal intubation is impossible and a step off below the larynx and crepitation exists. Emergency tracheostomy is necessary, however, and primary repair can be delayed for up to 24 hours if other conditions require attention. Tracheal resection for squamous cell carcinoma is possible, but only a small group of patients may be surgical candidates.