RESUMO
Post-tracheostomy 'lambdoid' deformity of the trachea is a specific and uncommon variant of adult post-intubation laryngotracheal stenosis, in which airway obstruction is caused by inward collapse of over-resected tracheal cartilage as a result of post-decannulation stomal contracture. We evaluated the results of endoscopic tracheoplasty as an alternative to open tracheal resection in 11 patients treated for this condition between 2004 and 2006. Patients were treated with endoscopic CO(2) laser resection, dilatation and endotracheal mitomycin C application. Suspension micro-laryngo-tracheoscopy and high-frequency supraglottic jet ventilation were used. Eleven patients with an average age of 56 years and lesion height and distance from glottis respectively of 11 +/- 5 mm and 35 +/- 12 mm were treated. The median number of treatments fell from four at the start of the series to two at the end (P = 0.08). The average follow-up was 17 +/- 8 months and all patients were cured with no cases of dysphagia or dysphonia. Almost all patients achieved and maintained a Medical Research Council Dyspnoea Scale of I or II. Endoscopic tracheoplasty is an effective treatment for this condition. It achieves a successful outcome while avoiding the operative risks, prolonged hospitalisation, and morbidity that is associated with tracheal resection. We recommend it as the standard of care for treating patients with this injury.
