Concentric tracheal and subglottic stenosis. Management using the Nd-YAG laser for mucosal sparing followed by gentle dilatation.

Treatment of tracheal stenosis varies with the type and extent of the disease. Tracheostomy with stents, end-to-end anastomosis, or extensive reconstructive procedures often is required, especially when tracheomalacia is present. High recurrence rate is associated with relatively less invasive endotracheal treatments, such as bougie dilatation or total laser ablation. Mucosal sparing technique using Nd:YAG laser photodissection (LPD) and gentle dilatation (GD) can provide durable successful results in selected patients with benign concentric tracheal stenosis (CTS). In our study of 18 patients with CTS, 12 were successfully treated with Nd:YAG LPD and GD. Of these patients, eight required a single treatment while four required two or more treatments. No patients required new tracheostomy to carry out the procedure. Follow-up periods ranging from 2 to 85 months (mean: 32.6 +/- 1.5 months) for 12 successfully treated patients have revealed no recurrence of their stenosis. Lengthy scars (> 1 cm) and tracheomalacia were the clinical features common to those patients who failed the treatment. We advocate the use of Nd:YAG LPD in conjunction with "gentle" rigid bronchoscopic dilatation as the initial treatment of CTS.