Surgery of the Adult Airway

PROGRAM DESCRIPTION: The etiology of laryngotracheal stenosis in adults is often multifactorial. Identification and appropriate management of medical co-morbidities and other systemic disease is essential to achieving an adequate airway following either endoscopic or open laryngotracheal reconstruction. This course will review and present cases of laryngotracheal stenosis, where outcomes were affected by appropriate management of other underlying medical disorders and the value of a team approach. Key concepts and approaches will be discussed, with a rotating set of cases presented. Disorders discussed will include acquired subglottic stenosis, posterior glottic stenosis, tracheal stenosis (with special attention to COVID-19 related stenosis) and autoimmune airway diseases including granulomatosis with polyangiitis, relapsing polychondritis, and idiopathic subglottic stenosis.

Surgical management of adult laryngotracheal stenosis is tailored to the specific level of obstruction and degree of symptomatic manifestation. The instructors have considerable experience managing adult airway disease, and will present pearls and pitfalls of techniques of endoscopic management and open reconstruction that include balloon dilation, intratracheal stenting, endoscopic and open tracheal skin grafting, tracheal resection, partial cricotracheal resection, slide tracheoplasty and laryngotracheal expansion with primary and staged cartilage grafts.

Meticulous perioperative and postoperative care and management are as essential as a well thought out operation. We maintain that pre-operative evaluation and optimization, often with a team approach, improves outcomes.

OUTCOME OBJECTIVE 1: Review etiologies of adult LTS and discuss systematic evaluation to facilitate management of the co-morbidities and systemic diseases that affect medical and surgical management outcomes.

OUTCOME OBJECTIVE 2: Review options for surgical management from conservative to aggressive. Discuss advantages of single stage vs. multi-staged reconstructions in adults.

OUTCOME OBJECTIVE 3: To discuss specific disease entities (e.g., idiopathic subglottic stenosis), and also current management strategies for COVID-19 related tracheotomy dependency

BACKGROUND STATEMENT: The management of adult airway disease has often been fragmented. However, both medical management and endoscopic and open airway surgery are more sharply in focus, especially given the current surge in patients with tracheotomy dependency due to COVID-19.