Patient Information:
Surgical Diseases of the Airways

This information sheet is designed to help you understand more about conditions affecting the airways that may require surgical treatment. Your airways (including the trachea or windpipe, and bronchi) are vital for breathing, and sometimes problems can arise that need surgical intervention.
 

What Are Surgical Airway Diseases?
 

Surgical airway diseases are conditions that cause a significant narrowing, blockage, collapse, or malformation of the main air passages (trachea and bronchi) that cannot be adequately managed with medication or other non-invasive treatments alone. Surgery aims to restore normal airway function and relieve symptoms.
 

Common Types of Surgical Airway Diseases
 

Several conditions can affect your airways and may require surgery. Some of the more common ones include:
 

• Tracheal Stenosis: A narrowing of the trachea (windpipe). This can be caused by:

  • Post-intubation stenosis: Scar tissue forming after a breathing tube (endotracheal tube or tracheostomy tube) was in place. This is the most common cause.

  • Idiopathic stenosis: Narrowing with no known cause, often occurring just below the vocal cords.

  • Trauma: Injury to the neck or chest.

  • Certain autoimmune conditions: Like Wegener's granulomatosis (Granulomatosis with Polyangiitis).

  • Congenital stenosis: A rare condition present at birth.
     

• Tracheobronchomalacia (TBM) / Tracheomalacia: Weakness and floppiness of the trachea and/or bronchi walls, causing them to collapse, especially during coughing, breathing out, or physical activity. This can be congenital (present at birth) or acquired later in life due to chronic inflammation, trauma, or prolonged pressure (e.g., from a goiter or tumor).
   

• Airway Tumors:

  • Benign (non-cancerous) tumors: Such as papillomas or hamartomas.

  • Malignant (cancerous) tumors: Primary lung cancers invading the airway, or cancers that have spread (metastasized) from other parts of the body.
     

• Tracheoesophageal Fistula (TEF): An abnormal connection between the trachea and the esophagus (food pipe). This can be congenital or acquired (e.g., after trauma, surgery, or due to cancer).
   

• Foreign Body Aspiration: While often managed with non-surgical bronchoscopy, large or impacted foreign objects in the airway may require surgical removal.
   

• Laryngotracheal Stenosis: Narrowing that involves both the larynx (voice box) and the upper trachea.
   

Common Symptoms
 

Symptoms often depend on the location and severity of the airway problem but can include:
 

• Progressive shortness of breath, especially with exertion.

• Noisy breathing (stridor – a high-pitched sound, or wheezing).

• Persistent cough, sometimes with difficulty clearing secretions.

• Recurrent pneumonia or bronchitis.

• Voice changes (hoarseness).

• Difficulty swallowing (dysphagia) if the esophagus is also affected or compressed.

• Episodes of "dying spells" or severe breathing difficulty, especially with tracheomalacia.
   

How Are Surgical Airway Diseases Diagnosed?
 

Diagnosing these conditions usually involves:
 

1. Detailed Medical History: Including previous surgeries, intubations, existing medical conditions, and the nature of your symptoms.
    

2. Physical Examination: Focusing on your breathing sounds and any signs of respiratory distress.
    

3. Pulmonary Function Tests (PFTs): To measure lung function and assess the degree of airway obstruction. Specific patterns on these tests (like a flattened flow-volume loop) can suggest central airway obstruction.
    

4. Imaging Studies:

   • Chest X-ray: Can sometimes show severe narrowing or masses.

   • Computed Tomography (CT) Scan: Provides detailed images of the airways, showing the location, length, and severity of stenosis, tumors, or malacia. Dynamic CT scans (taken during breathing) can help diagnose tracheomalacia.

   • Magnetic Resonance Imaging (MRI): May be used in some specific cases, particularly for soft tissue assessment.
      

5. Bronchoscopy: This is a key diagnostic tool. A thin, flexible tube with a light and camera (bronchoscope) is passed through your nose or mouth into your airways. This allows the doctor to:

   • Directly visualize the airway lining and any abnormalities.

   • Assess the extent and nature of narrowing or collapse.

   • Take biopsies (small tissue samples) if a tumor or inflammation is suspected.

   • Perform therapeutic interventions in some cases (see below).
      

6. Dynamic Bronchoscopy: Bronchoscopy performed while you are breathing spontaneously, often used to confirm tracheomalacia by observing airway collapse during exhalation or coughing.
    

How Are Surgical Airway Diseases Managed?
 

Treatment depends on the specific condition, its severity, your overall health, and your preferences.
 

1. Endoscopic (Minimally Invasive) Procedures via Bronchoscopy:

   • Dilation: Stretching a narrowed segment of the airway using balloons or rigid dilators. This often provides temporary relief for stenosis and may need to be repeated.

   • Laser Resection/Ablation: Using a laser to remove scar tissue or small tumors.

   • Stent Placement: Inserting a small mesh tube (stent) into the airway to hold it open. Stents can be made of silicone or metal and may be temporary or permanent. They are used for stenosis, malacia, or obstruction by tumors.

   • Electrocautery or Argon Plasma Coagulation (APC): Using heat to remove tissue or control bleeding.

   • Cryotherapy: Using extreme cold to destroy abnormal tissue.
      

2. Open Surgical Procedures:

   • Tracheal Resection and Reconstruction: This is often the preferred treatment for significant tracheal stenosis. The narrowed segment of the trachea is surgically removed, and the healthy ends are reconnected. This is a complex operation but can offer a long-term cure.

   • Laryngotracheal Reconstruction: For stenosis involving the larynx and upper trachea, using cartilage grafts (often from a rib) to widen the airway.

   • Tracheoplasty/Bronchoplasty: Surgical repair or reshaping of the trachea or bronchus.

   • Tracheobronchopexy / Aortopexy: Procedures to suspend or support a floppy (malacic) airway by attaching it to surrounding stable structures like the sternum or aorta, preventing its collapse.

   • Tumor Resection: Surgical removal of benign or malignant tumors from the airway. This can range from local excision to more extensive procedures like sleeve resection (removing a segment of airway with the tumor and rejoining the ends).

   • Repair of Tracheoesophageal Fistula: Closing the abnormal connection between the trachea and esophagus.

   • Tracheostomy: Creating a surgical opening in the neck into the trachea to insert a breathing tube. This may be temporary (to bypass an obstruction or allow healing after surgery) or permanent (for severe, uncorrectable airway problems or long-term ventilation needs).
      

Post-Operative Care and Recovery
 

Recovery after airway surgery can vary greatly depending on the procedure.
 

• You may need to stay in an intensive care unit (ICU) initially.

• A temporary breathing tube or tracheostomy might be in place.

• Pain management is important.

• You will receive instructions on wound care, breathing exercises, and voice rest (if applicable).

• Follow-up bronchoscopies are often needed to monitor healing and the airway.

• Pulmonary rehabilitation may be recommended.
   

Living with a Surgical Airway Condition
 

• Follow-up: Regular follow-up with your surgical and respiratory team is crucial.

• Medication: You may need to continue medications for underlying conditions or to prevent complications.

• Lifestyle: Maintaining a healthy lifestyle, avoiding irritants, and getting appropriate vaccinations are important.

• Support: Coping with an airway condition can be challenging. Seek support from healthcare professionals, family, and patient support groups.
   

Disclaimer: This information sheet provides general guidance and is not a substitute for professional medical advice, diagnosis, or treatment. Surgical decisions are complex and individualized. Always discuss your specific condition, treatment options, risks, and benefits thoroughly with your surgeon and healthcare team.