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Laryngeal and tracheal stents are crucial in managing complex airway conditions, offering mechanical support, and preventing collapse in patients with stenosis, tumors, or scar tissue. While congenital and acquired factors contribute to laryngotracheal pathologies, various treatment approaches, including endoscopic stent placement, aim to alleviate airway obstruction. Many types of stents exist, each with its indications and complications. Proper stent selection is paramount to optimizing patient outcomes. This activity for healthcare professionals reviews the diverse causes of laryngotracheal conditions, explores endoscopic and open stenting procedures, and addresses associated complications. The activity also highlights the important role of the interprofessional healthcare team in improving outcomes for patients with laryngotracheal stenosis who require mechanical stenting. Objectives: Identify appropriate candidates for laryngeal and tracheal stent placement based on their clinical history. Select the most appropriate laryngeal or tracheal stent and corresponding surgical approach for a potential patient. Identify and manage the common complications following laryngeal or tracheal stent placement. Develop and implement effective interprofessional team strategies to improve outcomes for patients undergoing laryngeal or tracheal stent placement. Access free multiple choice questions on this topic.

Laryngeal and tracheal stenosis are a relatively rare but potentially catastrophic cause of acute airway compromise.[1] Laryngeal stenosis may be due to narrowing of the supraglottis, glottis, or subglottis; the subglottis is defined as the airway situated 10mm below the apex of the laryngeal ventricle and 5mm below the posterior inferior surface of the true vocal folds.[2] Tracheal stenosis occurs from the inferior margin of the subglottis to the carina, and bronchial stenosis affects the mainstem bronchi and distal airways.[3] It is imperative to differentiate between laryngeal and tracheal stenosis despite some shared presentation, etiology, and management aspects. The long-term management and prognosis of these two processes can significantly diverge. However, stenting is a potential treatment avenue for both conditions, be they congenital anomalies or those acquired later in life. Laryngeal stenosis is predominately congenital; it is the third-most common congenital laryngeal anomaly after laryngomalacia and congenital vocal fold palsy.[4] However, laryngeal stenosis is often acquired and is frequently subglottic and idiopathic. Acquired idiopathic subglottic laryngeal stenosis disproportionately affects adult women for reasons unknown.[5] Airway stenosis following endotracheal intubation poses a substantial healthcare burden, manifesting as either subglottic laryngeal stenosis, tracheal stenosis, or a combination of both.[6] Additional causes for acquired laryngeal and tracheal stenosis include caustic injury, infection, tumor, or granulomatous disease.[7] Laryngotracheal stenosis lacks a universally standardized management protocol or algorithm; cause- and location-specific treatment must be personalized for each patient. Airway stenosis may be managed with endoscopic dilatation, laryngeal microsurgery, laser-assisted excision, open airway surgery, or endoscopic stent placement.[8] Laryngeal and tracheal stents, crafted from solid or hollow materials, prevent the collapse of the airway lumen. Stents stabilize surgical reconstructions of the larynx or trachea and mechanically expand areas affected by scar tissue or tumor encroachment.[9] Stents may be absorbable or nonabsorbable and are available in diverse sizes and shapes tailored to the underlying condition. Recent advancements have explored the use of extraluminal tracheal suspension devices.[10][11]

Potential complications of laryngeal stents include: Granulation tissue formation at stent edges (up to 80%) [63] Stent dislodgement and potential aspiration Stent occlusion by secretions Stent-associated infection (most often Staphylococcus aureus or Pseudomonas aeruginosa) [64] Stent migration (7%-30%) [65] Recurrence of stenosis after stent removal (40%-80%) [66] Dysphagia Aspiration The complications that can arise from tracheal stents are similar to those of laryngeal stents. The most common issues are migration and granulation tissue formation, which can lead to restenosis at the end of the stent.[67][68] Potential complications of tracheal stents include: Granulation tissue formation Stent migration (17%-50%) [69] Stent dislodgement and potential aspiration Stent occlusion by secretions Tracheoinnominate fistula (rare; 0.1%-1% rate) [70] Tracheoesophageal fistula (up to 39% recurrence rate if the stent was placed to treat a fistula initially) [71] Recurrence of stenosis formation (67%-90%) [68] Stent fracture (~10%) [67]

In the management of laryngeal and tracheal stents, it is crucial to have a collaborative and interprofessional approach to ensure optimum patient-centered care, favorable outcomes, patient safety, and effective team performance. Physicians play a critical role in the initial diagnosis, treatment planning, and decision-making regarding the type and placement of stents based on the patient's condition. Advanced practitioners, including nurse practitioners or physician assistants, contribute to the care continuum by assisting in patient assessments, monitoring stent-related complications, and ensuring adherence to treatment plans. Nurses are pivotal in patient education, postoperative care, and ongoing monitoring, bridging patients and the broader healthcare team. Pharmacists are integral in managing medications, ensuring appropriate drug interactions, and promoting medication safety. Interprofessional communication is paramount, facilitating the exchange of critical information among team members, which enhances care coordination. Regular team meetings and case discussions enable shared decision-making and the alignment of treatment goals. This collaborative approach helps address any emerging issues promptly, improving patient safety and overall outcomes. Additionally, a coordinated effort ensures that patient care is seamless and consistent across various healthcare settings, from initial diagnosis to postoperative follow-up, enhancing the overall quality of care for individuals with laryngeal and tracheal stents.