Which of the following statements about the treatment of postintubation airway stenosis are correct?

E. Acquired tracheoesophageal fistula due to intubation injury is corrected by surgical closure of the fistula concurrent with resection and reconstruction of the damaged trachea.

DISCUSSION: Emergency management of postintubation tracheal stenosis is accomplished by dilatation under general anesthesia using rigid bronchoscopes and dilators. Tracheostomy is employed only when the patient requires a prolonged or a permanent airway before or instead of resection and reconstruction. If a new tracheostomy is needed it is preferable to place it through the area of existing stenosis—in this case the site of prior tracheostomy—rather than to injure normal trachea that will be needed for resection and reconstruction. If the stenosis is below the sternal notch, a long tracheostomy tube is inserted at the usual position (second and third rings) but extends past the now dilated stenotic lesion.

Lasering almost never results in a permanently satisfactory airway; the exception is the very limited lesion described as a thin, weblike stenosis. Such lesions are rare. Unfortunately, laser is widely used and often compounds existing damage by concurrent placement of a tracheostomy tube below the lesion in the normal trachea. T-tubes are very useful for temporizing when repair is not possible or must be delayed. It almost never leads to resolution of a stricture unless it is an extremely limited one. Soon after removal of the T-tube the stricture reasserts itself.

If the lesion involves the subglottic larynx, complex repair is required to preserve the recurrent laryngeal nerve's anatomy and function. The posterior cricoid plate is salvaged and resurfaced with a flap of membranous tracheal wall; the anterior subglottic larynx is reconstructed with a “prow” of distal tracheal cartilage and mucosa.

A tracheoesophageal fistula is managed (after weaning from a respirator) by layered closure of the esophagus, interposition of a flap of well-vascularized tissue (such as a pedicled strap muscle), and resection and reconstruction of the damaged trachea. Since the fistula results from the pressure of a cuff, often against an esophageal feeding tube, there is circumferential damage to the trachea at the level of the fistula. Resection and reconstruction are therefore necessary, in addition to closure of the fistula, for successful treatment of this complex lesion.