Comprehensive Treatment of Laryngotracheal Stenosis

Published in HeadWay - Winter 2017

One night in October 2013, when Kinzie Landers was 14 years old, her parents rushed her to the local emergency room near their home in Texas as she was sliding into a coma. Unaware that their daughter had type 1 diabetes, her parents listened helplessly as doctors explained that they’d need to intubate her. She was minutes away from losing the ability to breathe on her own.

“It was a lifesaving moment for which we’re forever grateful,” her mother, Shelly Landers, says.

But, Shelly adds, that single intervention led to future complications that Kinzie and her family never imagined. Months later, she’d developed so much scar tissue within her trachea that she struggled to breathe. Her airway was so swollen, remembers her mother, that doctors told her it was the diameter of a coffee straw.

After barely staying abreast of this problem with a series of balloon dilations, Kinzie and her family moved to Maryland in June 2015. That’s when they made the decision to visit the Johns Hopkins Complex Airway Clinic, directed by otolaryngologist–head and neck surgeon Alexander Hillel.

Hillel, along with colleagues including thoracic surgeon Richard Battafarano and interventional pulmonologists David Feller-Kopman, Lonny Yarmus and Hans Lee, started the monthly clinic in May 2014 to treat patients with laryngotracheal stenosis. This narrowing of the airway from scarring—typically from intubation, but sometimes from autoimmune diseases or an idiopathic cause—often requires the expertise of multiple clinicians due to the severity and extent of scar tissue. To ease the burden on patients and their families, as well as provide better, more coordinated care, the team meets with patients to provide group exams and decide on a course of treatment.

A patient’s treatment plan might be as conservative as simple monitoring, explains Hillel, or it might extend to balloon dilations or endoscopically excising the scar tissue and placing a stent within the airway to keep it open as it heals.

For some patients with particularly challenging cases, the only curative options for permanently restoring airflow are laryngotracheoplasty or cricotracheal resection. With Kinzie’s recurring problems, Hillel told her parents, she was an excellent candidate for a resection. In March 2016, Hillel and his colleagues performed this procedure. Several weeks later, after removing her tracheostomy, Kinzie was able to breathe and speak easily again for the first time in years.

“We’ve gone through watching her struggle to breathe from walking across the living room to the bathroom to seeing her become able-bodied again and have a life,” Shelly says. “It’s been like switching on a light.”

Seeing patients like Kinzie thrive, says Hillel, is the greatest reward from his work: “The ability to restore a person’s ability to breathe and allow them to live again is why we do what we do.”