Diseases of the Trachea and Airway

Diseases of the trachea and airways are uncommon and diverse. We have a special interest in these conditions, including tracheal stenosis, tracheal and airway tumors, tracheoesophageal fistula, and tracheomalacia.

Two of our surgeons (Drs. Natalie Lui and Joseph Shrager) trained at the Massachusetts General Hospital, the world leader in management of these difficult problems. We work closely with the Division of Interventional Pulmonology and the Department of Otolaryngology Head and Neck Surgery to offer the full spectrum of treatments, from bronchoscopic procedures such as ablation and stent placement, to surgical procedures such as tracheal resection and reconstruction and tracheoplasty.

The normal trachea (windpipe) brings air from the mouth and nose to the lungs (Figure 1). Tracheal stenosis is a narrowing of the trachea that can cause shortness of breath, cough, wheezing, and stridor (Figure 2). The most common cause is prolonged intubation or tracheostomy, when a tube is used to assist with breathing via a mechanical ventilator. It can also be caused by inflammatory or immunologic diseases. Another cause is idiopathic tracheal stenosis, which occurs mostly in women for unknown reasons.

Evaluation includes a computed tomography (CT) scan and bronchoscopy, during which the length of stenosis and normal trachea, as well as the health of the surrounding tissues, are evaluated. Treatment may start with bronchoscopic procedures, such as balloon or rigid bronchoscopic dilation, ablation, or stent placement.

Many patients require a more definitive surgical procedure called a tracheal resection and reconstruction (Figure 4). The goal of this operation is to remove the abnormal segment of trachea and to re-connect the two remaining ends together, allowing the patient to breathe comfortably again. Most commonly, this operation can be done through a neck incision that is well-tolerated. The operation is effective in resolving the problem in approximately 95% of patients, and it requires an approximately 5 day hospital stay.

Figure 1. Airway and lungs

Figure 2. Tracheal stenosis

Figure 4. Tracheal resection and reconstruction

If you would like to make an appointment to see one of our surgeons for any of these problems, please call (650) 498-6000 and ask for the Thoracic Surgery new patient coordinator, or call (650) 721-2086.

The Division of Thoracic Surgery in the Department of Cardiothoracic Surgery at the Stanford School of Medicine is located in the San Francisco Bay Area in northern California. For more information about our services, please contact Donna Yoshida at (650) 721-2086 or Angela Lee, RN, MS, at (650) 721-5402. For new patient Thoracic Surgery Clinic Scheduling, please call (650) 498-6000.