Airway and Tracheal Surgery Program

Conditions we treat

Tracheal stenosis is a narrowing of the portion of the windpipe that is below the voice box.

What are the symptoms of tracheal stenosis?

People with tracheal stenosis may experience symptoms such as:

• A hoarse voice
• Persistent coughing
• Shortness of breath
• Voice changes
• Wheezing, noisy breathing

What causes tracheal stenosis?

The most common causes of tracheal obstruction are:

• Prolonged oral intubation and ventilation (post-intubation tracheal stenosis)—unintentional injury to the trachea can occur after a breathing tube has been inserted, typically in an intensive care unit (ICU) setting, to help the patient maintain their breathing
• Tracheostomy (post-tracheostomy tracheal stenosis)—an opening in the trachea that is surgically created after a week or more in an ICU on a breathing tube and ventilator
• Idiopathic (no known cause) subglottic stenosis (idiopathic laryngotracheal stenosis)—typically seen in women with inflammatory scarring and narrowing of the lower larynx and the very top of the trachea
• Benign or malignant tumors
• Certain autoimmune or inflammatory disorders—Granulomatosis with polyangiitis (formerly known as Wegener’s granulomatosis) and relapsing polychondritis

Can tracheal stenosis be cured or treated?

Your Mass General Brigham airway and trachea team will work with you to create a personalized treatment plan following your evaluation. Post-intubation and post-tracheostomy tracheal stenosis are most often surgically treated through single-stage resection and reconstruction, which provides long-term relief while preserving both the voice and airway. Patients who undergo resection and reconstruction for tracheal stenosis will not require other interventions such as prolonged dilations, lasers and tracheostomies. The typical length of hospital stay at Mass General Brigham following surgery to treat tracheal stenosis is roughly five to seven days.

We also offer endoscopic management—dilations, laser treatments, cryotherapy and stenting—for patients with tracheal stenosis who are not candidates for a tracheal resection.

Tracheal tumors, benign (not cancerous) or malignant (cancerous), are rare and cause a narrowing of the trachea that restricts airflow to the lungs.

The most common malignant tracheal cancers are:

• Adenoid cystic cancer
• Squamous cancer
• The most common benign tracheal tumors are:
• Chondromas
• Hemangiomas
• Papillomas

How are tracheal tumors diagnosed?

Tracheal tumors can be difficult to diagnose, as they often grow slowly and can produce similar symptoms as other airway diseases.

What are the symptoms of tracheal tumors?

People with a tracheal tumor may experience symptoms such as:

• Persistent coughing and coughing up blood
• Labored breathing
• Wheezing
• Hoarseness in the throat

What causes tracheal tumors?

Some tracheal tumors, such as adenoid cystic cancer, have no known cause. Squamous cancers, a malignant tracheal tumor, are usually caused by smoking. Papillomas, a benign tracheal tumor, are caused by the human papilloma (HPV) virus.

Can tracheal tumors be cured or treated?

Tracheal tumors are most often surgically resected. During surgery, your surgeon will remove the tumor and then reconnect the ends of the healthy trachea, preserving the blood supply to the trachea throughout the duration of the operation. Mass General Brigham thoracic surgeons are specially trained in this complex surgery. Most patients also require radiation after resection of a malignant tracheal tumor.

Papillomas are treated with endoscopic (minimally invasive) techniques.

A tracheoesophageal fistula is an abnormal connection, or fistula, between two tubular structures, the esophagus and the trachea. The esophagus connects the throat to the stomach, while the trachea connects the throat to the windpipe and lungs. Normally, these two tubes are not connected.

What are the symptoms of tracheoesophageal fistulas?

People with tracheoesophageal fistulas may experience symptoms such as:

• Choking
• Coughing following swallowing
• Difficulty swallowing and breathing
• Pneumonia

What causes tracheoesophageal fistulas?

Tracheoesophageal fistulas in adults are acquired, resulting from either a benign circumstance, such as a complication from a previous long intubation, or a malignancy, such as esophageal cancer.

Can tracheoesophageal fistulas be cured or treated?

With a tracheoesophageal fistula, the connection between the esophagus and trachea can usually be successfully closed by surgery. At Mass General Brigham, thoracic surgeons are specially trained to both repair the damaged trachea and the esophagus to restore a normal anatomy and function.

Tracheobronchomalacia (TBM) is a condition that causes the shape of the trachea (and often bronchi) to become altered and the airway to collapse. TBM comes in two forms:

• Excessive dynamic airway collapse, the most common form of tracheobronchomalacia and occurs when the airway’s posterior thin membranous wall collapses and becomes narrowed, both immediately and progressively worse over time
• A weakening of the airway’s cartilaginous wall, a rarer form of tracheobronchomalacia when the weakened wall widens and splays out, causing a subsequent narrowing of the airway

What are the symptoms of tracheobronchomalacia?

People with TBM may experience symptoms such as:

• Persistent coughing
• Shortness of breath
• Difficulty raising phlegm
• Recurrent lung infections

How is tracheobronchomalacia diagnosed?

A thorough medical evaluation is a very important first step to diagnosis, as there are many causes for persistent coughing and shortness of breath. Patients seeking evaluation for TBM can expect to undergo lung function testing, including:

• A CT scan or dynamic MRI of the chest that monitors inhales and exhales to see if the trachea collapses during it
• A bronchoscopy while under local anesthesia (minimal sedation) to examine the airway during breathwork and observe the collapse in greater detail

Can tracheobronchomalacia be cured or treated?

Mass General Brigham offers minimally invasive robotic surgery for patients with tracheobronchomalacia. This minimally invasive approach allows for quicker recovery with less discomfort. During this procedure, the posterior thin membranous wall is stiffened through suturing, which is a special type of mesh that is placed in the back wall to give the airway a more normal shape that will not collapse.

Our approach to airway and tracheal care

Our team of highly skilled thoracic surgeons use a variety of techniques, including tracheal resection and reconstruction, to restore proper function of the airway (trachea and bronchi). When you come to Mass General Brigham for airway and tracheal care, you can expect a care team consisting of:

• Thoracic surgeons
• Chest radiologists
• Laryngeal and voice rehabilitation specialists from the Mass General Brigham Voice Center
• Thoracic oncologists from the Mass General Brigham Cancer Institute

Patients may be referred to us by outside physicians who are treating an underlying condition that has created the airway and tracheal issue, such as cancer or an obstruction caused by benign disease. Patients can contact individual thoracic surgeons to inquire about treatment options. We offer both bronchoscopies (a monitoring procedure to observe the function of the trachea) and surgical options for patients with airway obstructions from benign blockages (strictures) or tumors.

New patients undergo a comprehensive evaluation that concludes with a thorough review of the recommended course of treatment with a Mass General Brigham care team. If you elect to undergo a procedure to treat tracheal stenosis, trachea-esophageal fistulas or another disease of the trachea and airway, your care team will explain each step using diagrams and answer questions that you may have about your condition or care. As complex airway problems often require sophisticated x-ray evaluation, our team uses cutting-edge equipment if needed. Careful collaboration with our anesthesiology, radiologic, pulmonary and voice specialists—national leaders in the field in both clinical care and research—ensure the best possible treatment and outcomes.

In the operating room, you will receive general anesthesia so that the surgeon can examine the airway (trachea and bronchi) using a bronchoscope, a thin, tube-like imaging instrument for precise evaluation and measurements.

Anesthesiologists play a critical role in the management of patients with airway problems. We have a very skilled group that is amongst the most experienced nationwide in dealing with airway management. Our intensive care team cares for our airway patients on a regular basis. Our dedicated thoracic surgery floor nurses are well-trained on how to help patients recover from surgery.

After surgery, your surgeon will review the recovery plan and any additional treatment needs with you and your family. You will receive a personalized plan to ensure the best outcomes. Plans and results are communicated to referring physicians so that everyone on your care team provides you with coordinated, consistent care.

Your care team will remain in close communication with you to ensure your recovery goes smoothly, even after you are discharged and return home.

Mass General Brigham has played a leading role in advancing the treatment of airway and tracheal disease for decades. Building upon a long tradition of innovation in airway reconstruction, our clinicians and researchers continue to develop new approaches to diagnosis, surgical technique, regenerative medicine, and patient outcomes research. Current areas of focus include:

• Airway reconstruction outcomes
• Tracheal stenosis research
• Regenerative medicine applications
• Biomaterials and airway replacement technologies
• Rare inflammatory airway disorders
• Long-term outcomes following airway surgery