[Comparative cinematographic, endoscopic and functional studies of the preoperative estimation of the severity of tracheal stenoses].

Structural tracheal stenoses have different functional effects according to degree, localization and extent of the stenosis. Further modifications are due to malacic components within the range of the stenosis or tracheal segments abutting on the stenosis. Nineteen patients with mainly cervical tracheal stenoses (12 patients) were investigated in order to examine if a functional X-ray-diagnostic procedure (X-ray-cinetracheobronchography--CTBG--of the central airways in several beam-directions during forced breathing, cough and Valsalva-maneuver after contrasting of the trachea and main-bronchi with powdered tantalum) yields an increase of findings in comparison with a static roentgenologic procedure (chest films p. a. and frontal; tomography) and an endoscopic examination. The judgement of the stenosis is made by measurement of the length and of the diameter compared with the normal trachea. Malacic components reveal themselves by changes of the stenosis-configuration during Valsalva-maneuver, forced breathing and strong coughing. In 11 of 19 patients there was evidence of a malacic stenosis-component and in 5 patients there was a mural weakness of abutting segments. In comparison with the endoscopic examination we found in 8 of 15 patients a diagnostic improvement by demonstration of unfixed stenotic compartments. Besides information about stenotic degree, configuration, localization and length, a CTBG offers the possibility of localizing and grading malacic stenotic components or of adjacent segments--provided that films are made in at least two planes. The application of CTBG in patients with tracheal stenosis is useful if there are signs of tracheomalacia or if the localization and the extent of the stenosis require a difficult reconstructive surgical intervention or if discrepancies between clinical aspect and stenosis-degree make it advisable to extend the field of diagnostic procedures.