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Classification systems for tracheal and subglottic stenosis

Classification systems for tracheal and subglottic stenosis
Cotton-Myer classification for subglottic stenosis[1] Freitag classification[2] Simple versus complex[3]

Grade I – Up to 50% obstruction

Grade II – From 51 to 70%

Grade III – Above 70% to any detectable lumen

Grade IV – No detectable lumen		 Types:
  • Structural – Exophytic/intraluminal, extrinsic, distortion, or scar/stricture
  • Dynamic – Damaged cartilage/malacia or floppy membrane

Location:

  • Upper one-third, middle one-third, or lower one-third of the trachea
  • Right or left mainstem bronchus

Degree/grade:

  • 0 – No appreciable stenosis
  • 1 – 25% stenosis
  • 2 – 50% stenosis
  • 3 – 75% stenosis
  • 4 – 90% stenosis
  • 5 – Complete obstruction

Transition zone:

  • Description of the transition zone of stenosis (eg, web-like or slow bottleneck
 Simple stenoses:
  • Endoluminal occlusion of a short segment (<1 cm) and single-level involvement, without tracheomalacia or loss of cartilaginous support

Complex stenoses:

  • Multilevel, long lesions (≥1 cm), involvement of the tracheal wall and cartilage, associated malacia, and proximity to the vocal cords (<1 cm)
Additional notes: This classification is simple and easy to use. Limitations include: does not describe subtle dimensional changes, ignores the fact that most stenoses are not perfectly oval or circular, and does not accurately describe multiple sites of airway disease. Additional notes: This classification is simple, reproducible between centers, and places stenoses into a finite number of categories that can be more easily collated. Limitations include: does not describe subtle dimensional changes, ignores the fact that most stenoses are not perfectly oval or circular, and does not accurately describe multiple sites of airway disease. Additional notes: This classification provides useful descriptors that assist with therapeutic decisions.
References:
  1. Myer CM 3rd, O'Connor DM, Cotton RT. Proposed grading system for subglottic stenosis based on endotracheal tube sizes. Ann Otol Rhinol Laryngol 1994; 103:319.
  2. Freitag L, Ernst A, Unger M, et al. A proposed classification system of central airway stenosis. Eur Respir J 2007; 30:7.
  3. Galluccio G, Lucantoni G, Battistoni P, et al. Interventional endoscopy in the management of benign tracheal stenoses: definitive treatment at long-term follow-up. Eur J Cardiothorac Surg 2009; 35:429.
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