The main manifestation of tracheal stenosis, regardless of the cause, is dyspnea, with a predominantly inspiratory difficulty. The cause should be identified first. There are many causes of tracheal stenosis, with two main categories. One category is tumor, including benign or malignant tumors; the other category is currently the most important is scar stenosis, including trauma or tracheal intubation tracheotomy complications. In recent decades, the wide application of ventilators has successfully rescued a large number of acute and critical illnesses and saved the lives of countless patients. However, a considerable number of tracheal stenoses have also resulted from the application of ventilators requiring tracheal intubation or tracheotomy. Except for small tumors or simple tracheal stenosis that can be treated with fiberoptic bronchoscopy or rigid metal bronchoscopy by electrocautery, laser or cryotherapy, involvement of the tracheal wall as well as larger tracheal tumors, large segments or complex scarring stenosis ultimately require surgical treatment. The diseased trachea is removed and sufficient tracheal lumen patency is restored. Surgery is the most fundamental and effective treatment for tracheal stenosis. However, in clinical practice, a considerable number of patients do not receive timely or appropriate treatment, and as a result, the condition becomes more and more severe and the lesions become longer and longer, making surgery extremely difficult or losing the chance of surgery altogether. Some patients end up having to use tracheal stents to hold open the narrowed trachea and keep them alive. Patients with benign disease will carry a tracheal stent for the rest of their lives. Tracheal stents are foreign bodies that can cause severe coughing and even sleepless nights and pain. Prolonged irritation can cause granulation and cause the trachea to narrow again. The granulation requires periodic tracheoscopic laser or freezing removal, which, in addition to the pain and monetary expense, also has the potential to cause other serious complications such as granulation, perforation, and hemorrhage. What’s more, stent wear and tear causes tracheovascular fistula, hemorrhage and death; causes tracheoesophageal fistula, eating and drinking can choke into the lungs, causing pneumonia or lung abscess. Therefore, in recent years, for the application of esophageal or tracheal stents, the academic community are crying out: benign tracheal or esophageal diseases should be treated as much as possible without stents! (See my article: The Tragedy of Tracheal Stenting for Benign Diseases.) This is because the scope of the lesion (including granulomatous stenosis, etc.) will be significantly enlarged after placing a tracheal stent, and the scope of tracheal resection is very limited, and there is almost no way to surgically resect an overly long lesion (see my article on Zhao’s artificial trachea). Therefore, it is necessary to present guidelines for tracheal stenosis consultation so that more patients can be treated promptly and appropriately. Clinically, tracheotomy is a visit to the thoracic surgery department, especially for large sections of tracheotomy. This is because the major part of the trachea is located in the chest cavity. Whenever the lesion is long, it is necessary to consider whether to open the chest surgery. The vast majority of thoracic surgeries are also experienced in tracheoscopy and treatment. Most importantly, the thoracic surgery department can take a comprehensive view of what treatment is in the best interest of the patient. Almost all of the cases of tracheotomy and artificial trachea for large segments of more than 4 cm or even 6 cm reported in China are reported in the Journal of Thoracic Surgery. Nowadays, most respiratory departments have tracheoscopes, and all pentacameral departments have laryngoscopes and tracheoscopes, which can carry out trans-tracheoscopic dilatation, laser or cryotherapy, and therefore can also be consulted. But only simple stenosis, and small benign tumors. It should be noted that tracheoscopy and trans-tracheoscopic cryo-laser dilatation or stenting can be carried out in the respiratory and pancreatic departments of many tertiary hospitals in China. A large number of patients with early and relatively small tracheal stenosis have also been cured. However, it should also be noted here that dilatation is a good approach for some milder cases, and in some cases a cure can be achieved. In complex cases, however, dilation may lead to more trauma and more severe scar formation. Therefore complex or long segmental stenosis, larger benign tumors or malignant tumors of any size should be seen by the thoracic surgeon. First, symptomatic diagnosis: clinicians should consider the presence or absence of tracheal stenosis in patients presenting with symptoms such as irritating cough, shortness of breath or shortness of breath after exercise. Many patients with tracheal tumors have been diagnosed with chronic bronchitis or asthma for a long period of time (even more than a few years), and examples of such cases, which are clinically numerous, are found. If there is a history of tracheal trauma or tracheal intubation after tracheotomy can not be pulled out of the tube, dyspnea after extubation, should be immediately thought of the possibility of tracheal stenosis. Confirmation of diagnosis: CT and bronchoscopy.CT and two-dimensional three-dimensional reconstruction can clearly show the site of tracheal stenosis, length, degree of stenosis, distance from the vocal folds and rales, and relationship with the surrounding large blood vessels, which is crucial for further treatment, especially surgery. Fiberoptic bronchoscopy can observe the narrowed section of trachea under direct vision from the lumen of the trachea and take biopsy to get pathological diagnosis. However, it is completely incapable of understanding the situation outside the lumen. The two can complement each other to make the diagnosis of tracheal stenosis more accurate and guide further treatment. Treatment options: 1. Simple benign tracheal stenosis: small benign tumors growing in the lumen, usually no more than going 1.5cm, can be removed by freezing or laser. Scar stenosis length does not exceed 1~2cm, no cartilage ring destruction (in recent years, in some places to do tracheotomy, in the anterior wall of the trachea excision of a garden-shaped window, will be obvious destruction of 1~2 tracheal cartilage ring, this kind of stenosis often not only scar stenosis, but also tracheal softening factors. Therefore, medical treatment is not effective. (Even if the scar is removed using laser or freezing, the tracheal softening remains unresolved.) Trans-tracheoscopic laser or cryotherapy can be considered. I prefer cryotherapy because it is less dangerous and less likely to bleed (cryostasis) perforate. If there is more granulation growth after treatment and the lesion has a tendency to expand, it is best not to simply choose this medical treatment, and surgical treatment should be considered because a small segment of tracheotomy anastomosis is easy and simple to perform and has the best effect to achieve complete cure! 2. Complex benign tracheal stenosis: longer segments of tracheal granulation growth or scarring stenosis, because the laser may induce further post-granulation growth and scarring, so improper treatment, the scope of the lesion may be getting bigger and bigger, once the resection range is more than 4~5cm, at present, there are very few surgeons in the domestic surgical world, who are able to do such a surgery. As a result, the patient will be unable to undergo further treatment. Therefore, it is advocated to have a thoracic surgeon take a look at it as early as possible to evaluate the prospect of endoscopic treatment, the possibility of surgery, and the risks. Try not to put in a stent. For benign stenosis, stenting should only be considered for those who cannot be treated surgically. Whenever you can operate, always remove the stenosis surgically and never place a stent. It is easy to put a stent in, but the consequences are endless! 3.Malignant stenosis: malignant tumors, no matter whether the primary tracheal tumor or peripheral tumor invades the trachea, only surgery is the only correct treatment choice. Therefore, one should consult the thoracic surgery department. At present, our Thoracic Surgery Department has successfully resected dozens of cases of tracheal stenosis and tumors, with the longest resection of trachea 5~8 cm. which is a clear leader in China. Recently, we have also successfully operated on several cases of tracheal stenosis in adolescents, enabling him/her to live the life of normal children. In conclusion, there are many causes of tracheal stenosis and many treatment methods, but the initial treatment must be chosen carefully, otherwise, it may get worse and worse, with constant complications and lifelong pain, or even untreatable and death by suffocation. Never visit the thoracic surgery department as early as possible, and choose surgical treatment at the appropriate time to achieve once and for all.