Laser Burns

Despite warnings and precautions, occasionally, a plastic endotracheal tube has been ignited by a laser, producing disastrous tracheal and bronchial thermal burns.21 Such a lesion is managed in the same fashion as inhalation burns, but the extent and depth may well be fatal, especially if the injury extends into the bronchial tree. Even Y or T-Y stents become useless. Similar burns have been produced by inept use of the cautery during tracheostomy.

A laser burn of the left main bronchus was incurred in an ill-advised and ill-executed attempt to destroy an area of dysplasia. The resulting complete stenosis of the bronchus was successfully treated by bronchial resection and anastomosis (see Figure 38 [Color Plate 16]). A tracheoesophageal fistula produced by laser treatment of cuff stenosis was managed by standard reconstructive techniques. Since the laser damage was localized, reconstruction was feasible in this case.

Injuries caused by external irradiation are discussed in Chapter 41, "Radiation Therapy in the Management of Tracheal Cancer." I have encountered an irremediable main bronchial stenosis due to a misguided use of brachytherapy to irradiate peribronchial tissue rather than the intralumenal tumor. The resulting complete stenosis was fused to the adjacent pulmonary vessels.

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