Introduction

Overview of Tracheobronchomalacia (TBM)

Tracheobronchomalacia TBM is characterised as a medical condition in which the respiratory tract considerably in the trachea portion of the airway gets weakened resulting in the collapsing of the airway leading to breathing complications which may become fatal or emergence in complex conditions, need hospitalisation for major complications. It is one of highly common complications among kids, elders are more targeted. 

Challenges in management

Due to a complex and challenging condition, many challenges are being faced in the treatment and palliation of this disorder such as:

• Delayed or misdiagnosis of disorder
• Limited treatment options due to less research
• Surgical and prot surgical challenges
• High probability to acquire respiratory infections 
• Ventilatory support issues 
• Lack of awareness among healthcare workers

Pathophysiology of TBM

In tracheobronchomalacia TBM structure and functioning of the trachea are highly compromised due to structure; changes due to the collapsing of the trachea, aggravated by the weakened cartilages that can be the leading cause of TBM. Secondly, a major pathophysiological factor is congenital TBM in which connective disorders occur such as marfan syndrome or other, premature birth weakening cartilages, or acquired complications of TBM due to chronic disorders like tuberculosis, pneumonia, COPD, GERD or others. It may be aggravated by the progression of disorder or aggravated complications.

Indications for airway stenting in TBM

Airway stenting is a procedural technique done manually in order to prevent collapsing of airways by the insertion of stents in the trachea or other vessels like in heart vessels and preventing further aggravation of cartilage weakening. It is used in moderate to complex conditions on the basis of MDM of a doctor that suggests the procedure on the basis of medical conditions and symptoms of the individual, used in case other treatment or management options are not affecting the individual condition. Many different types of stents are being used on the basis of their nature and material, and severity of the medical condition such as:

Types of airway stents used

• Self-expanding Metallic Stents (SEMS)
• Silicone Stents
• Hybrid Stents

Techniques for airway stenting

Various techniques are used for airway stenting in case of tracehobronchocomalcia on the basis of severity and medical complexity including:

Endoscopic placement

It is a type of placement technique in which a non-invasive procedure is done to stabilize and manage symptoms of TBM. In this placement patient selection on the basis of medical severity of an individual and anaesthesia selection is highly considerate about initial assessment. Different types of stents are used for placement done with endoscopy along with post placement management needs to be considerate about the procedure for better placement and efficient results.

Post-procedure care

Post-procedure care covers post-surgical care including stent migration, granulation tissue formation, infection or mucus plugging, stent induced airway injury and regular bronchoscopy for monitoring is necessary for the analysis of place stent functionality and recovery of TBM. It is provided by nursing staff, medical practitioners and other professionals along with patient adherence and compliance to the provided treatment.

Outcomes and effectiveness

Stent placement is efficient in offering short-term success in terms of tracheobronchomalacia TBM, effective to relieve symptoms like dyspnea, chronic cough, wheezing, respiratory stress and others are relieved that show significant effects in palliative care of tracheobronchomalacia TBM. Long-term outcomes improve quality of life by improving breathing and reducing hospitalisation due to recurrent infections.

Complications associated with airway stenting

Airway stenting in TBM provides temporary airway stabilisation but is associated with multiple complications. Stent migration is common, particularly with silicone stents, leading to airway obstruction and requiring repositioning. Granulation tissue formation occurs frequently, especially with metallic stents, causing airway narrowing and necessitating repeated bronchoscopic interventions.

Mucus plugging and secretion retention impair airway clearance, increasing the risk of atelectasis and infections like tracheobronchitis and pneumonia. Bacterial and fungal colonisation (e.g., Pseudomonas, Candida) may require antibiotic or antifungal therapy. Stent fracture or collapse can lead to obstruction, while airway erosion and perforation may result in life-threatening complications such as tracheoesophageal or tracheovascular fistulas.

Patients may experience chronic cough, dysphagia, or persistent dyspnea due to airway irritation. Long-term stenting risks include tracheal stenosis and fibrosis, often requiring surgical intervention. Regular bronchoscopy follow-ups are essential to monitor for complications.

To minimise risks, stenting should be reserved for patients who fail conservative therapy or as a diagnostic bridge to surgery (e.g., tracheobronchoplasty). Proper stent selection, airway clearance techniques, and infection prevention strategies are crucial for optimising patient outcomes. Despite its benefits, airway stenting is rarely a permanent solution in TBM management.

FAQs

Is airway stenting a permanent solution for TBM?

No, airway stenting is typically a temporary measure to stabilise the airway. Long-term solutions like tracheobronchoplasty are preferred for eligible patients.

What are the most common complications of airway stenting?

Common complications include stent migration, granulation tissue formation, mucus plugging, airway infections, and tracheal perforation.

How is an airway stent placed?

Airway stents are placed using an endoscopic procedure, where a stent is inserted into the trachea to keep it open.

Can TBM be managed without stenting?

Yes, mild cases can be managed with medical therapy, pulmonary rehabilitation, and lifestyle modifications. Stenting is reserved for severe cases where other treatments fail.

How often do patients need follow-up after stenting?

Regular bronchoscopy every 3–6 months is recommended to monitor stent function and detect complications early.

Summary

Airway stenting is a key intervention for moderate to complex Tracheobronchomalacia (TBM) offering structural support to prevent airway collapse. While it can provide significant short-term relief from symptoms and improve quality of life, it is generally a temporary solution with potential complications such as stent migration and granulation tissue formation. Successful outcomes depend on careful patient management, with stenting serving as a palliative measure to definitive surgery.