Tracheobronchomalacia: When Posterior Tracheobronchopexy Did Not Achieve Adequate Airway Patency

This protocol addresses symptomatic tracheobronchomalacia (TBM) in patients who have already undergone a posterior surgical approach but have not met the required functional airway target. A further structured step is available for this situation.

The first surgical approach — posterior tracheobronchopexy — was undertaken to improve symptomatic TBM. The specific functional target it was required to achieve was:

Failure to reach that threshold is the defined trigger for escalation to the anterior approach described by this protocol.

When the posterior approach has not been sufficient, anterior procedures targeting the trachea and/or main bronchi are the structured next step — anchoring and supporting the anterior airway wall to the chest under direct bronchoscopic guidance.

The full technique — including the precise anterior fixation approach and the role of specific interposed structures — is detailed in the complete protocol…