AG, aged 35, housewife, who was seen in consultation for progressive inspiratory dyspnea. One (01) month ago, she underwent a caesarean section for eclampsia. This surgery was complicated by cardio-respiratory arrest requiring tracheal intubation for months in intensive care. Dyspnea occurring 10 days after extubation was associated with dysphonia. There was no dysphagia, fever, neck pain. She had a history of unmonitored arterial hypertension and an obstetrical history of caesarean section with eclampsia. On general examination, the conjunctivae were stained, no cyanosis, the temperature was at 36.5˚C, the heart rate was at 110 beats/min, the respiratory rate was at 27 cycles/min, the blood pressure was at 130/100 mm/hg.

The ENT physical examination revealed Chevalier Jackson and Pineau stage III dyspnea requiring an emergency tracheostomy (sternal and supraclavicular pulling strong, spinning pulse, high blood pressure, agitated patient). Corticosteroid therapy and antibiotic prophylaxis were instituted.

The cervical computed tomography performed showed a tracheal stenosis next to C6 up to T1 (Figure 1). A laryngotracheal endoscopy was performed to clarify the characteristics of the stenosis, it was a complex 2.5 cm stenosis with damage to 2 cartilaginous rings. The biological and radiological operability assessments performed came back normal.

We proceeded to a surgical treatment of the end-to-end tracheal anastomosis resection type under general anesthesia and intubation through the tracheotomy orifice (Figure 2(a)). The approach was an arciform cervical incision above the sternum of the Kocher type, the technique adopted was that of Montgomery which combines a section of the mylohyoid and geniohyoid muscles inserted on the superior face of the hyoid bone and the small horns and a section on either side of the body inside the large horns. The trachea-tracheal suture was performed without tension with Vicryl 3.0 curved needle in separate stitches. The suture begins with the posterior plane then the anterior plane by circling an upper and lower ring. A suction drain was placed for 72 hours. We put in place a naso -gastric tube for 10 days. The neck was kept in a neutral position using a

suture to avoid hyper-extension for 2 weeks (Figure 3(a)). We did not encounter any difficulties during the surgery. The patient stayed in intensive care for 48 hours before being transferred to the service. The postoperative course was simple (Figure 3(b)), with clinical and endoscopic monitoring for up to 6 months without complications before being lost sight.

SD, 18-year-old student, male, presented with inspiratory dyspnea that gradually began and continued to evolve after a 4-day intubation for cerebral malaria.

This respiratory distress, which appeared 15 days earlier, was associated with a dry cough. He had no notion of fever, dysphonia, dysphagia, wrong food route. No specific medical and surgical history was found, he was a non-alcoholic and tobacco user.

On general examination, the conjunctivae were colored, with no cyanosis, temperature 37.1˚C, heart rate 85 beats/min, respiratory rate 22 cycles/min, blood pressure 120/80 mm/hg.

The ENT physical examination revealed Chevalier Jackson and Pineau stage II dyspnea (moderate sternal indrawing, agitated patient). Nasofibroscopy revealed subglottic stenosis at the tracheal level and inflammation of the vocal cord mucosa.

Cervical computed tomography showed tight stenosis of the trachea over 31 mm from C6 to T2 associated with pseudo-nodular infiltrations of the upper lobes of the thyroid gland (Figure 4).

At the end of the endoscopic and radiological assessment, it was a complex stenosis characterized by a 3 cm stenosis with a fibrotic lesional process extending to the entire tracheal wall and involving 3 cartilaginous rings. A safety tracheotomy and an endoscopic assessment were performed beforehand, associated with prophylactic antibiotics and corticosteroid therapy.

After a preoperative assessment which came back without particularities, we performed a resection with trachea-tracheal anastomosis under general anesthesia using the same surgical technique and the same material as the previous case. We did not encounter any operational difficulties (Figure 5). A naso-gastric tube for 10 days. The neck was maintained in a neutral position using a suture in order to avoid hyper-extension for 2 weeks (Figure 5(b)). The patient spent 48 hours in intensive care before being transferred to the service. The evolution was marked by a re-stenosis following the reconstitution of a granuloma after 45 days leading to dyspnea and then the death of the patient.

The frequency of STPI is variably assessed by the different series. Recent prospective studies report a frequency of stenosis after intubation and/or tracheotomy of 10% to 19% [1] [4] . The stenoses responsible for a significant functional narrowing are however much rarer, their frequency is of the order of 1% [1] [4] [6] [7] [8] .

STPIs represent a frequent and formidable complication of respiratory assistance. They are due to the healing process of the lesions caused by the contact of the balloon with the tracheal mucosa [9] [10] [11] . Strictures may also be due to mucosal erosions caused by the distal end of the airway tube, especially in children intubated with uncuffed tubes [12] . Gradual improvements in tubing materials and design as well as the widespread use of high-volume, low-pressure balloon tubing have reduced the incidence of STPI [9] [11] . In the literature, all age groups can be affected, the average age varies between 20 and 52 years and the male sex seems to predominate [1] [6] [13] [14] . In our series, the frequency was 1.4%, the age of our patients was respectively 18 and 35 years with an equal distribution between the two sexes.

The clinical diagnosis of STPI is made on the association of inspiratory bradypnea with indrawing and horniness in a patient with a history of intubation and/or tracheotomy. This diagnosis is sometimes difficult but should be considered in any patient with a history of intubation and/or tracheostomy presenting with recent or unusual dyspnoea [4] [7] [15] . In our series, STPI was identified as such on admission in both cases.

The duration of intubation is also considered as a risk factor for stenosis, it is 12% in the event of intubation for more than 10 days [1] [16] [17] [18] [19] . The time to onset of tracheal stenosis is variable in the literature. It is from a few hours after extubation or decanulation, to several months or even a few years. This period is between the 15^th day and the 5^th month [20] [21] [22] . In our series, the duration of intubation was 4 days and 30 days; and the time to onset of stenosis was 15 days and 10 days respectively for our patients.

A rigorous para-clinical assessment must be established, not only to make the diagnosis of a tracheal stenosis, but also to determine the characteristics of this stenosis and to pose the appropriate therapeutic indication [1] [2] [15] .

The laryngotracheal endoscopy is the essential stage of the exploration, it makes it possible to specify the seat, the extent, the inflammatory or organized nature of these lesions, to appreciate their complexity and to check the laryngeal mobility [1] [2] [15] [20] .

The radiological assessment is also an essential step in the management of tracheal stenosis. Currently, the reference examination is computed tomography (CT).

Iodine opacification is not compulsory and is reserved only for the exploration of tumor pathologies or in the presence of a para-tracheal mass with extrinsic compression [1] [2] [23] .

Multi-slice CT (MB-CT) has established itself as the reference imaging technique for exploring the trachea in adults. Axial sections have certain limitations for analyzing the trachea: difficulty in detecting moderate stenoses, underestimation of the longitudinal extension of stenoses, difficulty in analyzing anatomically complex lesions. Thanks to CT-MB, several types of reconstructions are currently possible: 2D and 3D reconstructions [1] [2] .

Magnetic resonance imaging (MRI) has demonstrated its superiority for the study of tracheal lesions, thanks to its power of spatial resolution and contrast and its multiplanar T1 T2 acquisitions. Indeed, it gives a dynamic sequence, it makes it possible to identify the part of the thickening of the mucosa and the collapse of the tracheal wall in the genesis of the stenosis.

But it remains uncommonly used and very few authors have reported their experience in exploring STPI by MRI [1] [2] [23] .

In our study, all our two patients benefited from endoscopy and CT to confirm the diagnosis, locate the stenosis, specify type and importance and finally guide treatment.