- OBJECTIVE: To determine the predictive value of endoscopic examination and radiological imaging in the evaluation of substomal tracheomalacia in advanced laryngotracheal stenosis. METHODS: Forty nine patients with advanced laryngotracheal stenosis were preoperatively evaluated with radiological (magnetic resonance imaging [MRI]) and endoscopy to determine the grade of laryngotracheal stenosis and presence of substomal tracheomalacia. The intraoperative findings were compared with the preoperative findings, and the percentage of operative plan changes was calculated. RESULTS: In a preoperative evaluation, 37 patients were found to have no substomal tracheomalacia; but during the surgical procedure, we detected substomal tracheomalacia in 12 (32.4%) of these patients and changed our preoperative plan during the procedure (p < 0.05). CONCLUSION: Laryngotracheal reconstruction plans are dependent on preoperative evaluations which can change significantly during the surgical procedure. Therefore, experienced physicians who can alter the preoperative plan immediately during the procedure and successfully perform an alternative procedure are necessary.