Laryngotracheal stenosis (LTS) is a refractory airway disorder characterised by pathological scar formation and airway luminal narrowing, which severely impairs respiratory function and quality of life. This review systematically summarises the pathological mechanisms, anatomical characteristics and latest therapeutic progress of LTS, including iatrogenic and idiopathic subtypes. The core pathogenesis of LTS lies in disordered wound healing, persistent chronic inflammation and excessive extracellular matrix deposition, driven by key fibrotic mediators such as transforming growth factor-β1. Current interventions cover endoscopic techniques such as laser and cold-knife resection, balloon dilation, as well as open procedures including tracheal resection and anastomosis, and graft reconstruction. For lesions beyond the safe limits of conventional resection (> 6 cm), graft-based reconstruction using autologous tissues, allografts, or tissue-engineered constructs becomes necessary. Each therapy has distinct indications, curative effects and limitations. Multimodal therapy, individualised regimens and multidisciplinary collaboration have become the core principles to improve clinical outcomes. Adjunctive pharmacologic therapies, including topical mitomycin C and corticosteroids, are increasingly integrated to modulate wound healing and reduce recurrence risk. For refractory long-segment stenosis and recurrent cases, biomaterials, tissue engineering and precision medicine represent the key research directions for future LTS treatment.