Early and Late Dilatation for Acquired Subglottic Stenosis

Abstract

There has been widespread use of periodic dilatations in the management of subglottic stenosis. However, some authorities have questioned the value in the overall rehabilitation of patients affected by this disorder. The first phase of this study included fourteen large dogs in which acute subglottic lesions were created by use of a high-speed electric drill and electrocautery. Twelve animals served as the experimental group and two animals were controls. Obstructing lesions developed in all the animals within 7 to 21 days. When at least a 50% obstruction developed in an animal, a treatment plan was instituted that included at least weekly dilatation, removal of granulations, and administration of intralesional steroids and/or systemic steroids and antibiotics. The two control animals became totally obstructed and were killed. Varying degrees of subglottic stenosis developed in all twelve experimental animals after 8 weeks of dilatation, but none required a tracheotomy. These twelve animals were then subjected to 8 additional weeks of dilatation and antibiotics, and supplemental steroids were used in some animals from this study. It can be concluded that early periodic dilatation and granulation removal in the acutely injured subglottis is effective in prevention of severe stenosis, late periodic dilatations in chronic subglottic stenosis are not helpful in further alleviation of obstruction, the concomitant use of antibiotics and systemic steroids did not appreciably prevent or alter the development of subglottic stenosis, and the concomitant use of intralesional steroids appeared to be of benefit in the management of chronic acquired subglottic stenosis.

A comparison of the efficacy of 5-fluorouracil/triamcinolone, carnitine and dexamethasone therapy on wound healing in tracheal injury: potential for preventing tracheal stenosis?

“…Our study yielded similar results to previous studies demonstrating 5-FU/TA as an effective drug for the prevention of TS. The role of intralesional corticosteroids for tracheal stenosis is controversial [1,20]. We determined that there were no histopathological or biochemical evidence of delayed tissue healing in 5-FU/TA group.…”

“…They hamper expression of injury-induced growth factors and cytokines released by macrophages at the wound site by their immune-suppressive effects, delay wound contraction and impair the recovery of epithelization [18]. Corticosteroids have been tried in the treatment of subglottic stenosis [22] but many studies argue otherwise [12,20,23]. A canine study showed that steroids did not prevent subglottic stenosis, and showed neither gross nor a histological difference from controls [12].…”

The Problem of Pediatric Laryngotracheal Stenosis: A Clinical and Experimental Study on the Efficacy of Autogenous Cartilaginous Grafts Placed Between the Vertically Divided Halves of the Posterior Lamina of the Cricoid Cartilage

“…191 A further study using a similar animal model showed benefit from the use of intralesional steroids in the management of chronic acquired subglottic stenosis; the use of systemic antibiotics and systemic steroids did not prevent or alter the development of subglottic stenosis. 192 Several authors have reported adequate results using the carbon dioxide laser in the management of posterior glottic stenosis and mild or moderate subglottic stenosis, generally with multiple procedures. 105.189,193-202 There are no reports of significant success with the carbon dioxide laser in the management of complete laryngotracheal stenosis.…”

Mitomycin C and the endoscopic treatment of laryngotracheal stenosis: Are two applications better than one?

“…Treatments have been investigated in animal studies and clinical practice for over 30 years. These include systemic antibiotics and systemic steroids,5–7 local injection of steroids,8–12 and stents 13–16. In recent years, the most attention has been turned to mitomycin‐C (MMC) 17.…”