Endoscopic Management of Subglottic Stenosis

Feinstein, Aaron J.; Goel, Alexander N.; Raghavan, Govind; Long, Jennifer L.; Chhetri, Dinesh K.; Berke, Gerald S.; Mendelsohn, Abie H.

doi:10.1001/jamaoto.2016.4131

Cited by 71 publications

(80 citation statements)

References 29 publications

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“…Treatment options for high‐grade LTS vary from endoscopic to open‐neck procedures . However, it has been reported that higher grade of stenosis purported a higher probability of its recurrence after endoscopic treatment, independently from the etiology of the stenosis itself .…”

Section: Introductionmentioning

confidence: 99%

Multicentric study applying the european laryngological society classification of benign laryngotracheal stenosis in adults treated by tracheal or cricotracheal resection and anastomosis

Fiz¹,

Monnier

Koelmel³

et al. 2019

The Laryngoscope

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Objectives/Hypothesis Introduction and widespread use of cricotracheal resection and anastomosis (CTRA) as routine treatment for high‐grade benign laryngotracheal stenosis (LTS) led to the need for a new classification system that could accurately predict surgical outcomes by integrating crucial stenosis and patient‐related information. In 2015, the European Laryngological Society (ELS) proposed a new classification for benign LTS. We retrospectively tested it in adults treated at three referral centers to assess its reliability in predicting surgical outcomes. Study Design Retrospective cohort study. Methods We included 166 adults treated by open tracheal resection and anastomosis (TRA) and CTRA procedures, restaged according to the ELS classification evaluating grade of stenosis (I–IV, Myer‐Cotton), number of subsites involved, and presence of systemic comorbidities. We correlated these parameters with decannulation, number of retreatments, and complications. Results Final decannulation was predicted by a proposed ELS score ≥ IIIb, history of previous treatment, and length of resection (P < .05). Decannulation was achieved in 99% of patients without and in 88% of patients with surgical complications (P < .01). The incidence of surgical complications was related to the proposed ELS score (P < .01); an ELS score < IIIb showed a lower complication rate compared to patients with a ≥ IIIb score (32.8% vs. 57.7%, P < .01). Additional treatment was required in 73 (44%) patients (mean = 2.7 ± 2.2, range = 1–11). ELS score ≥ IIIb, length of resection, and occurrence of surgical complications predicted the number of such treatments (P < .05, P < .05, and P < .001, respectively). Conclusions ELS classification of benign LTS is able to accurately predict success in adult TRA/CTRA procedures and may be helpful in choice of therapy and patient counseling. Level of Evidence 2b Laryngoscope, 130:1640–1645, 2020

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Section: Introductionmentioning

confidence: 99%

Multicentric study applying the european laryngological society classification of benign laryngotracheal stenosis in adults treated by tracheal or cricotracheal resection and anastomosis

Fiz¹,

Monnier

Koelmel³

et al. 2019

The Laryngoscope

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“…Surgical treatments of ISS may include endoscopic procedures, open neck surgery, or tracheostomy, though no optimal management has been established. 15 The endoscopic approach with CO 2laser dilatation is a minimally invasive procedure with improved tolerability and shorter hospital stays and has been recommended as a first-line treatment modality in patients with first presentation of less severe and anatomically simple ISS. 16,17 However, patients are more likely to experience recurrence at rates between 55-80%, 20 thus requiring multiple interventions.…”

Section: Discussionmentioning

confidence: 99%

Recurrent Idiopathic Subglottic Stenosis in Multiple Pregnancies: A Case Report

Shao¹

2019

UWOMJ

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Introduction: Idiopathic subglottic stenosis (ISS) is a type of central airway obstruction primarily affecting adult Caucasian females. Its rarity and similar clinical presentation to asthma contribute to its frequent misdiagnosis. Timely treatment of ISS is crucial for pregnant patients who are at risk for emergent surgeries necessitating ventilation and intubation. Case: A 29-year-old, previously healthy female reported new onset dyspnea on exertion and a dry, non-productive cough to her family physician. Clinical exam was unremarkable; however, pulmonary function testing revealed a moderate, fixed airway obstruction. Endoscopy visualized subglottic stenosis 1.7 cmdistal to her vocal cords and surgical intervention using CO2 laser dilatation was scheduled with Otolaryngology. However, the patient received a positive pregnancy test prior to her elective surgery dateand after consideration of risks and benefits to mother and fetus, the surgery was postponed to her second trimester. Unfortunately, the patient miscarried her fetus and was scheduled for an emergent dilatation and curettage (D&C). She was successfully bag-mask ventilated during the D&C and subsequently underwent surgery for ISS with full resolution of her symptoms. In subsequent follow-up, the patient reported a return of dyspnea coinciding with another positive pregnancy test. ISS recurrence was diagnosed; however, as symptoms were mild, a repeat surgery was postponed until the patient safely delivered her child. Discussion: This case illustrates the difficulties in the diagnosis and management of ISS in pregnant patients during their childbearing years as surgical intervention will impact both the mother and fetus.

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“…Surgical tracheoplasty is the only definitive treatment option for high, moderate, or severe stenosis whereas endoscopic excision of stenotic segment, bronchoscopic dilatation, and tracheal stenting may be feasible in mild to moderate cases. 7,8 We in this report discuss about the difficulties with prolonged tracheostomy tube in a postoperative cardiac surgical child with critical SGTS and the anticipated problems during his transfer.…”

Section: Introductionmentioning

confidence: 99%

Severe Subglottic Tracheal Stenosis Dictates Intercontinental Transfer of a 2-Year-Old Child with Tracheostomy Tube In Situ

et al. 2019

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Atrioventricular septal defect (AVSD) is the most common congenital cardiac anomaly associated with Down’s syndrome. Children with AVSD develop pulmonary arterial hypertension and often require extensive therapy with pulmonary vasodilators in the postoperative period. The postoperative management is complicated by prolonged mechanical ventilation through endotracheal tube or tracheostomy tube. This artificial airway may trigger various airway complications including subglottic tracheal stenosis. The incidence and severity of subglottic tracheal stenosis is high in children with congenital syndromes. Inability to extubate or decannulate trachea and rapid respiratory compromise while attempting to do so directs toward a diagnosis of subglottic tracheal stenosis. The following case report discusses a 2–year-old boy from Nigeria who was discharged with tracheostomy tube in situ due to severe subglottic tracheal stenosis and surgical tracheoplasty could not be done at his present age. The implications of prolonged tracheostomy tube in situ and the hazards thereof during transfer of the child are being described.

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Endoscopic Management of Subglottic Stenosis

Abstract: Endoscopic surgery for subglottic stenosis is a critical aspect of patient management. Neither surgical technique nor grade of stenosis was seen to alter the surgical intervals. Mitomycin application was associated with an extended time interval between endoscopic treatments.

Cited by 71 publications

References 29 publications

Multicentric study applying the european laryngological society classification of benign laryngotracheal stenosis in adults treated by tracheal or cricotracheal resection and anastomosis

Multicentric study applying the european laryngological society classification of benign laryngotracheal stenosis in adults treated by tracheal or cricotracheal resection and anastomosis

Recurrent Idiopathic Subglottic Stenosis in Multiple Pregnancies: A Case Report

Severe Subglottic Tracheal Stenosis Dictates Intercontinental Transfer of a 2-Year-Old Child with Tracheostomy Tube In Situ

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