Tracheal and subglottic stenosis are chronic inflammatory processes which can occur as a result of several possible aetiologies, most commonly as a result of prolonged intubation. All consecutive cases of subglottic and tracheal stenosis, secondary to prolonged intubation treated endoscopically over a period of 2 years were reviewed. The surgical approach consisted of radial incision and ablation using Holmium YAG laser, balloon dilatation and topical instillation of mitomycin C through flexible fiberoptic bronchoscope. Ventilation throughout was maintained through LMA. Laser fiber delivered through working channel of bronchoscope. CRA balloon passed through adopter of LMA. Every patient followed for 1 year with 1, 3, 6 months and 1 year interval. Serial balloon dilatation and mitomycin C instillation done in patients during follow up visit. Thirteen patients who underwent airway intervention during study period were studied for clinical outcome. Average follow up was 1 year. Etiology for airway stenosis in all patients of study group was intubation injury. Average frequency of balloon dilatation required was three. Average tracheal lumen achieved at the end of 1 year in our study group was 70%. Symptomatic improvement observed in all patients. Average PEFR achieved was up to 60% of predicted value. Benign subglottic and tracheal stenosis can be safely and effectively managed with flexible bronchoscopy, holmium YAG lasar ablation, balloon dilatation and Mitomycin-C after securing the airway with LMA for general anaesthesia and optimal ventilation.
This is a preview of subscription content, log in to check access.
The authors would like to thank MGM Medical College and Hospital, Auranagabad and Residents of Department of Respiratory Medicine.
Compliance with Ethical Standards
Conflict of interest
The authors declare that they have no conflict of interest.
All procedures performed in this study involving human participants were in accordance with the ethical standards of the institution and with the 1964 Helsinki declaration and its later amendments. This article does not contain any studies with animals performed by any of the authors. For this type of study formal consent is not required.
Couraud L, Brichon PY, Velly JF (1988) The surgical treatment of inflammatory and fibrous laryngotracheal stenosis. Eur J Cardiothorac Surg 2:410–415CrossRefPubMedGoogle Scholar
Ernst A, Feller-Kopman D, Becker HD et al (2004) Central airway obstruction. Am J Respir Crit Care Med 169:1278–1297CrossRefPubMedGoogle Scholar
Karagiannidis C, Velehorschi V, Obertrifter B, Macha HN, Linder A, Freitag L (2006) High level expression of matrix-associated transforming growth factor-β1 in benign airway stenosis. Chest J 129(5):1298–1304CrossRefGoogle Scholar
Chen T, Kunnavatana SS, Koch RJ (2006) Effects of mitomycin-C on normal dermal fibroblasts. Laryngoscope 116(4):514–517CrossRefPubMedGoogle Scholar
Smith ME, Elstad M (2009) Mitomycin C and the endoscopic treatment of laryngotracheal stenosis: are two applications better than one? Laryngoscope 119(2):272–283CrossRefPubMedGoogle Scholar
Jameson JJ, Moses RD, Vellayappan U, Lathi KG (2000) Use of the laryngeal mask airway for laser treatment of the subglottis. Otolaryngol Head Neck Surg 123:101–102CrossRefPubMedGoogle Scholar
Kanagalingam J, Hurley R, Grant HR, Patel A (2003) A new technique for the management of inaccessible anterior glottic lesions. J Laryngol Otol 117:302–306CrossRefPubMedGoogle Scholar
Ogata J (2004) The airway management using laryngeal mask airway and tracheal fiberoscopy in a paediatric patient with tracheal stenosis after tracheostomy. Masui 53:1282–1285PubMedGoogle Scholar
Campbell CJ, Rittler MC, Koester CJ (1963) The optical maser as a retinal coagulator: an evaluation. Trans Am Acad Ophthalmol Otolaryngol 67:58–67PubMedGoogle Scholar
Noyori KS, Campbell CJ, Rittler MC, Koester CJ (1963) Ocular thermal effects produced by photocoagulation. Arch Ophtalmol 70:817–822CrossRefGoogle Scholar
Jamel HD (1992) Effect of brief exposure to mitomycin-C on viability and proliferation of cultured human Tenon’s capsule fibroblasts. Ophthalmology 99:1471–1476CrossRefGoogle Scholar
Khaw PT, Sherwood MB, MacKay SL et al (1992) Five-minute treatments with fluorouracil, floxuridine, and mitomycin have long-term effects on human Tenon’s capsule fibroblasts. Arch Ophthalmol 110:1150–1154CrossRefPubMedGoogle Scholar
Lee DA, Lee TC, Cortes AE et al (1990) Effects of mitramycin, mitomycin, daunorubicin and bleomycin on human subconjunctival fibroblasts attachment and proliferation. Invest Ophtalmol Vis Sci 31:2136–2144Google Scholar
Myers L, Bakthavachalam S, Thomason T, Klein K (2006) Holmium: Yag laser fiberoptic bronchoscopy via Laryngeal mask airway. Int J Otorhinolaryngol 6(2):1–4Google Scholar