Advertisement

Management of Subglottic Stenosis and Subglottic Stenosis in Systemic Disease

  • António BugalhoEmail author
Chapter

Abstract

Subglottic stenosis (SGS) remains a difficult therapeutic problem for the interventional pulmonologist. It may be classified as congenital or acquired. Acquired causes frequently result from iatrogenic injuries. Further etiologies include tumors, infections, and rare diseases such as Wegener’s granulomatosis, relapsing polychondritis, and amyloidosis. Bronchoscopy is the primary procedure for the diagnostic and pre-interventional evaluation of these patients. Laser resection, dilatation, local adjuvant drugs, and airway stents have been used individually or in combination to manage SGS. Endoscopic treatment has a high success rate in simple low-grade stenoses and constitutes a valid option for patients that are unsuitable candidates for surgery. Complex stenoses often require a multidisciplinary approach. There is no universally accepted treatment strategy that consistently relieves symptoms and avoids recurrence in all patients. Management must be individualized according to pathological findings and the patient’s health status. Current minimally invasive techniques performed wisely and proficiently allow the interventional pulmonologist to overcome most problems related to SGS.

Keywords

Vocal Cord Adenoid Cystic Carcinoma Granular Cell Tumor Relapse Polychondritis Subglottic Stenosis 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Suggested Reading

  1. 1.
    Brichet A, Verkindre C, Dupont J, Carlier ML, Darras J, Wurtz A, Ramon P, Marquette CH. Multidisciplinary approach to management of postintubation tracheal stenoses. Eur Respir J. 1999;13(4):888–93.PubMedCrossRefGoogle Scholar
  2. 2.
    Carretta A, Casiraghi M, Melloni G, Bandiera A, Ciriaco P, Ferla L, Puglisi A, Zannini P. Montgomery T-tube placement in the treatment of benign tracheal lesions. Eur J Cardiothorac Surg. 2009;36(2):352–6.PubMedCrossRefGoogle Scholar
  3. 3.
    Cavaliere S, Bezzi M, Toninelli C, Foccoli P. Management of post-intubation tracheal stenoses using the endoscopic approach. Monaldi Arch Chest Dis. 2007;67(2):73–80.PubMedGoogle Scholar
  4. 4.
    Colt HG, Harrell J, Neuman TR, Robbins T. External fixation of subglottic tracheal stents. Chest. 1994;105(6):1653–7.PubMedCrossRefGoogle Scholar
  5. 5.
    Damrose E. On the development of idiopathic subglottic stenosis. Med Hypotheses. 2008;71(1):122–5.PubMedCrossRefGoogle Scholar
  6. 6.
    Ernst A, Rafeq S, Boiselle P, Sung A, Reddy C, Michaud G, Majid A, Herth FJ, Trentham D. Relapsing polychondritis and airway involvement. Chest. 2009;135(4):1024–30.PubMedCrossRefGoogle Scholar
  7. 7.
    Freitag L, Ernst A, Unger M, Kovitz K, Marquette CH. A proposed classification system of central airway stenosis. Eur Respir J. 2007;30(1):7–12.PubMedCrossRefGoogle Scholar
  8. 8.
    Galluccio G, Lucantoni G, Battistoni P, Paone G, Batzella S, Lucifora V, Dello Iacono R. Interventional endoscopy in the management of benign tracheal stenoses: definitive treatment at long-term follow-up. Eur J Cardiothorac Surg. 2009;35(3):429–33.PubMedCrossRefGoogle Scholar
  9. 9.
    Herrington HC, Weber SM, Andersen PE. Modern management of laryngotracheal stenosis. Laryngoscope. 2006;116(9):1553–7.PubMedCrossRefGoogle Scholar
  10. 10.
    Hirshoren N, Eliashar R. Wound-healing modulation in upper airway stenosis – myths and facts. Head Neck. 2009;31(1):111–26.PubMedCrossRefGoogle Scholar
  11. 11.
    Hoffman GS, Thomas-Golbanov CK, Chan J, Akst LM, Eliachar I. Treatment of subglottic stenosis, due to Wegener’s granulomatosis, with intralesional corticosteroids and dilation. J Rheumatol. 2003;30(5):1017–21.PubMedGoogle Scholar
  12. 12.
    Ko PJ, Liu CY, Wu YC, Chao YK, Hsieh MJ, Wu CY, Wang CJ, Liu YH, Liu HP. Granulation formation following tracheal stenosis stenting: influence of stent position. Laryngoscope. 2009;119(12):2331–6.PubMedCrossRefGoogle Scholar
  13. 13.
    Langford CA, Sneller MC, Hallahan CW, Hoffman GS, Kammerer WA, Talar-Williams C, Fauci AS, Lebovics RS. Clinical features and therapeutic management of subglottic stenosis in patients with Wegener’s granulomatosis. Arthritis Rheum. 1996;39(10):1754–60.PubMedCrossRefGoogle Scholar
  14. 14.
    Lano Jr CF, Duncavage JA, Reinisch L, Ossoff RH, Courey MS, Netterville JL. Laryngotracheal reconstruction in the adult: a ten year experience. Ann Otol Rhinol Laryngol. 1998;107(2):92–6.PubMedGoogle Scholar
  15. 15.
    Lee KH, Rutter MJ. Role of balloon dilation in the management of adult idiopathic subglottic stenosis. Ann Otol Rhinol Laryngol. 2008;117(2):81–4.PubMedGoogle Scholar
  16. 16.
    Mark EJ, Meng F, Kradin RL, Mathisen DJ, Matsubara O. Idiopathic tracheal stenosis: a clinicopathologic study of 63 cases and comparison of the pathology with chondromalacia. Am J Surg Pathol. 2008;32(8):1138–43.PubMedCrossRefGoogle Scholar
  17. 17.
    Martinez-Ballarin JI, Diaz-Jimenez JP, Castro MJ, Moya JA. Silicone stents in the management of benign tracheobronchial stenoses. Tolerance and early results in 63 patients. Chest. 1996;109(3):626–9.PubMedCrossRefGoogle Scholar
  18. 18.
    McCaffrey TV. Classification of laryngotracheal stenosis. Laryngoscope. 1992;102(12Pt1):335–40.Google Scholar
  19. 19.
    Mehta AC, Lee FY, Cordasco EM, Kirby T, Eliachar I, De Boer G. Concentric tracheal and subglottic stenosis. Management using the Nd-YAG laser for mucosal sparing followed by gentle dilatation. Chest. 1993;104(3):673–7.PubMedCrossRefGoogle Scholar
  20. 20.
    Melkane AE, Matar NE, Haddad AC, Nassar MN, Almoutran HG, Rohayem Z, Daher M, Chalouhy G, Dabar G. Management of postintubation tracheal stenosis: appropriate indications make outcome differences. Respiration. 2010;79(5):395–401.PubMedCrossRefGoogle Scholar
  21. 21.
    Monnier P, George M, Monod ML, Lang F. The role of CO2 laser in the management of laryngotracheal stenosis: a survey of 100 cases. Eur Arch Otorhinolaryngol. 2005;262(8):602–8.PubMedCrossRefGoogle Scholar
  22. 22.
    Myer 3 CM, O’Connor DM, Cotton RT. Proposed grading system for subglottic stenosis based on endotracheal tube sizes. Ann Otol Rhinol Laryngol. 1994;103(4 Pt 1):319–23.PubMedGoogle Scholar
  23. 23.
    Nouraei SA, Nouraei SM, Randhawa PS, Butler CR, Magill JC, Howard DJ, Sandhu GS. Sensitivity and responsiveness of the Medical Research Council dyspnoea scale to the presence and treatment of adult laryngotracheal stenosis. Clin Otolaryngol. 2008;33(6):575–80.PubMedCrossRefGoogle Scholar
  24. 24.
    Nouraei SA, Obholzer R, Ind PW, Salama AD, Pusey CD, Porter F, Howard DJ, Sandhu GS. Results of endoscopic surgery and intralesional steroid therapy for airway compromise due to tracheobronchial Wegener’s granulomatosis. Thorax. 2008;63(1):49–52.PubMedCrossRefGoogle Scholar
  25. 25.
    Piazza C, Cavaliere S, Foccoli P, Toninelli C, Bolzoni A, Peretti G. Endoscopic management of laryngo-tracheobronchial amyloidosis: a series of 32 patients. Eur Arch Otorhinolaryngol. 2003;260(7):349–54.PubMedCrossRefGoogle Scholar
  26. 26.
    Roh JL, Lee YW, Park HT. Effect of acid, pepsin, and bile acid on the stenotic progression of traumatized subglottis. Am J Gastroenterol. 2006;101(6):1186–92.PubMedCrossRefGoogle Scholar
  27. 27.
    Shapshay SM, Beamis Jr JF, Dumon JF. Total cervical tracheal stenosis: treatment by laser, dilation, and stenting. Ann Otol Rhinol Laryngol. 1989;98(11):890–5.PubMedGoogle Scholar
  28. 28.
    Simpson GT, Strong MS, Healy GB, Shapshay SM, Vaughan CW. Predictive factors of success or failure in the endoscopic management of laryngeal and tracheal stenosis. Ann Otol Rhinol Laryngol. 1982;91(4Pt1):384–8.PubMedGoogle Scholar
  29. 29.
    Veen EJ, Dikkers FG. Topical use of mitomycin c in the upper aerodigestive tract: a review on the side effects. Eur Arch Otorhinolaryngol. 2010;267(3):327–34.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  1. 1.Interventional Pulmonology Unit, Hospital Beatriz Angelo, Loures, Portugal and Pulmonology Department, Chronic Diseases Research Center, Faculty of Medical Sciences, LisbonHospital Beatriz Angelo and Universidade Nova de LisboaLisbonPortugal

Personalised recommendations