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Original Investigation
May 2017

Endoscopic Management of Subglottic Stenosis

Author Affiliations
  • 1Department of Head and Neck Surgery, David Geffen School of Medicine at University of California Los Angeles
  • 2medical student at David Geffen School of Medicine at University of California Los Angeles
JAMA Otolaryngol Head Neck Surg. 2017;143(5):500-505. doi:10.1001/jamaoto.2016.4131
Key Points

Question  Are surgical techniques or adjunctive intraoperative medical therapies associated with the length of time between endoscopic surgical procedures in treatment of subglottic stenosis?

Findings  In this retrospective analysis of 101 patients, we did not identify a difference in duration between operations according to surgical technique or use of glucocorticoid injection. Application of topical mitomycin was associated with an increased duration between operations.

Meaning  Mitomycin may be a useful adjunctive therapy for patients with subglottic stenosis requiring endoscopic surgery, worthy of further study in prospective trials.

Abstract

Importance  Optimal management of subglottic stenosis has not been established. Endoscopic techniques include balloon dilation, radial incisions with carbon dioxide laser or cold knife, and combinations of techniques. Adjunctive measures include mitomycin application and glucocorticoid injection.

Objective  To determine whether surgical technique or adjunctive measures are associated with duration between surgical procedures.

Design, Setting, and Participants  Adult patients with subglottic stenosis treated endoscopically between 1995-2015 at a quaternary academic medical center were identified. Patients with isolated subglottic (cricotracheal) stenosis 18 years and older were included. Patients with prior open surgical procedures, prior laryngeal surgical procedures, glottic stenosis, or vocal fold paralysis were excluded.

Interventions  Patients underwent endoscopic procedures including laser radial incisions, balloon dilation, or both, with some patients receiving topical mitomycin, glucocorticoid injection, or both.

Main Outcomes and Measures  Time interval between endoscopic treatments.

Results  A total of 101 patients (mean [SD] age, 52.3 [15.9] years; 77.2% female) were included in the analysis, with etiologies including idiopathic (47 [46.5%]), intubation (31 [30.7%]), granulomatosis with polyangiitis (9 [8.9%]), and other autoimmune diseases (6 [5.9%]). Among the 219 operations, both laser and balloon dilation were used in 117 (53.4%), while balloon dilation alone was used in 96 (43.8%) and laser alone in 6 (2.7%). Mitomycin application and steroid injection were used in 144 (65.8%) and 93 (42.5%) cases, respectively. Mitomycin application was associated with improvement in the mean interval to next procedure from 317 to 474 days (absolute difference, 157 days; 95% CI, 15-299 days). Advanced grade of stenosis, dilation technique, and steroid injection did not significantly alter the surgical intervals.

Conclusions and Relevance  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.

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