Open AccessAirway Management and Bronchoscopic Treatment of Subglottic and Tracheal Stenosis Using Holmium Laser with Balloon Dilatation
Author(s) -
Ashish Deshmukh,
Sunil Jadhav,
Virendra Wadgoankar,
Unmesh Takalkar,
Hafiz Deshmukh,
Pramod Apsingkar,
Pravin Sonwatikar,
Philips Antony
Publication year - 2018
Publication title -
indian journal of otolaryngology and head and neck surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.229
H-Index - 22
eISSN - 2231-3796
pISSN - 0973-7707
DOI - 10.1007/s12070-018-1348-x
Subject(s) - medicine , subglottic stenosis , surgery , airway , intubation , tracheal stenosis , tracheal tube , stenosis , subglottis , balloon , bronchoscopy , anesthesia , tracheal intubation , larynx , radiology , glottis
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.