Adult Subglottic Stenosis: Management With Laser Incisions and Mitomycin-C

Department of Otolaryngology, Head and Neck Surgery, University of California, San Francisco, California, USA.
The Laryngoscope (Impact Factor: 2.14). 10/2008; 118(9):1542-6. DOI: 10.1097/MLG.0b013e318179247a
Source: PubMed


To assess the efficacy of endoscopic laser radial incisions with mitomycin-C application (ELRM) in managing adult subglottic stenosis (SGS).
Retrospective case series review.
Fifteen consecutive cases of adult SGS treated with ELRM at a single tertiary referral center over three years were reviewed. Subjects with SGS secondary to Wegener's granulomatosis (WG) and idiopathic SGS were included. Patients with cartilaginous SGS were excluded. The primary outcome measure was postoperative reduction in symptoms. Secondary outcome measures included total number of procedures required to relieve symptoms, interval between procedures, and improvement in pulmonary function tests when available. In addition to surgery, 14 of 15 patients were treated medically for reflux.
Ten women and five men with average age 48 years were identified. Ten patients had idiopathic SGS and five had WG. The predominant presenting symptom was dyspnea on exertion in all patients. All subjects reported at least a temporary postoperative reduction in symptoms. Six patients (40%) required only one ELRM and nine patients (60%) required repeat ELRM at an average interval of 9 months. The average interval for the six patients with idiopathic etiology requiring a second procedure was 9 months. One subject with WG required four procedures. His interval improved from 2.5 to 7 months between procedures. Evidence of extrathoracic airway obstruction resolved in three of four patients with pre and postoperative pulmonary function tests.
ELRM is an effective method of managing SGS associated with idiopathic causes. In patients with WG, ELRM reduced airway associated symptoms and avoided need for tracheotomy.

Download full-text


Available from: Lisa A Orloff,
  • [Show abstract] [Hide abstract]
    ABSTRACT: Hintergrund Ziel dieser Arbeit über Patienten mit symptomatischen subglottischen Trachealstenosen war die Beurteilung der Ergebnisse nach laserchirurgischer Auftrennung, kombiniert mit Applikation von Mitomycin C und/oder Triamcinolonacetonid. Material und Methoden Elf Patientinnen mit subglottischen Trachealstenosen wurden in 2 Gruppen unterteilt: idiopathische Trachealstenose (n = 6) und subglottische Stenose bekannter Ätiologie (n = 5, davon 4 mit M. Wegener und eine Patientin mit Polychondritis der Trachea). Drei Patientinnen zeigten Zeichen einer Refluxkrankheit. Die Auswertung erfolgte anhand des klinischen Bildes und des Atemwegswiderstands. Ergebnisse In allen Fällen wurde eine laserchirurgische Auftrennung der Stenose und die Applikation von Mitomycin C und Triamcinolonacetonid durchgeführt. Bei den Kontrolluntersuchungen in einem Beobachtungszeitraum von 7–72 Monaten wurde bei allen Patienten eine Verbesserung des Atemwegswiderstands sowie der klinischen Symptomatik festgestellt. Schlussfolgerung Eine oder mehrere CO2-Laserungen der stenotischen Bereiche, kombiniert mit intraläsionalen Steroidinjektionen und der topischen Anwendung von Mitomycin C, sind eine effektive Methode zur Behandlung von subglottischen Trachealstenosen. Die langfristige orale Steroidgabe und immunsuppressive Therapie sowie die Gabe von Protonenpumpenhemmern beeinflussen das postoperative Ergebnis ebenfalls positiv.
    HNO 06/2012; 60(6). DOI:10.1007/s00106-011-2447-0 · 0.58 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Free radicals derived primarily from oxygen have been implicated in the pathophysiology of a wide variety of human diseases. Quantification of products of free radical damage in biological systems is necessary to understand the role of free radicals in disease states. Measures of lipid peroxidation are often used to quantitate oxidative damage though many of these measures have inherent problems with sensitivity and specificity especially when used to quantitate in vivo oxidative injury. The discovery of the F(2)-isoprostanes (F(2)-IsoPs), prostaglandin F(2)-like compounds derived by the free radical peroxidation of arachidonic acid (AA, C20:4, omega-6) has largely overcome these limitations. The measurement of the F(2)-IsoPs has been shown to be one of the most accurate approaches to quantifying oxidative damage in vivo. We have extended our studies of lipid peroxidation and the F(2)-IsoPs to docosahexaenoic acid (DHA, C22:6, omega-3) and its peroxidation products. We have found that DHA oxidizes both in vitro and in vivo to form F(2)-IsoP-like compounds termed F(4)-neuroprostanes (F(4)-NPs). DHA is specifically enriched in neuronal membranes making the F(4)-NPs sensitive and specific markers of neuronal oxidative damage. Adapting the methodology used to quantitate the F(2)-IsoPs, we utilize stable isotope dilution, negative ion chemical ionization, gas chromatography mass spectrometry (GC/MS) to quantitate the F(4)-NPs with a limit of detection in the low picomolar range. Methods have been developed to quantitate both the F(4)-NPs and the neurofurans (NFs), DHA derived peroxidation products containing a substituted tetrahydrofuran ring, in brain tissue and cerebrospinal fluid. This review outlines in detail proper sample handling, extraction and hydrolysis of the F(4)-NPs and NFs from tissue membrane phospholipids or biological fluids, and purification and derivatization of the compounds for analysis by GC/MS.
    Methods in Enzymology 02/2007; 433:127-43. DOI:10.1016/S0076-6879(07)33007-3 · 2.09 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: The pulmonary vasculitides are a heterogeneous group of rare disorders that result from an inflammatory process damaging the vessel wall and consequent impaired blood flow, ischaemia and tissue necrosis. The clinical manifestation of these vasculitides depends on the site, size, type and severity of the inflammatory process. Vasculitis involving the airways is a common feature of the anti-neutrophil cytoplasmic antibody (ANCA)-associated systemic vasculitides (AASVs) and can predate the diagnosis by years. Secondary causes of vasculitis associated with connective tissue disorders are also capable of presenting with pulmonary features. Recognition of involvement, investigation and treatment are important to ameliorate symptoms for patients. This article concentrates on the assessment and specific management of upper and lower airway problems of AASV.
    Best practice & research. Clinical rheumatology 07/2009; 23(3):403-17. DOI:10.1016/j.berh.2009.02.003 · 2.60 Impact Factor
Show more