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. 2019 Oct;71(Suppl 1):453-458.
doi: 10.1007/s12070-018-1348-x. Epub 2018 Apr 12.

Airway Management and Bronchoscopic Treatment of Subglottic and Tracheal Stenosis Using Holmium Laser with Balloon Dilatation

Ashish Deshmukh  1   2 , Sunil Jadhav  1   2 , Virendra Wadgoankar  1 , Unmesh Takalkar  3 , Hafiz Deshmukh  4 , Pramod Apsingkar  5 , Pravin Sonwatikar  6 , Philips Antony  4
Affiliations

Airway Management and Bronchoscopic Treatment of Subglottic and Tracheal Stenosis Using Holmium Laser with Balloon Dilatation

Ashish Deshmukh et al. Indian J Otolaryngol Head Neck Surg. 2019 Oct.

Abstract

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.

Keywords: Bronchoscopic balloon dilatation; Laryngeal mask airway; Laser ablation; Mitomycin-C; Tracheal stenosis.

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Conflict of interest statement

Conflict of interestThe authors declare that they have no conflict of interest.

Figures

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Fig. 1
Pre Treatment
Fig. 2
Fig. 2
Post surgical intervention
Fig. 3
Fig. 3
One year post treatment
See this image and copyright information in PMC

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