An Updated Review of Subglottic Stenosis: Etiology, Evaluation, and Management

Abstract

Purpose of review: To assimilate the newly published literature regarding subglottic stenosis (SGS), including basic science and translational research on mechanisms of etiology, clinical diagnostics, and therapeutic treatments.

Recent findings: The role of inflammation in development of iatrogenic and idiopathic SGS (iSGS) is continuing to be studied. The IL-23/IL-17A inflammatory axis appears to be a potential mechanism for development of iSGS. Additionally, as anticipated in an inflammatory milieu, PD-1/PD-L1 expression is upregulated. If the PD-1/PD-L1 axis is important in SGS pathogenesis, then it may represent a potential target for immunotherapeutic inhibition, given its success in cancer treatment. In terms of surgical management, prospective studies show that endoscopic approaches have more frequent recurrence compared to open techniques.

Summary: SGS arises from various etiologies, and further understanding of its pathogenesis can aid in the development of novel therapies. It is imperative to obtain a thorough history for each patient presenting with respiratory complaints, as misdiagnosis can delay proper treatment. Endoscopic and open surgical techniques continue to be investigated in a growing number of prospective clinical trials to determine optimal treatment protocols. In-office injections are gaining popularity and show promise in the treatment of SGS.

Keywords: Iatrogenic; Idiopathic; Laryngotracheal stenosis; Review; Subglottic stenosis.

Fig. 1

Mild residual cricotracheal stenosis is seen in a patient following prolonged intubation (A). After appropriate topical anesthesia is achieved, corticosteroid is injected in submucosal fashion (B) through the cricothyroid space or anterior tracheal wall directly into the scar tissue, with blanching indicating proper placement (black asterisk). Avoidance of perforating the mucosa allows the injected material to remain in place without leakage. If additional posterior areas require treatment, the needle (white arrowhead) may also be passed transluminally into posterior scar tissue (C)