An Eleven-Year Review on Treatment Outcome after Endoscope-Based and Open Surgery for Subglottic Stenosis

Introduction:

The treatment of subglottic stenosis (SGS) remains a challenge. Objecitve of this study was the evaluation of treatment outcomes after open and endoscopic surgery for SGS focusing on endoscopic treatment.

Methods:

Retrospective chart review of patients treated between January 2005 and December 2016 at an academic tertiary referral center.

Results:

Forty-six patients (21 male, 25 female; mean age of 47.5 years) were treated via open surgery (43.4%, Myer-Cotton grade 2.62 in average) or endoscopically (56.5%, Myer-Cotton grade 1.69 in average). Endoscopic techniques included dilation (2 patients) or transoral removal of the stenosis with either cutting micro-instruments (15 patients) or a microdebrider (9 patients). Etiologies included idiopathic SGS (32.6%), intubation or tracheotomy (50.0%), granulomatosis with polyangiitis (6.5%), external trauma (6,5%), congenital SGS (2.2%) and prior surgery (2.2%). Pulmonary function test showed a mean increase of 40.7% for the forced inspiratory volume in 1 second after endoscopic surgery. One patient treated endoscopically (3.9%) consecutively needed major open airway surgery. Decannulation rate was 61.1% (11/18 patients) for open and 75.0% (3/4 patients) for endoscope-based surgery. Likelihood for recidivism at 5 years was 42.9% after open surgery, 100% after placement of suprastomal stents and 38.5% after endoscope-based surgery.

Conclusion:

With proper selection endoscopic techniques, including endoscopic removals with a microdebrider, seem to be safe with comparable results to open surgery for mild to moderate SGS. A shift to open laryngotracheal surgery is still possible.

Publication History

Publication Date:
18 April 2018 (online)