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

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 2years 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 1year with 1, 3, 6months and 1year 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 1year. 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 1year 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.