Surgical treatment of subglottic stenosis

Abstract

IntroductionSubglottic stenosis is rare, its primary pathogenic mechanism being tracheal intubation. Its incidence has declined in recent decades due to improved material and reduced intubation time. The objective of this study was to analyse the experience in treating this disease, emphasising the type of treatment used, the rate of decannulation obtained, symptomatic changes after treatment, and the total number of procedures performed per patient. Materials and methodsThe study included 16 patients diagnosed and treated for subglottic stenosis in our department from 1995 to 2007. Clinicopathologic data were collected including: age, sex, etiology and severity (the Cotton classification), diagnostic methods used, type of treatment, progression of symptoms, decannulation and number of procedures performed per patient.To identify changes, morbidity and success rate with the proposed treatment, we analysed our results, comparing them with those collected in other studies. ResultsOf the cases analysed, 75% were women, with a mean age of 60 years; 75% of the total cases had a history of prolonged intubation. The presenting symptom was dyspnea (94%), and 69% required an emergency tracheotomy. Ten patients were treated surgically: 7/10 CO2 laser, 2/10 dilation and 1/10 open surgery. Decannulation after surgery was possible in 60% of the total. The number of procedures per patient was 1.37. ConclusionsSubglottic stenosis treatment must be individualised based on patient characteristics, type of stenosis and severity. The use of endoscopic laser provides the best results in mild to moderate degrees with low morbidity. Open surgery was reserved for severe degrees, and after the failure of the CO2 laser.