Treatment of Adult Idiopathic Subglottic Stenosis with CO2 Laser and Balloon Dilation

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Author: Brandon Kim
Published:
Specialties: Otolaryngology
Schools: Emory School of Medicine, University of Southern California
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Basic Info

Contributors: Michael M. Johns III and  Benjamin Anthony

The patient is a 53 year-old female with history of idiopathic subglottic stenosis and long-standing right vocal fold scarring who had previously been treated endoscopically in the operating room and in the office with steroid injections. She returns to the operating room for scheduled endoscopic CO2 laser treatment, Depo-Medrol injection (not shown), balloon dilation, and Mitomycin C application (not shown).

DOI: http://dx.doi.org/10.17797/p7s4gn9n20

Editor Recruited By: Michael M. Johns, III, MD

Advanced

Procedure

1. Mask induction achieved. 2. Ossoff-Pilling microlaryngoscope introduced, patient suspended, and jet ventilation initiated. 3. Using operating microscope and AcuBlade CO2 laser, releasing incisions made at 12 o? clock, 1 o?clock, and 4 o?clock with a wedge resection at 4 o? clock. 4. Depo-Medrol injected into surrounding tissues (not shown). 5. Acclarent 16 mm balloon dilated for 60 seconds. 6. Mitomycin C 0.4 mg/mL applied topically for 2 minutes (not shown).

Indications

Adult Idiopathic Subglottic Stenosis

Contraindications

Inability to tolerate general anesthesia or achieve adequate oxygenation/ventilation via face mask and jet ventilation. Treatment medication allergy.

Instrumentation

Setup

Mask ventilation, Ossoff Pilling Microlaryngoscope, Suspension Arm, Operating Microscope, AcuBlade CO2 laser, Laryngeal injection needle with Depo-Medrol, Acclarent 16 mm endoscopic balloon, and Mitomycin C.

Preoperative Workup

Prior scope imaging and cross-sectional radiological imaging. Clinical and/or laboratory analyses to rule out Granulomatosis with Polyangitis and clinical assessment for Gastroesophageal Reflux Disorder.

Anatomy and Landmarks

Suspension Microlaryngoscopy to identify glottic airway and identify the subglottis stenosis. Limit treatment to the subglottic narrowing without applying laser energy to tracheal wall proper or extra-luminally.

Advantages/Disadvantages

Well-tolerated without external scar but subglottic stenosis may recur.

Complications/Risks

Orodental trauma, injury to trachea, esophageal perforation, laser injury (including to eyes and skin), pneumothorax, adverse reaction to medication, pain, bleeding, infection, scarring, failure of the intended procedure, recurrence of subglottic stenosis, loss of airway, death.

Disclosure of Conflicts

Orodental trauma, injury to trachea, esophageal perforation, laser injury (including to eyes and skin), pneumothorax, adverse reaction to medication, pain, bleeding, infection, scarring, failure of the intended procedure, recurrence of subglottic stenosis, loss of airway, death.

Acknowledgements

None

References

None

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