Abstract
Laryngeal stenosis is one of the most complex and challenging problems in the field of head and neck surgery. The management involves a multidisciplinary approach with multiple complex procedures. In this study we discuss our experience of laryngeal stenosis with regards to patient characteristics, cause and management. A retrospective analysis of 35 patients of laryngeal stenosis treated at a tertiary care centre was evaluated. Inclusion criteria were all patients with laryngeal stenosis who required surgical intervention. Exclusion criteria were patients with associated tracheal stenosis and laryngeal stenosis due to cancer. Demographic data was recorded and findings relating to aetiology, characteristics of stenosis and the various aspects of therapeutic procedures performed are discussed with review of literature. Among 35 patients, 24 were males and 11 females of the age group 2–79 years. 2 (5.7 %) patients had supraglottic stenosis, 11 (31.4 %) had glottis stenosis, 16 (45.7 %) had subglottic stenosis and 6 (17.1 %) had combined multiple sites stenosis. Each patient underwent an average of 3.22 surgical procedures like microlaryngoscopy and excision with cold instrument, CO2 laser excision or open procedures like laryngofissure and excision and laryngoplasty. Montgomery t tube insertion was a common procedure in 17 patients (48.6 %). Of the total 35 patients with severe LS, 27 (77.1 %) patients were successfully decanulated. The results of glottic (100 %) and supraglottic stenosis (100 %) are excellent as compared to subglottic (68.8 %) and combined stenosis (50 %) of multiple sites. Laryngeal stenosis with airway compromise causes significant morbidity to the patients and is a difficult condition to treat in both adult and pediatric population. The need for multiple surgical procedures is common in the treatment of laryngeal stenosis with the t-tube being an important aid in the management of this condition. Trauma especially post intubation trauma is the commonest cause of laryngeal stenosis and the involvement of subglottis has poor outcome as compared to other subsites.
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References
Gallo A, Pagliuca G, Greco A, Martellucci S, Mascelli A, Fusconi M, de Vincentiis M (2012) Laryngotracheal stenosis treated with multiple surgeries: experience, results and prognostic factors in 70 patients. Acta Otorhinolaryngol Ital 32:182–188
Shekhar A, Natarajan K, Sampath R, Kameswaran M, Murali S (2012) Outcomes in management of paediatric laryngotracheal stenosis: our experience. Int J Phonosurgery Laryngol 2(1):14–19
Maran AGD (1997) Trauma and stenosis of larynx. In: Alan G, Kerr ED (eds) Scott-brown’s otolaryngology, vol 5, 6th edn. Butterworth-Heinemann, Oxford
Roediger FC, Orloff LA, Courey MS (2008) Adult subglottic stenosis: management with laser incisions and mitomycin-C. Laryngoscope 118:1542–1546
Cotton RT (1984) Pediatric laryngeal stenosis. J Pediatr Surg 19(6):699–704
Yamamoto K, Kojima F, Tomiyama K, Nakamura T, Hayashino Y (2011) Meta-analysis of therapeutic procedures for acquired subglottic stenosis in adults. Ann Thorac Surg 91(6):1747–1753
Maresh A, Preciado DA, O’Connell AP, Zalzal GH (2014) A comparative analysis of open surgery versus endoscopic balloon dilation for pediatric subglottic stenosis. JAMA Otolaryngol Head Neck Surg 140(10):901–905
Lang M, Brietzke SE (2014) A systematic review and meta-analysis of endoscopic balloon dilation of pediatric subglottic stenosis. Otolaryngol Head Neck Surg 150(2):174–179
Montgomery WW, Montgomery SK (1990) Manual for use of Montgomery laryngeal, tracheal, and esophageal prostheses: up- date 1990. Ann Otol Rhinol Laryngol Supp 99:1–28
Aslan H, Öztürkcan S, Eren E, Başoğlu M, Songu M, Kulduk E, Kılavuz A, Katılmış H (2013) Results of Montgomery T-tube in primary treatment of laryngotracheal stenosis. Int J Otolaryngol Head Neck Surg 2(5):151–155
Dass A, Nagarkar NM, Singhal SK, Verma H (2014) Tracheal T-tube stent for laryngotracheal stenosis: ten year experience. Iran J Otorhinolaryngol 26(74):37–42
Prasanna Kumar S, Ravikumar A, Senthil K, Somu L, Nazrin MI (2014) Role of Montgomery T-tube stent for laryngotracheal stenosis. Auris Nasus Larynx 41(2):195–200
Shi S, Chen D, Li X, Wen W, Shen X, Liu F, Chen S, Zheng H (2014) Outcome and safety of the montgomery T-tube for laryngotracheal stenosis: a single-center retrospective analysis of 546 cases. ORL 76(6):314–320
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Nair, S., Nilakantan, A., Sood, A. et al. Challenges in the Management of Laryngeal Stenosis. Indian J Otolaryngol Head Neck Surg 68, 294–299 (2016). https://doi.org/10.1007/s12070-015-0936-2
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DOI: https://doi.org/10.1007/s12070-015-0936-2