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

  • Ashish Deshmukh
  • Sunil Jadhav
  • Virendra Wadgoankar
  • Unmesh Takalkar
  • Hafiz Deshmukh
  • Pramod Apsingkar
  • Pravin Sonwatikar
  • Philips Antony
Original Article
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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 2 years 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 1 year with 1, 3, 6 months and 1 year 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 1 year. 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 1 year 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.

Keywords

Tracheal stenosis Laryngeal mask airway Laser ablation Mitomycin-C Bronchoscopic balloon dilatation 

Notes

Acknowledgement

The authors would like to thank MGM Medical College and Hospital, Auranagabad and Residents of Department of Respiratory Medicine.

Compliance with Ethical Standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical Approval

All procedures performed in this study involving human participants were in accordance with the ethical standards of the institution and with the 1964 Helsinki declaration and its later amendments. This article does not contain any studies with animals performed by any of the authors. For this type of study formal consent is not required.

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Copyright information

© Association of Otolaryngologists of India 2018

Authors and Affiliations

  • Ashish Deshmukh
    • 1
    • 2
  • Sunil Jadhav
    • 1
    • 2
  • Virendra Wadgoankar
    • 1
  • Unmesh Takalkar
    • 3
  • Hafiz Deshmukh
    • 4
  • Pramod Apsingkar
    • 5
  • Pravin Sonwatikar
    • 6
  • Philips Antony
    • 4
  1. 1.United CIIGMA HospitalAurangabadIndia
  2. 2.Department of Respiratory MedicineMGM Medical College and HospitalAurangabadIndia
  3. 3.Department of General Surgery and LaparoscopyUnited Ciigma HospitalAurangabadIndia
  4. 4.Department of Respiratory MedicineMGM Medical College and HospitalAurangabadIndia
  5. 5.Department of AnaesthesiologyUnited Ciigma HospitalAurangabadIndia
  6. 6.Department of OtorhinolaryngologyUnited Ciigma HospitalAurangabadIndia

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