New approaches to the management of subglottic stenosis in Wegener's granulomatosis.

Further development of conservative endoscopic procedures at the CCF has provided patients with dependable surgical adjuncts to the systemic medications of WG. In most instances, a single surgical dilatation procedure stabilizes the patients at an airway diameter that exceeds 50% of the norm, thereby rendering the patient almost asymptomatic at rest and minimally restricted during exercise. The more chronic patients presenting with history of previous surgical procedures performed on their larynx and trachea, usually in other institutions, have been observed to require consecutive treatments after the original treatment, enjoying shorter symptom-free intervals. We have not encountered any local complications such as damage to the vocal cords, altered voice, or compromised structural integrity of the larynx and the trachea. The procedure has been found to be effective and well-tolerated as a means for treating, maintaining, and rehabilitating patients with chronic airway obstruction, particularly in those that have been initially treated by our service, and those that were managed from the very beginning of their disease. However, even the more difficult and complicated cases clearly demonstrate an improvement in their condition through the above treatment protocol, and the interval between treatments gradually increases in this group as well. The more aggressive long-term tube-free tracheostomy procedure, usually performed only on difficult and select patients with severe complications, has proven itself to be a highly gratifying procedure, achieving a permanent mode of management for these patients which safely allows for almost complete freedom from symptoms combined with good tolerance and functional rehabilitation. Video documentation will serve to further demonstrate the beneficial effects of both these modes of treatment.