OBJECTIVES/HYPOTHESIS: To assess the efficacy of endoscopic laser radial incisions with mitomycin-C application (ELRM) in managing adult subglottic stenosis (SGS). STUDY DESIGN: Retrospective case series review. METHODS: Fifteen consecutive cases of adult SGS treated with ELRM at a single tertiary referral center over three years were reviewed. Subjects with SGS secondary to Wegener's granulomatosis (WG) and idiopathic SGS were included. Patients with cartilaginous SGS were excluded. The primary outcome measure was postoperative reduction in symptoms. Secondary outcome measures included total number of procedures required to relieve symptoms, interval between procedures, and improvement in pulmonary function tests when available. In addition to surgery, 14 of 15 patients were treated medically for reflux. RESULTS: Ten women and five men with average age 48 years were identified. Ten patients had idiopathic SGS and five had WG. The predominant presenting symptom was dyspnea on exertion in all patients. All subjects reported at least a temporary postoperative reduction in symptoms. Six patients (40%) required only one ELRM and nine patients (60%) required repeat ELRM at an average interval of 9 months. The average interval for the six patients with idiopathic etiology requiring a second procedure was 9 months. One subject with WG required four procedures. His interval improved from 2.5 to 7 months between procedures. Evidence of extrathoracic airway obstruction resolved in three of four patients with pre and postoperative pulmonary function tests. CONCLUSIONS: ELRM is an effective method of managing SGS associated with idiopathic causes. In patients with WG, ELRM reduced airway associated symptoms and avoided need for tracheotomy.
OBJECTIVES/HYPOTHESIS: To assess the efficacy of endoscopic laser radial incisions with mitomycin-C application (ELRM) in managing adult subglottic stenosis (SGS). STUDY DESIGN: Retrospective case series review. METHODS: Fifteen consecutive cases of adult SGS treated with ELRM at a single tertiary referral center over three years were reviewed. Subjects with SGS secondary to Wegener's granulomatosis (WG) and idiopathic SGS were included. Patients with cartilaginous SGS were excluded. The primary outcome measure was postoperative reduction in symptoms. Secondary outcome measures included total number of procedures required to relieve symptoms, interval between procedures, and improvement in pulmonary function tests when available. In addition to surgery, 14 of 15 patients were treated medically for reflux. RESULTS: Ten women and five men with average age 48 years were identified. Ten patients had idiopathic SGS and five had WG. The predominant presenting symptom was dyspnea on exertion in all patients. All subjects reported at least a temporary postoperative reduction in symptoms. Six patients (40%) required only one ELRM and nine patients (60%) required repeat ELRM at an average interval of 9 months. The average interval for the six patients with idiopathic etiology requiring a second procedure was 9 months. One subject with WG required four procedures. His interval improved from 2.5 to 7 months between procedures. Evidence of extrathoracic airway obstruction resolved in three of four patients with pre and postoperative pulmonary function tests. CONCLUSIONS: ELRM is an effective method of managing SGS associated with idiopathic causes. In patients with WG, ELRM reduced airway associated symptoms and avoided need for tracheotomy.
Authors: Aaron J Feinstein; Alex Goel; Govind Raghavan; Jennifer Long; Dinesh K Chhetri; Gerald S Berke; Abie H Mendelsohn Journal: JAMA Otolaryngol Head Neck Surg Date: 2017-05-01 Impact factor: 6.223
Authors: Caitlin Bertelsen; Hagit Shoffel-Havakuk; Karla O'Dell; Michael M Johns; Lindsay S Reder Journal: JAMA Otolaryngol Head Neck Surg Date: 2018-03-01 Impact factor: 6.223
Authors: Lena W Chen; Ioan Lina; Kevin Motz; Alexandra J Berges; Rafael Ospino; Philip Seo; Alexander T Hillel Journal: Otolaryngol Head Neck Surg Date: 2021-04-13 Impact factor: 3.497
Authors: Tuhina Raman; Kshitij Chatterjee; Bashar N Alzghoul; Ayoub A Innabi; Ozlem Tulunay; Thaddeus Bartter; Nikhil K Meena Journal: SAGE Open Med Case Rep Date: 2017-06-06