OBJECTIVES: Idiopathic subglottic stenosis (iSGS) is a rare disease in which patients develop airway narrowing and dyspnea from relapsing subglottic and tracheal granulation and scar tissue that narrows the airway. Definitive management has involved surgical resection and reconstruction of the subglottis and trachea. However, treatment options remain highly variable at different institutions. Here, we present our outcomes and experience after cricotracheal resection (CTR) for iSGS at a high-volume tertiary care center. METHODS: A review of one surgeon's experience with a population of iSGS patients who underwent CTR between the years 1999 and 2017. The diagnosis of iSGS was one of exclusion and was based on history and microlaryngoscopy and bronchoscopy exams. Recurrence of subglottic stenosis was evaluated using Kaplan-Meier survival estimate analysis. RESULTS: Sixty-one patients met criteria for iSGS and underwent CTR. Our population was 97% female and had an average of 4.3 balloon dilations prior to CTR. Mean follow-up time after CTR was 7.14 years. Eight (13%) patients developed recurrence of subglottic stenosis after CTR. Mean and median time to recurrence after CTR was 12.5 years and 14.1 years, respectively. CONCLUSION: Cricotracheal resection is associated with a small, long-term recurrence rate of stenosis. It remains an important option for individuals with refractory iSGS. It may be reasonable to consider early CTR in the management of certain patients with iSGS. Further research should investigate risk factors that predispose patients to recurrence after CTR. LEVEL OF EVIDENCE: 4. Laryngoscope, 128:2268-2272, 2018.
OBJECTIVES:Idiopathic subglottic stenosis (iSGS) is a rare disease in which patients develop airway narrowing and dyspnea from relapsing subglottic and tracheal granulation and scar tissue that narrows the airway. Definitive management has involved surgical resection and reconstruction of the subglottis and trachea. However, treatment options remain highly variable at different institutions. Here, we present our outcomes and experience after cricotracheal resection (CTR) for iSGS at a high-volume tertiary care center. METHODS: A review of one surgeon's experience with a population of iSGS patients who underwent CTR between the years 1999 and 2017. The diagnosis of iSGS was one of exclusion and was based on history and microlaryngoscopy and bronchoscopy exams. Recurrence of subglottic stenosis was evaluated using Kaplan-Meier survival estimate analysis. RESULTS: Sixty-one patients met criteria for iSGS and underwent CTR. Our population was 97% female and had an average of 4.3 balloon dilations prior to CTR. Mean follow-up time after CTR was 7.14 years. Eight (13%) patients developed recurrence of subglottic stenosis after CTR. Mean and median time to recurrence after CTR was 12.5 years and 14.1 years, respectively. CONCLUSION: Cricotracheal resection is associated with a small, long-term recurrence rate of stenosis. It remains an important option for individuals with refractory iSGS. It may be reasonable to consider early CTR in the management of certain patients with iSGS. Further research should investigate risk factors that predispose patients to recurrence after CTR. LEVEL OF EVIDENCE: 4. Laryngoscope, 128:2268-2272, 2018.
Authors: Ruth J Davis; Ioan Lina; Kevin Motz; Alexander Gelbard; Robert R Lorenz; Guri S Sandhu; Alexander T Hillel Journal: Otolaryngol Head Neck Surg Date: 2021-07-13 Impact factor: 5.591