ABSTRACT

Background: The treatment for the acquired subglottic stenosis almost in the actuality is controversial, it will depend of the experience of the physician, the condition of the patient, the grade of stenosis and the medical resources of the hospital. The objective of this article is show the endoscopic treatment that is offer in the Bronchoscopy Service of the Instituto Nacional de Enfermedades Respiratorias in the last 5 years. Methods: It was review all the expedients with diagnostic of acquired subglottic stenosis in the Bronchoscopy Service of the INER between January 1 of the 2004 to July 30 of 2008. Results: The patients were classified by the grade of stenosis based on the Cotton classification in the following form: grade 1 (27), grade 2 (7), grade 3 (6), grade 4 (1). They were dilated (13), dilated and with application of mitomycin C (8), conserve treatment and follow up (20). Conclusion: In the Bronchoscopy Service of the INER the dilated with endotracheal tube with metallic guide and with balloon of controlled radial pressure are a safety, efficacy and economic treatment.

KEYWORDS

Bronchoscopic, subglottic stenosis, pediatric, treatment.

REFERENCES

1. McClay J. Subglottic stenosis. Otolaryngol Clin North Am 2006; 33(1): 111-130.

2. Urday G, Jiménez H. Estenosis laringotraqueales. Sisbib Tomo V, Pag 1-7.

3. Catlin F, Smith R. Acquired subglottic stenosis in children. Ann Otol Rhinol Laryngol 1987; 96: 488-492.

4. Cotton R. Management of subglottic stenosis. Otolaryngologic Clinics of North America 2000; 33: 1-19.

5. Benjamín B. Prolonged intubation injuries of the larynx: endoscopic diagnosis, classification, and treatment. Ann Otol Rhinol Laryngol 1993; 160: 1-15.

6. Myer C, Cotton R, Connor D. Proposed grading system for subglottic stenosis based on endotracheal tube sizes. Ann Otol Rhinol Laryngol 1994; 103: 319-323.

7. Mehta A, Harris R, De Boer G. Endoscopic management or benign airway stenosis. Clinics in Chest Medicine 1995; 16: 401-413.

8. Simpson G, Stuart M, Shapshay S, Healy G, Vaughan C. Predictive factors of success or failure in the endoscopic management of laryngeal and tracheal stenosis. Ann Otol Rhinol Laryngol 1982; 91: 384-388.

9. Maronian N, Waugh P, Azadeh H, Hillel A. Association of laryngopharyngeal reflux disease and subglottic stenosis. Ann Otol Rhinol Laryngol 2001; 110: 606-612.

10. Briscoe M, Ulualp S, Quinn F. Pediatric congenital subglottic stenosis. Clinical Otolaryngol 2007; 24(2): 117-121.

11. Ludemann J, Noah Z, Hughes C, Holinger L. Complications of pediatric laryngotracheal reconstruction: prevention strategies. Ann Otol Rhinol Laryngol 1999; 108: 1019-1026.

12. Kotton B. The treatment of subglottic stenosis in children by prolonged dilatation. The Laryngoscope 1979; 89: 1983-1990.

13. Warner D, Brietzke S. Mitomycin C and airway surgery: How well does it work? Otolaryngol Head Neck Surg 2008; 138: 700-709.

14. Rahbar R, Shapsay S, Healy G. Mitomycin: effects on laryngeal and tracheal stenosis, benefits, and complications. Ann Otol Rhinol Laryngol 2001; 110: 1-6.

15. Braidy J, Breton G, Clement L. Effects of corticosteroids on post-intubation tracheal stenosis. Thorax 1989; 44: 753-755.

16. McCurdy E, Simpson B. Airway complications from topical mitomycin C. Head Neck Surg 2005; 133: 831-835.

17. Shvidler J, Bothwell N, Cable B. Refining indications for the use of mitomycin C using a randomized controlled trial with an animal model. Head Neck Surg 2007; 136: 653-657.

18. Fearon B, Crysdale W, Bird R. Subglottic stenosis of the larynx in the infant and child: methods of management. Ann Otol 1978; 87: 645-648.

19. Axon P, Hartley C, Rothera P. Endoscopic balloon dilatation of subglottic stenosis. Journal of Laryngology and Otology 1995; 109: 876-879.

20. Holinger L. Histopathology of congenital subglottic stenosis. Ann Otol Rhinol Laryngol 1999; 108: 101-111.

21. Mehta A, Lee F, Cordasco E, Kirby T, Eliachar I. Concentric tracheal and subglottic stenosis. Chest 1993; 104: 673-677.

22. Mayse M, Greenheck J, Friedman M, Kovitz K. Successful bronchoscopic balloon dilation of non-malignant tracheobronquial obstruction without fluoroscopy. Chest 2004; 126: 634-637.

23. Schweinfurth J. Endoscopic treatment of severe tracheal stenosis. Ann Otol Rhinol Laryngol 2006; 115: 30-34.

24. Shapshay S, Hybels R, Beamis J, Bohigian R. Endoscopic treatment of subglottic and tracheal stenosis by radial laser incision and dilation. Ann Otol Rhinol Laryngol 1987; 96: 661-664.

25. Pashley N. Customized dilator for the treatment of subglottic stenosis in children. Ann Otol 1981; 90: 287.