External Fixation of Subglottic Tracheal Stents: Discussion

External Fixation of Subglottic Tracheal Stents: DiscussionAn 84-year-old woman with diabetes mellitus, Guillain-Barre syndrome, and respiratory failure requiring intubation, tracheotomy, and prolonged mechanical ventilation was referred for bronchoscopy. Severe tracheal stenosis with malacia and granulation tissue of the upper trachea was discovered. Rigid bronchoscopic laser resection enlarged the subglottic region to 10 mm. A 16 mm/40 mm straight silicone stent was inserted, but would not expand. A 14 mm/40 mm stent was placed but was subsequently removed because it was loose-fitting. A No. 6 uncuffed, nonfenestrated tracheotomy cannula was, therefore, inserted, but the patient continued to have respiratory difficulty. Two weeks later, a 14 mm/50 mm specially manufactured silicone stent with an outer ring at its proximal tip was inserted. The next day, stent migration prompted reintervention to suture the stent into place. Allergy medications in detail One week later, granulation tissue was removed from below the vocal cords. Further stent obstruction has not occurred, and bronchoscopic follow-up has been uneventful.
Management of subglottic stenosis demands clinical experience and collaboration between otolaryngologists, thoracic surgeons, and interventional pulmonologists. Curative, single-stage laryngotracheal resection and reconstruction is frequently successful, but it may cause vocal cord and recurrent laryngeal nerve damage. Unfortunately, many potential candidates for open surgical intervention have concomitant medical illnesses that increase surgical risk. Results from more conservative approaches, such as the endoscopic microtrapdoor technique using the CO2 laser, have been promising, but this procedure is usually limited to small, thin stenoses less than 10 mm in length. Palliation, therefore, with Montgomery T-tubes is often used, and has several advantages: T-tubes are fixed by their sidearm, rarely migrate, provide easy access for bronchoscopy, and can be removed at the bedside. Disadvantages, however, include required maintenance of a tracheotomy, stomal infections, and respiratory discomfort because of obstruction by dried airway secretions. Some patients refuse the tracheotomy and “protruding” sidearm for esthetic reasons.

This entry was posted in Subglottic Tracheal Stents and tagged bronchoscope, granulation tissue, rigid bronchoscopies, subglottic stenosis, tracheal stenosis.