External Fixation of Subglottic Tracheal Stents: Recommendation

Another therapeutic alternative, bronchoscopic laser resection and dilatation, is safe, provides rapid palliation with little associated morbidity, and can be repeated in case of recurrence. When possible, multiple radial incisions of circumferential scar tissue are made with the CO2 or Nd:YAG laser. More recently, the green, 532-nm wavelength (KTP) laser has also been used because of its dual cutting and coagulating properties. When resection is incomplete or impossible because stenoses are complex, caused by extrinsic compression, or are associated with tracheomalacia, stenting is desirable. Both coated-metal and straight silicone stents have been successfully used. Uncoated self-expanding metal stents should probably be avoided, especially for treating benign strictures, because of their tendency toward continued expansion and risk of perforation: once inserted, removal is difficult, if not impossible. Straight silicone stents, on the other hand, are safely and rapidly removed in case of obstruction by secretions, granulation tissue formation, or migration so generic claritin. Stents placed within 2 cm of the vocal cords, however, are particularly prone to complications. Inflammatory granulation tissue formation and tumor overgrowth cause obstruction and airway compromise that may require emergent endotracheal intubation with an uncuffed, small caliber endotracheal tube. Proximal migration may cause dyspho-nia, cough, or airway distress. Mitration distally results in stricture recurrence.
The external fixation technique described in this report is an additional modality that may be considered in carefully selected patients who have failed other therapies. For example, patients with subglottic stenosis who are not candidates for surgical correction, who have had multiple recurrences of stent migration, or who refuse tracheotomy and tracheostomy. We do not advocate external stent fixation instead of Montgomery T-tubes, rigid bronchoscopic dilatation, or routine endoscopic stent insertion, nor do we recommend using external fixation every time a subglottic silicone stent is placed. We do believe, however, that external fixation of an easily removable silicone stent is preferable to insertion of a metal stent into the upper third of the trachea.
External stent fixation has potential for great misuse, and precise rigid bronchoscopic technique is essential. After stent insertion the tip of the rigid tube is gently maintained between the vocal cords while forceps grasp the stent to prevent its displacement.

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