External Fixation of Subglottic Tracheal Stents

External Fixation of Subglottic Tracheal StentsWhen tracheal stenosis results from trauma, inflammatory disorders, or prolonged endotracheal intubation, conservation of laryngeal function after treatment is essential review canadian family pharmacy. Management of subglottic stenoses is particularly challenging because open surgical resection is often difficult without a stricture-free subglottic space. In addition, many patients are elderly or have severe underlying illnesses, making them unsuitable candidates for tracheal reconstruction. Tracheostomy followed by Montgomery T-tube insertion is often successful, but may be undesirable in patients with recurrent stomal infections or substantial tracheal tumor growth. Some patients refuse tracheostomy for esthetic reasons.
During the last decade, therefore, endoscopic resections have been widely performed to maximize preservation of tracheal epithelium. Results after carbon dioxide (CO2), neodymium-yttrium aluminum garnet (Nd:YAG), or potassium titanyl phosphate (KTP) laser resection are probably better than those obtained after balloon or rigid bronchoscopic dilatation alone, but repeat procedures may be necessary.2 When endoscopic resection is incomplete, tracheal stenting is often advocated. Loss of cartilaginous support and lack of extrinsic compression, however, makes subglottic stents prone to distal or proximal migration, causing cough, dyspnea, hoarseness, and respiratory distress. In carefully selected patients with subglottic stenosis and malacia who are not candidates for surgical resection, tracheotomy, or Montgomery T-tubes, or patients who have had repeated migration of indwelling stents, external stent fixation may be desirable. We extrapolated from techniques used to maintain laryngeal stents in place, and devised a method by which indwelling subglottic stents could be sutured and fixed externally during endoscopic insertion. This report describes the results of this technique in five patients, and discusses its potential role alongside other endoscopic therapeutic modalities used in patients with refractory subglottic tracheal stenosis. Stents were inserted as part of endoscopic treatment of severe subglottic tracheal stenosis. Rigid bronchoscopy (RB) was performed with a nonventilating rigid bronchoscope (EFER-Dumon, Bryan Corp, Woburn, Mass) with the patient under general anesthesia after premedication with 125 mg of methylprednisolone (Solu-Medrol) intravenously (IV).

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