Endoscopic management of adult subglottic stenosis: an alternative to open surgery.

Autor: Ferney A; Otolaryngology-Head and Neck Surgery Department, Grenoble Alpes University Hospital, BP 217, 38043, Grenoble Cedex 09, France.; School of Medicine, Grenoble Alpes University, Domaine de la Merci, BP 170 La Tronche, 38042, Grenoble Cedex 9, France., Ferney T; Food Science and Engineering, Nantes-Atlantic National College of Veterinary Medicine, Oniris, BP 40706, 44307, Nantes Cedex 03, France., Giraud L; Otolaryngology-Head and Neck Surgery Department, Grenoble Alpes University Hospital, BP 217, 38043, Grenoble Cedex 09, France.; School of Medicine, Grenoble Alpes University, Domaine de la Merci, BP 170 La Tronche, 38042, Grenoble Cedex 9, France., Briault A; School of Medicine, Grenoble Alpes University, Domaine de la Merci, BP 170 La Tronche, 38042, Grenoble Cedex 9, France.; Food Science and Engineering, Nantes-Atlantic National College of Veterinary Medicine, Oniris, BP 40706, 44307, Nantes Cedex 03, France.; Pulmonology Department, Grenoble Alpes University Hospital, BP 217, 38043, Grenoble Cedex 09, France., Aboussouan MP; Department of Anesthesiology and Intensive Care Medicine, Grenoble Alpes University Hospital, BP 217, 38043, Grenoble Cedex 09, France., Castellanos PF; Mercy Health, St. Rita's Ear, Nose and Throat, 770 West High Street, Suite 460, Lima, OH, 4580, USA., Atallah I; Otolaryngology-Head and Neck Surgery Department, Grenoble Alpes University Hospital, BP 217, 38043, Grenoble Cedex 09, France. iatallah@chu-grenoble.fr.; School of Medicine, Grenoble Alpes University, Domaine de la Merci, BP 170 La Tronche, 38042, Grenoble Cedex 9, France. iatallah@chu-grenoble.fr.
Jazyk: angličtina
Zdroj: European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery [Eur Arch Otorhinolaryngol] 2023 Apr; Vol. 280 (4), pp. 1865-1873. Date of Electronic Publication: 2022 Nov 18.
DOI: 10.1007/s00405-022-07733-9
Abstrakt: Purpose: Various surgical techniques could be used to treat subglottic stenosis (SGS). The aim of this study is to present our experience in endoscopic management of SGS and show the impact of symptoms' evaluation, clinical examination and spirometry in the therapeutic decision.
Methods: Endoscopic treatment was performed in patients referred for SGS and consisted of CO 2 scar lysis associated with balloon dilation and concomitant steroids' injection for patients with grade II or higher on the mMRC (modified Medical Research Council) dyspnea scale associated with a DI (Dyspnea Index) score higher than 10/40 and objective stenosis equal or higher than grade II. The preoperative DI score, EDI (expiratory disproportion index) and voice parameters were compared to postoperative results. The mean interval between endoscopic procedures (IEP) was calculated and we looked for the evolution of the IEP during repeated procedures.
Results: Nineteen patients were included. 35 dilations were performed. The mean IEP was 86 weeks. There was a significant decrease of the postoperative DI scores by 18.6 points ± 11 (SD). An important difference of 20.1 ± 13.5 (SD) was identified between the pre and postoperative EDI. Minimal changes occured in voice parameters.
Conclusions: Endoscopic treatment with CO 2 scar lysis associated with balloon dilation and concomitant steroids' injection is a safe, reliable and minimally invasive endoscopic procedure to treat SGS. Decision to treat has to be on an individual basis taking into account subjective symptoms including Dyspnea Index score and objective laryngoscopic findings and spirometry.
(© 2022. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)
Databáze: MEDLINE
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