4/1/2020 Adult Subglottic and Tracheal Stenosis Karla ODell, MD - - PDF document

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Adult Subglottic and Tracheal Stenosis

Karla O’Dell, MD Assistant Professor, Laryngology USC Voice Center Caruso Department of Otolaryngology, Head and Neck Co-Director USC Center for Airway Intervention and Reconstruction (AIR Center)

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Causes of subglottic or tracheal stenosis

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• “Idiopathic”
• Disease homogeneity
• Female
• Middle age
• Caucasian
• Stenosis subglottic and first ring
• Theories on cause –Estrogen, Inflammatory

markers IL-17

Idiopathic Subglottic Stenosis

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North American Airway Collaborative

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In Office Bronchoscopy

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Pulmonary Function Tests

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Initial Procedure- Endoscopic treatment

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• Qvar or steroid inhaler 1 month
• Bactrim 1 month
• Series of 3 subglottic Kenalog 40-80mg injected into scar

spaced 1 month apart

• PFTs pre, post, after serial steroid, q 3 months
• Repeat series if begin to have symptoms or progressive

change in PFTs

USC- Post dilation protocol

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• First described by Ramon Franco in 2015, alternative

treatment for iSGS

Serial steroid injections

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Removing all tissue except thin mucosal bridges

Endoscopic Resection

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Cricotracheal resection

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Maddern procedure

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• Intubation
• Cuff pressure  Necrosis  Exposed cartilage 

Circumferential scar Stenosis

• Trach tube placement
• Size of tube
• Perc trach vs. open
• High trach

Traumatic/Iatrogenic

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Cotton-Myer grade of stenosis

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Tracheal resection/Cricotracheal resection

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Tracheal Resection/CTR- USC

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• In the last 5 years

Etiology # of patients % of total Idiopathic 2 4.65% Traumatic Intubation 2 5% Tracheostomy 31 72% Autoimmune/Inflammatory 0% Cancer 8 19% Total patients 43

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• Multi-level stenosis
• Low stenosis
• Requires team

approach

Complex cases

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• Multi-level stenosis- Glottic and tracheal
• Manage the glottic stenosis first
• Low stenosis- Thoracic for mini sternotomy

Complex cases

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3 months post op

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• Radial forearm free flap with buried auricular cartilage
• Rarely used
• Option after failed resection

Composite Grafting

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Pre op 1 month post op

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Tracheal regeneration

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Any questions?

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