Efficacy of trans-nasal fiberendoscopic injection laryngoplasty with centrifuged autologous fat in the treatment of glottic insufficiency due to unilateral vocal fold paralysis Efficacia della laringoplastica iniettiva fibroendoscopica trans-nasale con grasso autologo centrifugato nel trattamento dell'insufficienza glottica da paralisi cordale monolaterale

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Adult idiopathic subglottic stenosis remains a rare entity. Fibrosis of the airway at the level of the cricoid results in narrowing of the airway and progressive dyspnoea. The aetiology remains uncertain but reflux and hormonal influences have recently been proposed. Multiple modalities including surgical excision, laser excision and balloon dilatation have been described. Additionally the adjunctive use of mitomycin or oestrogen has also been noted. From these options, cricotracheal resection and reconstruction for severe stenosis remains the modality providing the most favourable results. METHODS: We present our use of balloon dilatation in two cases as a management option with concomitant subglottic high frequency jet ventilation. Initially used in angioplasty, balloon dilatation has subsequently been successfully used for oesophageal dilatation and airway disorders. Control of ventilation during dilatation may be by endotracheal tube insertion and periodic removal, by supra-glottic jet ventilation, or our preferred modality of automated subglottic high frequency jet ventilation (Mistral model, Acutronic, Switzerland). RESULTS: The latter provides a clear visualisation of the stenotic region allowing sequential photodocumentation preand post-treatment with the additional ease of withdrawing and re-introduction of the catheter before and after dilation. The use of a hydrostatic balloon catheter (Cook Medical, USA) provides an optimal compliance curve that conforms to the stenotic region allowing radial dilation. CONCLUSIONS: Although this technique may not have the long-term efficacy of open surgical methods, it provides a non-invasive and relatively easily learned technique to manage this difficult condition.

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