Coblation of suprastomal granulomas in tracheostomy-dependent children

Abstract

Objective Suprastomal granulomas pose a persistent challenge for tracheostomy-dependent children. They can limit phonation, cause difficulty with tracheostomy tube changes and prevent decannulation. We describe the use of the coblator for radiofrequency plasma ablation of suprastomal granulomas in five consecutive children from September 2012 to January 2016. Method Retrospective case series at a tertiary medical center Results The suprastomal granuloma could be removed with the coblator in all 5 cases. Three were removed entirely endoscopically and 2 required additional external approach through the tracheal stoma for complete removal. There were no intraoperative or postoperative complications. One patient was subsequently decannulated and 2 patients have improved tolerance of their speaking valves. Two patients remain ventilator dependent, but their bleeding and difficulty with tracheostomy tube changes resolved. Three of the patients have had subsequent re-evaluation with bronchoscopy, demonstrating resolution or markedly decreased size of the granuloma. This technique is time efficient, simple and minimizes risks associated with other techniques. The relatively low temperature and use of continuous saline irrigation with the coblator device minimizes the risk of airway fires. Additionally, the risk of hypoxia from keeping a low fractional inspiratory oxygen level (FIO2) to prevent fire is avoided. The concurrent suction in the device decreases blood and tissue displacement into the distal airway. Conclusion Coblation can be used safely and effectively with an endoscopic or external approach to remove suprastomal granulomas in tracheostomy-dependent children. More studies that are larger and have longer follow-up are needed to evaluate the use of this technique.

A comparison of radiofrequency Coblation and cold steel excision in the treatment of idiopathic vocal process granulomas

“…In recent years, granuloma treatment by radiofrequency Coblation has been reported, specifically for intubated patients with laryngeal granulomas and paediatric patients with suprastomal granulomas, and higher remission rates have been obtained. 13,14 However, the granulomas in these studies resulted from a mechanical injury associated with the endotracheal tube. 13,14 In this study, we used radiofrequency Coblation assisted surgical excision to treat idiopathic vocal process granulomas that did not respond to three months of PPI treatment and voice therapy.…”

“…13,14 However, the granulomas in these studies resulted from a mechanical injury associated with the endotracheal tube. 13,14 In this study, we used radiofrequency Coblation assisted surgical excision to treat idiopathic vocal process granulomas that did not respond to three months of PPI treatment and voice therapy. The recurrence rate in the radiofrequency Coblation assisted group was significantly lower compared with that in the cold steel excision group (5.3 per cent vs 60.7 per cent; p < 0.001).…”

“…Sinha and Gallagher 19 found that radiofrequency Coblation afforded faster complete wound re-epithelialisation of oral mucosa compared with the KTP laser. Brown et al 14 reported two paediatric cases of recurrent suprastomal granuloma following removal with a carbon dioxide laser 12 months previously; these were removed with radiofrequency Coblation and the children showed no granuloma recurrence after 1 year of follow up. Another advantage of radiofrequency Coblation is that the plasma knife of radiofrequency ablation can bend in a larger range, allowing better angle adjustment during the operation, thereby aiding complete removal of the vocal process granuloma.…”

“…In recent years, granuloma treatment by radiofrequency Coblation has been reported, specifically for intubated patients with laryngeal granulomas and paediatric patients with suprastomal granulomas, and higher remission rates have been obtained. 13,14 However, the granulomas in these studies resulted from a mechanical injury associated with the endotracheal tube. 13,14…”

Tracheotomy-coblation for acquired subglottic tracheal stenosis: a case report

“…Thirdly, using tracheal stent has the drawback of easy stent migration. The coablation has advantages including rapid and precise ablation, little thermal damage, and the integrated function of suction and coagulation [4]. Kitsko et al [5] described the technique of coblation to remove a suprastomal granuloma in a single patient.…”