Serial intralesional triamcinolone acetonide injections for acquired subglottic stenosis in premature infants

Sekioka, Akinori; Fukumoto, Koji; Yamoto, Masaya; Takahashi, Toshiaki; Nakaya, Kengo; Nomura, Akiyoshi; Yamada, Yutaka; Urushihara, Naoto

doi:10.1007/s00383-018-4312-7

Cited by 8 publications

(4 citation statements)

References 18 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…[7][8][9] Steroid injections have also been utilized to decrease inflammation at the surgical site. [7][8][9]15 However, if inflammation and edema contributing to poor healing at the surgical site persists despite these interventions, other methods will need to be considered. In this case, we used a steroid-eluting implant in a pediatric patient with persistent granulation tissue, edema, and stenosis after dsLTR.…”

Section: Discussionmentioning

confidence: 99%

Steroid-Eluting Implants: An Adjunctive Therapy After Double-Stage Laryngotracheal Reconstruction

Drury,

Anderson,

Haupert

et al. 2023

Ann Otol Rhinol Laryngol

View full text Add to dashboard Cite

Objectives: The primary objective is to describe a case in which a steroid-eluting implant was utilized to help prevent postoperative granulation and restenosis in a patient who underwent double-stage laryngotracheal reconstruction (dsLTR) for subglottic stenosis. Methods: This case presents a 3-year-old female who underwent dsLTR with anterior cartilage graft placement and posterior sagittal split for subglottic stenosis. A silicone stent was placed at the time of the dsLTR. After stent removal, direct laryngoscopy and bronchoscopy (DLB) was performed at 4 to 5 week intervals. These visits revealed a significant amount of supraglottic and glottic edema, and granulation tissue at the proximal aspect of the graft contributing to airway obstruction and restenosis. This was treated twice with CO2 laser excision, balloon dilation, and triamcinolone injection. On the third treatment with these modalities, a mometasone furoate implant was inserted as an adjunctive therapy. The implant was inserted to lateralize the vocal folds, prevent webbing, and to extend to the narrowed area within the subglottis to prevent granulation and restenosis. These same treatments were repeated at the fourth visit with another mometasone furoate implant of a smaller size placed in the same location. Results: Findings on DLB since treatment with the steroid-eluting implants have shown persistent granulation tissue limited to the tracheostomy stoma site. Treatments with CO2 laser, balloon dilation, and triamcinolone injection have continued, with occasional use of silver nitrate cautery at the external stoma site. There has not been any significant evidence of edema, granulation, or stenosis in the glottis or subglottis to require another steroid-eluting implant. Conclusions: Steroid-eluting implants appear to be a safe and effective adjunctive therapy in the routine surveillance of pediatric patients with a tracheostomy who have undergone dsLTR. They may help combat granulation formation and restenosis seen in some dsLTR patients.

show abstract

Section: Discussionmentioning

confidence: 99%

Steroid-Eluting Implants: An Adjunctive Therapy After Double-Stage Laryngotracheal Reconstruction

Drury,

Anderson,

Haupert

et al. 2023

Ann Otol Rhinol Laryngol

View full text Add to dashboard Cite

show abstract

“…9 Sekioka et al found that serial triamcinolone acetide injections in infants with ASGS led to improvements in the patency of the subglottis. 10 However, not all studies have found post-injury steroids to be efficacious. In a canine model, Doolin et al found no change in collagen formation after subglottic injury with oral dexamethasone compared to controls.…”

Section: Discussionmentioning

confidence: 99%

A Randomized Controlled Trial of Dexamethasone as a Prophylactic Treatment for Subglottic Stenosis in a Rabbit Model

Wistermayer

Escalante

McIlwain

et al. 2020

Ann Otol Rhinol Laryngol

View full text Add to dashboard Cite

Objective: Iatrogenic injury is a common cause of subglottic stenosis (SGS). We investigated the role of pre-injury dexamethasone as a preventive treatment for iatrogenic subglottic stenosis. Methods: 16 New Zealand White rabbits were used in an IACUC approved study. Subjects were divided into two groups: intramuscular dexamethasone (DEX) at a dose of 2 mg/kg 15 minutes prior to an endoscopic injury to create SGS, and the same injury creation with a preoperative intramuscular saline (SAL) injection. Three independent, blinded raters evaluated endoscopic images to obtain cross sectional area (CSA) airway measurements. Rabbit airways were measured just prior to injury and at one week post-injury. All subjects were provided as-needed postoperative steroids and buprenorphine for symptoms of respiratory distress. Data analysis was performed using Student t-test. Intraclass correlation coefficients were used to assess inter-rater agreement. Results: All subjects survived to the one-week post-injury airway evaluation. There was no difference in airway size between groups prior to injury ( P = .28). Subjects in the DEX group demonstrated an average stenosis of 20.3% (95% CI 10.2-30.5) at one week compared to 60.6% (95% CI 40.3-80.9) in the SAL group ( P = .01). Subjects in the control group required significantly more doses of postoperative dexamethasone ( P = .02). Inter-rater agreement for between raters was excellent (ICC = .88). Conclusion: This is the first study to examine the role of pre-injury glucocorticoids in preventing iatrogenic subglottic stenosis. In our model, a single dose of intramuscular dexamethasone given prior to a subglottic injury resulted in a statistically significant reduction in airway stenosis. This research suggests that administering systemic dexamethasone should be considered prior to any procedure that may injure the subglottis, including traumatic intubation, to prevent iatrogenic subglottic stenosis.

show abstract

“…Likewise, the role of adjuvant therapies, such as topical agents or intralesional injections, remains nebulous. 3,5,14,15 Ciprodex solution (ciprofloxacin-dexamethasone; Novartis Pharmaceuticals Corporation) has been noted to decrease edema and granulation tissue in the airway 14,16 and is routinely applied by some surgeons after balloon dilation; however, reports of its efficacy are largely anecdotal. 4,14 Given the lack of clarity regarding these variables, use of an animal model is an appropriate means for further investigation, and our group has described a method for reliably producing subglottic stenosis in a live rabbit model.…”

mentioning

confidence: 99%

“…There is a theoretical risk that prolonged occlusion of the airway can lead to cardiopulmonary effects due to negative intrathoracic pressure or direct vagal stimulation, although a paucity of data on this subject exists in the medical literature. Likewise, the role of adjuvant therapies, such as topical agents or intralesional injections, remains nebulous 3,5,14,15 . Ciprodex solution (ciprofloxacin‐dexamethasone; Novartis Pharmaceuticals Corporation) has been noted to decrease edema and granulation tissue in the airway 14 , 16 and is routinely applied by some surgeons after balloon dilation; however, reports of its efficacy are largely anecdotal 4 , 14 .…”

mentioning

confidence: 99%

Randomized Controlled Trial of Balloon Dilation in Treatment of Subglottic Stenosis With a Rabbit Model

Wistermayer

McIlwain

Escalante

et al. 2020

Otolaryngol.--head neck surg.

View full text Add to dashboard Cite

Objectives Identify the effects of balloon dilation duration and topical ciprofloxacin-dexamethasone application in treatment of subglottic stenosis. Study Design Randomized controlled trial. Setting Animal research facility. Subjects and Methods Forty-four rabbits underwent subglottic injury in an Institutional Animal Care and Use Committee–approved study. One week after injury, the subglottis of each rabbit was measured and treated with endoscopic balloon dilation for 2 rounds of short duration (SBD; 3 seconds), long duration (LBD; 30 seconds), or LBD with topical ciprofloxacin-dexamethasone application (LBD+C). The subglottis of each rabbit was remeasured at the study endpoint: 1 month postdilation or following development of life-threatening respiratory distress. Results Of 44 rabbits, 35 (80%) survived to endoscopic balloon dilation, with 21 rabbits developing a grade III Cotton-Myer stenosis. Prior to dilation, there was no difference in stenosis rates among groups (all subjects, P = .99; grade III stenosis only, P = .52). Among grade III subjects, improvement in stenosis after dilation was –1% (SD, 21%) for SBD, 27% (SD, 38%) for LBD, and 58% (SD, 29%) for LBD+C ( P = .01). Early euthanasia/death rates among grade III subjects were 85% for SBD, 63% for LBD, and 17% for LBD+C ( P = .03). Time to early euthanasia/death was 5.0 days for the SBD group and 8.4 days for the LBD group ( P = .04). Conclusion SBD was inferior to LBD or LBD+C in multiple metrics. LBD+C offered significant improvements in stenosis size and mortality over the SBD group and had the lowest rate of early mortality. Further research is needed to identify optimal balloon dilation treatment duration.

show abstract

Serial intralesional triamcinolone acetonide injections for acquired subglottic stenosis in premature infants

Abstract: Serial intralesional steroid injections are likely to be effective in improving the patency of acquired SGS.

Cited by 8 publications

References 18 publications

Steroid-Eluting Implants: An Adjunctive Therapy After Double-Stage Laryngotracheal Reconstruction

Steroid-Eluting Implants: An Adjunctive Therapy After Double-Stage Laryngotracheal Reconstruction

A Randomized Controlled Trial of Dexamethasone as a Prophylactic Treatment for Subglottic Stenosis in a Rabbit Model

Randomized Controlled Trial of Balloon Dilation in Treatment of Subglottic Stenosis With a Rabbit Model

Contact Info

Product

Resources

About