Subglottic Stenosis in Wegener's Granulomatosis and the Nitinol Stent

Watters, Karen; Russell, John

doi:10.1097/00005537-200312000-00033

Cited by 23 publications

(12 citation statements)

References 14 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…The traditional view, which continues to be advocated,18 has held that, with the exception of life threatening lesions, which need to be bypassed with a tracheostomy or opened with a stent,19 active obstructive WG should not be approached surgically. Surgery should instead be directed towards decannulation and reconstruction of mature airway scars, once active inflammation has been brought under control.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Results of endoscopic surgery and intralesional steroid therapy for airway compromise due to tracheobronchial Wegener's granulomatosis

Nouraei

Obholzer

Ind

et al. 2008

Thorax

View full text Add to dashboard Cite

Background: Upper airway compromise due to tracheobronchial stenosis commonly occurs in patients with Wegener's granulomatosis (WG). There is at present no consensus on the optimal management of this life threatening condition. Objective: To assess the results of laryngo-tracheobronchoscopy, intralesional steroid therapy, laser surgery and dilatation in managing obstructive tracheobronchial WG. Methods: Records of 18 previously untreated stridulous patients with obstructive tracheobronchial WG, treated between 2004 and 2006, were prospectively recorded on an airway database and retrospectively reviewed. Information about patient and lesion characteristics and treatment details were recorded. Treatment progress was illustrated using a timeline plot, and intervention-free intervals were calculated with actuarial analysis. Results: There were nine males and the average age at presentation was 40 (16) years (range 13-74). There were 13 patients with tracheal and five with tracheal and bronchial lesions. The average tracheal lesion height was 8 (3) mm, located 23 (9) mm below the glottis. There were 1, 10 and 7 Myer-Cotton grade I, II and III lesions, respectively. Mean intervention-free interval following minimally invasive treatment was 26 (2.8) months. Following endobronchial therapy, the median interventionfree interval was 22 months (p.0.8 vs tracheal lesions). No patient required a tracheostomy or endoluminal stenting. Conclusions: Intralesional steroid therapy and conservative endoluminal surgery is an effective strategy for treating airway compromise due to active tracheal and bronchial WG, obviating the need for airway bypass or stenting. We recommend the combination of endotracheal dilatation, conservative laser surgery and steroid therapy as the standard of care for treating airway compromise due to obstructive tracheobronchial WG.

show abstract

Section: Discussionmentioning

confidence: 99%

“…Furthermore, evidence is accumulating to suggest that the underlying inflammation can be adequately treated with high dose intralesional steroid therapy 11 15 17. It was possible, using this approach, to reduce the requirement for placing a tracheostomy from 40–50%12 19 to zero.…”

Section: Discussionmentioning

confidence: 99%

Results of endoscopic surgery and intralesional steroid therapy for airway compromise due to tracheobronchial Wegener's granulomatosis

Nouraei

Obholzer

Ind

et al. 2008

Thorax

View full text Add to dashboard Cite

show abstract

“…1 Subglottic stenosis in Wegener's granulomatosis is due to necrotizing vasculitis, so any mucosal trauma resulting from major surgery, laser and stent leads to worst stenosis, so this should be avoided. 8,9 Use of controlled low pressure, large volume, nontraumatic endotracheal and tracheostomy cuffs and deflating cuff every two hourly for 5 to 10 minutes has decreased the incidence of intubation injuries. 6 Microlaryngoscopy and dilatation with local steroid, mitomycin-c give a good result in subglottic stenosis due to Wegener's granulomatosis.…”

Section: Resultsmentioning

confidence: 99%

Childhood Wegener's Granulomatosis with Subglottic Stenosis

2011

International Journal of Phonosurgery &Amp; Laryngology

View full text Add to dashboard Cite

Our aim is to highlight the possibility of subglottic stenosis caused by Wegener's granulomatosis. The incidence of subglottic stenosis in Wegener's granulomatosis is seen five times more often in children.We report a case of a 12-year-old female diagnosed as Wegener's granulomatosis who was on medical treatment since six months. She presented to us with stridor. As rigid laryngoscopy revealed a pinhole opening in the subglottic region, an emergency tracheostomy was performed. This was followed by a planned microlaryngoscopy using cold steel instruments. A triradiate incision with dilatation, local steroid injection and topical application of mitomycin-c was performed. In Wegener's granulomatosis, subglottic stenosis is caused due to vasculitis therefore, the use of laser and stent is contraindicated, as this may lead to a further worsening of the stenosis.Among various causes of subglottic stenosis, the most common cause is use of cuffed tracheostomy tube and endotracheal tube. It is essential to diagnose the etiology of subglottic stenosis to decide on the appropriate modality of treatment.

show abstract

“…8,16,18,[21][22][23][24][25][26][27] In the study by Gluth et al, 5 of the 27 patients with WG and subglottic stenosis, 11 (40.7%) required tracheostomy and 13 (48.1%) required multiple surgical procedures. The endoscopic diagnosis of laryngeal tracheobronchial stenoses allows, in some cases, minimally invasive treatment as an alternative for the surgical treatment.…”

Section: Rev Bras Reumatol 2012;52(2):227-235mentioning

confidence: 99%