Suspension laryngoscopy for endotracheal stenting.
OBJECTIVE
Airway stents have recently been used to establish and maintain patent airways in patients with malignant central airway obstruction, but insertion modalities remain controversial to date. The study seeks to determine the role of suspension laryngoscopy in interdisciplinary airway stenting.


METHODS
Retrospective, single-institution analysis of a case series treated by a multidisciplinary airway team.


METHODS
Ninety-three consecutive patients with malignant obstruction of the trachea and/or tracheobronchial bifurcation underwent endotracheal stenting through a suspension laryngoscopy approach for the relief of impending respiratory distress. Feasibility, mortality, survival, and complications were analyzed as main outcome measures.


RESULTS
Stenting through a suspension laryngoscopy approach was feasible 91 of 93 patients (97.8%). Fifteen patients needed repeated stenting, and in all, 121 stents were implanted during the observation period. This approach allowed for the repeated insertion of rigid bronchoscopes of graded sizes to establish an airway and for precise stent positioning. Optical instruments and stent introducer systems could easily be used while adequate ventilation was continuously maintained. Silicone stents of maximal size were inserted without injury of the vocal cords during intubation. Median survival for all patients was 8 months. No intraoperative airway complications were observed, and no patient died secondary to stenting.


CONCLUSIONS
Suspension laryngoscopy and jet ventilation provide an ideal setting for the precise placement of tracheal and bifurcation airway stents. Laryngologists should actively participate in interdisciplinary airway stenting programs.
Eckel
Hans Edmund
HE
Department of Otorhinolaryngology, Landeskrankenhaus Klagenfurt, Austria. hno.abteilung@lkh-klu.at
Berendes
Shahindocht
S
Damm
Michael
M
Klussmann
Jens Peter
JP
Wassermann
Klaus
K
D000402:Airway Obstruction / Q000209:etiology / Q000401:mortality / Q000628:therapy*; D004867:Equipment Design; D004869:Equipment Safety; D005260:Female; D006801:Humans; D007828:Laryngoscopy / Q000379:methods*; D008297:Male; D010166:Palliative Care; D011379:Prognosis; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D015607:Stents; D016019:Survival Analysis; D014134:Tracheal Neoplasms / Q000150:complications / Q000401:mortality / Q000628:therapy*; D014135:Tracheal Stenosis / Q000209:etiology / Q000401:mortality / Q000628:therapy*; D016896:Treatment Outcome