Endoscopic laser surgery for subglottic stenosis in Wegener's granulomatosis.
OBJECTIVE
Wegener's granulomatosis (WG) is a rare multisystem inflammatory disease, which infrequently involves the subglottic area and trachea. Treatment usually involves the use of immunosuppressive agents with corticosteroids. Some patients, however, continue to have symptoms of airway obstruction after clinical remission following the standard therapeutic regimen.


OBJECTIVE
To investigate laser treatment for subglottic stenosis in five patients suffering from WG.


METHODS
We endoscopically treated 5 patients with subglottic stenosis due to WG and airway obstruction by Nd:YAG and CO2 lasers. One of the patients had preoperative tracheostomy and after treatment was decannulated and could not breathe without dyspnea. Another patient required stenting of the subglottic area.


RESULTS
All five patients were able to breathe without dyspnea after the treatment. Three patients were treated with an Nd:YAG laser but needed repeated laser treatment every four to six months, whenever they complained of dyspnea. The other two patients were treated with a CO2 laser; one of these patients had preoperative tracheostomy and was treated twice by CO2 laser and decannulated, with no further difficulty in breathing. The follow-up period was 1-5 years.


CONCLUSIONS
Nd:YAG and CO2 lasers are recommended in the treatment of subglottic stenosis (SS) due to WG, particularly when the stenosis is in continuity or close proximity to the vocal cords.
Shvero
Jacob
J
Department of Otorhinolaryngology Head and Neck Surgery, Rabin Medical Center, Petah Tikva, Israel. asaf890@bezeqint.net
Shitrit
David
D
Koren
Rumelia
R
Shalomi
Dekel
D
Kramer
Mordechai Reuven
MR
D000328:Adult; D000369:Aged, 80 and over; D003251:Constriction, Pathologic / Q000601:surgery; D005260:Female; D014890:Granulomatosis with Polyangiitis / Q000473:pathology / Q000601:surgery*; D006801:Humans; D007828:Laryngoscopy; D007830:Larynx / Q000473:pathology / Q000601:surgery*; D053685:Laser Therapy; D008297:Male