title: Endoscopic cold incision, balloon dilation, mitomycin C application, and steroid injection for adult laryngotracheal stenosis.
abstract: OBJECTIVE
  To describe the presentation, stenosis characteristics, etiological differences, and outcomes of adult laryngotracheal stenosis treated with endoscopic cold incision, balloon dilation, topical mitomycin C application, and steroid injection.
  
  
  METHODS
  Retrospective chart review.
  
  
  METHODS
  Demographic and clinical data were extracted for patients treated between March 2000 and December 2010. Prolonged intubation and idiopathic patient data were utilized for comparative analysis.
  
  
  RESULTS
  Eighty patients (65 females; 15 males; 220 procedures; 2.9 years mean follow-up) presented with dyspnea (81%) and/or exercise intolerance (40%). Most commonly, etiologies were idiopathic (53 of 80; 66%) or prolonged intubation (14 of 80; 18%). Mean procedures per patient and interval between procedures were 2.8 procedures and 405 days, respectively. Mean stenosis length and distance from the caudal phonating edge of the true vocal folds were 9 mm and 19 mm. Complication, tracheotomy, and open-procedure rates were 1.8%, 1.4%, and 10.0%, respectively. Patients with more than two procedures demonstrated a mean 4-mm reduction in stenosis length and a 2-mm cephalad progression of stenosis over time. More caudal stenoses required more frequent procedures. Procedures were less frequent as more procedures were performed. Stenosis characteristics, interval between procedures, and total procedures were similar between idiopathic patients with or without intubation histories, but different between idiopathic and prolonged intubation patients.
  
  
  CONCLUSIONS
  This procedure was shown to be a viable option in adult laryngotracheal stenosis. Repeat dilation was likely, but was performed without adversely affecting stenosis characteristics. Stenoses farther from the vocal folds required procedures more frequently. Idiopathic patients with a history of brief, elective intubation had stenosis characteristics and responses to therapy similar to idiopathic patients without an intubation history. Both idiopathic groups together demonstrated stenosis characteristics and responses to therapy dissimilar to patients with a history of prolonged intubation.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, University of Minnesota Medical Center, Minneapolis, Minnesota, USA.
authors.forename: Noah P
authors.initials: NP
authors.lastname: Parker
authors.forename: Dipankar
authors.initials: D
authors.lastname: Bandyopadhyay
authors.forename: Stephanie
authors.initials: S
authors.lastname: Misono
authors.forename: George S
authors.initials: GS
authors.lastname: Goding
mesh_terms: D000328:Adult; D004724:Endoscopy / Q000009:adverse effects / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007829:Laryngostenosis / Q000188:drug therapy* / Q000209:etiology / Q000601:surgery; D008297:Male; D016685:Mitomycin / Q000008:administration & dosage* / Q000627:therapeutic use; D012189:Retrospective Studies; D013256:Steroids / Q000008:administration & dosage* / Q000627:therapeutic use; D014135:Tracheal Stenosis / Q000188:drug therapy* / Q000209:etiology / Q000601:surgery; D016896:Treatment Outcome
chemical_list: D013256:Steroids; D016685:Mitomycin