Early endoscopic dilation and mitomycin application in the treatment of acquired tracheal stenosis.
BACKGROUND
Acquired airway stenosis is a common complication in children after periods of tracheal intubation. We reviewed our experience in the endoscopic treatment of these lesions.


METHODS
We performed a retrospective review of patients who presented acquired tracheal-subglottic stenosis (SGS) treated at our center from 2005 to 2012. We reviewed the etiology, age, clinical presentation, methods of diagnosis, number of bronchoscopies, angioplasty balloon dilations performed, and long-term results.


RESULTS
A total of 18 patients (13 M, 5 F) were treated at our institution between 2005 and 2012. Median age at treatment was 3.5 months (range, 1-96 months). Of the 18 children, 16 children had SGS (all cases were postintubation), and 2 children presented tracheal stenosis (1 postintubation, 1 after tracheal surgery). Median intubation time was 30 days (range, 3-120 days). Extubation failure and stridor were the main clinical features. SGS were diagnosed as grade I in three patients, grade II in nine patients, and grade III in six patients. Bronchoscopy allowed diagnostic in all cases, and was followed by angioplasty balloon dilation, with a median of 2.5 (range, 1-5) sessions. In SGS grade I, the relation patient/number of dilations was 1; in SGS grade II 2.6, and in SGS grade III 3.5. Mitomycin was applied in 15 patients. No patients presented intraoperative complications or required reoperation. Median follow-up time was 36 months (range, 5-72 months) and no recurrence was noticed.


CONCLUSIONS
Early endoscopic dilation with balloon shows as an effective and safe treatment in acquired tracheal and SGS.
Department of Pediatric Surgery, Hospital Universitario La Paz, Madrid, Spain.
Ruben
R
Ortiz
Department of Pediatric Surgery, Hospital Universitario La Paz, Madrid, Spain.
Eva
E
Dominguez
Department of Pediatric Surgery, Hospital Universitario La Paz, Madrid, Spain.
Carlos
C
De La Torre
Department of Pediatric Surgery, Hospital Universitario La Paz, Madrid, Spain.
Francisco
F
Hernandez
Department of Pediatric Surgery, Hospital Universitario La Paz, Madrid, Spain.
Jose Luis
JL
Encinas
Department of Pediatric Surgery, Hospital Universitario La Paz, Madrid, Spain.
Sergio
S
Lopez-Fernandez
Division of Pediatric Anesthesia and Resuscitation, Hospital Universitario La Paz, Madrid, Spain.
Luis
L
Castro
Division of Pediatric Intensive Care, Hospital Universitario La Paz, Madrid, Spain.
Juan Jose
JJ
Menendez
Division of Pediatric Pulmonology, Hospital Universitario La Paz, Madrid, Spain.
Olga
O
De la Serna
Department of Pediatric Surgery, Hospital Universitario La Paz, Madrid, Spain.
Juan
J
Vazquez
Department of Pediatric Surgery, Hospital Universitario La Paz, Madrid, Spain.
Manuel Lopez
ML
Santamaria
Department of Pediatric Surgery, Hospital Universitario La Paz, Madrid, Spain.
Juan Antonio
JA
Tovar
D000800:Angioplasty, Balloon; D001999:Bronchoscopy; D002648:Child; D002675:Child, Preschool; D003131:Combined Modality Therapy; D061345:Early Medical Intervention; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007442:Intubation, Intratracheal / Q000009:adverse effects; D007829:Laryngostenosis / Q000145:classification / Q000175:diagnosis / Q000628:therapy*; D008297:Male; D016685:Mitomycin / Q000008:administration & dosage*; D011183:Postoperative Complications / Q000175:diagnosis / Q000628:therapy; D019233:Retreatment; D014135:Tracheal Stenosis / Q000145:classification / Q000175:diagnosis / Q000628:therapy*
D016685:Mitomycin