title: Treatment of postoperative tracheal granulation tissue with inhaled budesonide in congenital tracheal stenosis.
abstract: OBJECTIVE
  Tracheal obstruction by granulation tissue can compromise the postoperative course in congenital tracheal stenosis (CTS). Balloon dilatation and stenting may be required. Budesonide is a corticosteroid with topical anti-inflammatory effects. In 2008, we used inhaled budesonide for treatment of postoperative granulation tissue for the first time in CTS, resulting in significant improvement. The aim of this study was to evaluate the efficacy of inhaled budesonide for treatment of postoperative granulation tissue in CTS.
  
  
  METHODS
  Retrospective chart review was conducted. From 2004 through 2011, we performed 39 tracheoplasties. Forced stenting ± balloon dilatation (S/B) was required when airway obstruction with tissue granulation was life-threatening. We compared the requirement for S/B between the early group without budesonide (2004-Nov. 2008, Early) and the late group with budesonide (Dec. 2008-2011, Late). Statistical analysis was performed using Fisher's Exact test.
  
  
  RESULTS
  Eleven of 22 in Early and 8 of 17 in Late were successfully extubated, never having had life-threatening tissue granulation. The remaining patients in each group (11 in Early and 9 in Late) required tracheostomies due to postoperative complication. Ten in Early and 5 in Late with tracheostomies developed granulation tissue. Of these patients, the 10 in Early required S/B, while none of the 5 in Late required S/B (P=.0003). Bronchoscopy demonstrated significant regression of granulation tissue in all cases treated with inhaled budesonide.
  
  
  CONCLUSIONS
  Inhaled budesonide is effective for treatment of tracheal granulation tissue in patients with tracheostomies after repair of CTS.
authors: Department of Pediatric Surgery, Kobe Children's Hospital, Kobe, Japan. Electronic address: yokoi_kch@hp.pref.hyogo.jp.
authors: Akiko
authors: A
authors: Yokoi
authors: Department of Pediatric Surgery, Kobe Children's Hospital, Kobe, Japan.
authors: Makoto
authors: M
authors: Nakao
authors: Department of Pediatric Surgery, Kobe Children's Hospital, Kobe, Japan.
authors: Yuko
authors: Y
authors: Bitoh
authors: Department of Pediatric Surgery, Kobe Children's Hospital, Kobe, Japan.
authors: Hiroshi
authors: H
authors: Arai
authors: Department of Cardiovascular Surgery, Kobe Children's Hospital, Kobe, Japan.
authors: Yoshihiro
authors: Y
authors: Oshima
authors: Department of Pediatric Surgery, Kobe Children's Hospital, Kobe, Japan.
authors: Eiji
authors: E
authors: Nishijima
mesh_terms: D000280:Administration, Inhalation; D000800:Angioplasty, Balloon; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage*; D001999:Bronchoscopy; D019819:Budesonide / Q000008:administration & dosage*; D002648:Child; D005260:Female; D006097:Granulation Tissue / Q000473:pathology*; D006801:Humans; D008297:Male; D011183:Postoperative Complications / Q000188:drug therapy*; D012189:Retrospective Studies; D015607:Stents; D014135:Tracheal Stenosis / Q000188:drug therapy* / Q000209:etiology*; D016896:Treatment Outcome
chemical_list: D000893:Anti-Inflammatory Agents; D019819:Budesonide
keywords: Congenital tracheal stenosis; Inhaled corticosteroids; Tissue granulation; Tracheoplasty