title: Airway management and endoscopic treatment of subglottic and tracheal stenosis: the laryngeal mask airway technique.
abstract: OBJECTIVE
  The objective is to present clinical outcomes of subglottic and tracheal stenosis treated by flexible bronchoscopic delivery of carbon dioxide (CO2) laser via laryngeal mask airway (LMA).
  
  
  METHODS
  All consecutive, nontracheotomy dependent cases of subglottic and tracheal stenosis treated endoscopically over a 4-year period were retrospectively reviewed. The surgical approach consisted of radial incisions using a flexible fiber-based CO2 laser, balloon dilation, and topical application of mitomycin C. Ventilation during the procedure occurred through the LMA, and the CO2 laser fiber was delivered through the working channel of a flexible bronchoscope passed through the LMA. Number of dilations, period between dilations, and operative times were reviewed.
  
  
  RESULTS
  Eleven patients who underwent airway intervention during the study period were identified. Average follow-up was 28 months. Etiologies of airway stenosis included intubation injury (6), idiopathic (4), or autoimmune disease (1), requiring an average of 1.3, 1.5, and 3 dilations, respectively. Average operative time was 67 minutes. Autoimmune etiology correlated with more frequent dilations.
  
  
  CONCLUSIONS
  LMA is an effective way to manage ventilation while simultaneously allowing unencumbered flexible bronchoscopic access for laser surgery, balloon dilation, and mitomycin C application for airway stenosis. Long-term success in treating stenosis is achievable using this technique.
authors.affiliation: Department of Head and Neck Surgery, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California, USA.
authors.forename: Nopawan
authors.initials: N
authors.lastname: Vorasubin
authors.forename: Darshni
authors.initials: D
authors.lastname: Vira
authors.forename: Nausheen
authors.initials: N
authors.lastname: Jamal
authors.forename: Dinesh K
authors.initials: DK
authors.lastname: Chhetri
mesh_terms: D000328:Adult; D000368:Aged; D058109:Airway Management / Q000379:methods*; D000477:Alkylating Agents / Q000008:administration & dosage; D001999:Bronchoscopy; D004106:Dilatation; D005260:Female; D006801:Humans; D017214:Laryngeal Masks; D007829:Laryngostenosis / Q000209:etiology / Q000473:pathology / Q000628:therapy*; D053685:Laser Therapy; D054020:Lasers, Gas / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D016685:Mitomycin / Q000008:administration & dosage; D012189:Retrospective Studies; D014135:Tracheal Stenosis / Q000209:etiology / Q000473:pathology / Q000628:therapy*; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000477:Alkylating Agents; D016685:Mitomycin
keywords: CO2 laser; airway management; balloon dilation; laryngeal mask airway; subglottic stenosis; tracheal stenosis