title: Idiopathic Subglottic Stenosis: Long-Term Outcomes of Open Surgical Techniques.
abstract: Objectives Idiopathic subglottic stenosis (iSGS) is rare, and its cause remains elusive. Treatment options include empiric medical therapy and endoscopic or open surgery. We present our results for open surgical technique. Study Design Case series with chart review (1978-2015). Setting Tertiary academic center. Subjects/Methods Thirty-three patients (32 female; median age, 51 years) met inclusion criteria and underwent cricotracheal resection with thyrotracheal anastomosis, tracheal resection with primary anastomosis, or laryngotracheoplasty with rib grafting. Continuous variables were summarized using medians and ranges while categorical features are presented using frequency counts and percentages. Results Sixteen patients (48%) underwent a single-stage approach with immediate extubation or temporary intubation following surgery (median, 1 day; range, 1-3 days). Seventeen patients (52%) underwent a double-staged approach with a median time to decannulation of 35 days (range, 13-100 days). Twenty-four (73%) patients underwent a previous intervention. Median stay in the intensive care unit was 1 day (range, 0-3 days), with a median hospital stay of 4 days (range, 2-7 days). Recurrence requiring further surgical intervention was observed in 12 patients (36%). The median time to recurrence was 8 years over an average follow-up of 9.7 years. The most common complaint following surgery was change in voice quality (fair to poor; n = 10; 30%). Conclusions Open surgery should be reserved for refractory cases of iSGS; cricotracheal resection with thyrotracheal anastomosis is the preferred open technique. Recurrence may occur after open treatment, highlighting the importance of long-term follow-up. Patients should be counseled about the potential for worsening voice quality with the open approach.
authors.affiliation: 1 Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic Minnesota, Rochester, Minnesota, USA.
authors.forename: Deanna C
authors.initials: DC
authors.lastname: Menapace
authors.affiliation: 1 Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic Minnesota, Rochester, Minnesota, USA.
authors.forename: Mara C
authors.initials: MC
authors.lastname: Modest
authors.affiliation: 1 Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic Minnesota, Rochester, Minnesota, USA.
authors.forename: Dale C
authors.initials: DC
authors.lastname: Ekbom
authors.affiliation: 1 Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic Minnesota, Rochester, Minnesota, USA.
authors.forename: Eric J
authors.initials: EJ
authors.lastname: Moore
authors.affiliation: 2 Department of Pulmonology, Mayo Clinic School of Medicine, Rochester, Minnesota, USA.
authors.forename: Eric S
authors.initials: ES
authors.lastname: Edell
authors.affiliation: 1 Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic Minnesota, Rochester, Minnesota, USA.
authors.forename: Jan L
authors.initials: JL
authors.lastname: Kasperbauer
mesh_terms: D000046:Academic Medical Centers; D000328:Adult; D000368:Aged; D000714:Anastomosis, Surgical / Q000379:methods; D016025:Bone Transplantation / Q000379:methods*; D015331:Cohort Studies; D003413:Cricoid Cartilage / Q000601:surgery*; D004417:Dyspnea / Q000175:diagnosis / Q000209:etiology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D058753:Laryngoplasty / Q000379:methods*; D007828:Laryngoscopy / Q000379:methods; D007829:Laryngostenosis / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000009:adverse effects / Q000379:methods; D018579:Patient Selection; D011183:Postoperative Complications / Q000503:physiopathology / Q000601:surgery; D012008:Recurrence; D012086:Reoperation / Q000379:methods; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D062606:Tertiary Care Centers; D014135:Tracheal Stenosis / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D016896:Treatment Outcome; D014833:Voice Quality
keywords: cricotracheal resection; idiopathic subglottic stenosis; laryngotracheoplasty; tracheal resection