title: Endoscopic Management of Subglottic Stenosis.
abstract: Optimal management of subglottic stenosis has not been established. Endoscopic techniques include balloon dilation, radial incisions with carbon dioxide laser or cold knife, and combinations of techniques. Adjunctive measures include mitomycin application and glucocorticoid injection.
  
  
  
  To determine whether surgical technique or adjunctive measures are associated with duration between surgical procedures.
  
  
  
  Adult patients with subglottic stenosis treated endoscopically between 1995-2015 at a quaternary academic medical center were identified. Patients with isolated subglottic (cricotracheal) stenosis 18 years and older were included. Patients with prior open surgical procedures, prior laryngeal surgical procedures, glottic stenosis, or vocal fold paralysis were excluded.
  
  
  
  Patients underwent endoscopic procedures including laser radial incisions, balloon dilation, or both, with some patients receiving topical mitomycin, glucocorticoid injection, or both.
  
  
  
  Time interval between endoscopic treatments.
  
  
  
  A total of 101 patients (mean [SD] age, 52.3 [15.9] years; 77.2% female) were included in the analysis, with etiologies including idiopathic (47 [46.5%]), intubation (31 [30.7%]), granulomatosis with polyangiitis (9 [8.9%]), and other autoimmune diseases (6 [5.9%]). Among the 219 operations, both laser and balloon dilation were used in 117 (53.4%), while balloon dilation alone was used in 96 (43.8%) and laser alone in 6 (2.7%). Mitomycin application and steroid injection were used in 144 (65.8%) and 93 (42.5%) cases, respectively. Mitomycin application was associated with improvement in the mean interval to next procedure from 317 to 474 days (absolute difference, 157 days; 95% CI, 15-299 days). Advanced grade of stenosis, dilation technique, and steroid injection did not significantly alter the surgical intervals.
  
  
  
  Endoscopic surgery for subglottic stenosis is a critical aspect of patient management. Neither surgical technique nor grade of stenosis was seen to alter the surgical intervals. Mitomycin application was associated with an extended time interval between endoscopic treatments.
authors.affiliation: Department of Head and Neck Surgery, David Geffen School of Medicine at University of California Los Angeles.
authors.forename: Aaron J
authors.initials: AJ
authors.lastname: Feinstein
authors.affiliation: medical student at David Geffen School of Medicine at University of California Los Angeles.
authors.forename: Alex
authors.initials: A
authors.lastname: Goel
authors.affiliation: medical student at David Geffen School of Medicine at University of California Los Angeles.
authors.forename: Govind
authors.initials: G
authors.lastname: Raghavan
authors.affiliation: Department of Head and Neck Surgery, David Geffen School of Medicine at University of California Los Angeles.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Long
authors.affiliation: Department of Head and Neck Surgery, David Geffen School of Medicine at University of California Los Angeles.
authors.forename: Dinesh K
authors.initials: DK
authors.lastname: Chhetri
authors.affiliation: Department of Head and Neck Surgery, David Geffen School of Medicine at University of California Los Angeles.
authors.forename: Gerald S
authors.initials: GS
authors.lastname: Berke
authors.affiliation: Department of Head and Neck Surgery, David Geffen School of Medicine at University of California Los Angeles.
authors.forename: Abie H
authors.initials: AH
authors.lastname: Mendelsohn
mesh_terms: D000477:Alkylating Agents / Q000008:administration & dosage; D004106:Dilatation / Q000379:methods; D004724:Endoscopy / Q000379:methods*; D005260:Female; D005938:Glucocorticoids / Q000008:administration & dosage; D006801:Humans; D007829:Laryngostenosis / Q000209:etiology / Q000601:surgery*; D053685:Laser Therapy / Q000379:methods; D008297:Male; D008875:Middle Aged; D016685:Mitomycin / Q000008:administration & dosage; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D000477:Alkylating Agents; D005938:Glucocorticoids; D016685:Mitomycin