title: Coblation of suprastomal granulomas in tracheostomy-dependent children.
abstract: OBJECTIVE
  Suprastomal granulomas pose a persistent challenge for tracheostomy-dependent children. They can limit phonation, cause difficulty with tracheostomy tube changes and prevent decannulation. We describe the use of the coblator for radiofrequency plasma ablation of suprastomal granulomas in five consecutive children from September 2012 to January 2016.
  
  
  METHODS
  Retrospective case series at a tertiary medical center.
  
  
  RESULTS
  The suprastomal granuloma could be removed with the coblator in all 5 cases. Three were removed entirely endoscopically and 2 required additional external approach through the tracheal stoma for complete removal. There were no intraoperative or postoperative complications. One patient was subsequently decannulated and 2 patients have improved tolerance of their speaking valves. Two patients remain ventilator dependent, but their bleeding and difficulty with tracheostomy tube changes resolved. Three of the patients have had subsequent re-evaluation with bronchoscopy, demonstrating resolution or markedly decreased size of the granuloma. This technique is time efficient, simple and minimizes risks associated with other techniques. The relatively low temperature and use of continuous saline irrigation with the coblator device minimizes the risk of airway fires. Additionally, the risk of hypoxia from keeping a low fractional inspiratory oxygen level (FIO2) to prevent fire is avoided. The concurrent suction in the device decreases blood and tissue displacement into the distal airway.
  
  
  CONCLUSIONS
  Coblation can be used safely and effectively with an endoscopic or external approach to remove suprastomal granulomas in tracheostomy-dependent children. More studies that are larger and have longer follow-up are needed to evaluate the use of this technique.
authors.affiliation: Duke University Medical Center, Division of Otolaryngology-Head and Neck Surgery & Communication Sciences, Department of Surgery, 40 Duke Medicine Circle, DUMC 3805, Durham, NC 27710, USA. Electronic address: clifford.brown@duke.edu.
authors.forename: C Scott
authors.initials: CS
authors.lastname: Brown
authors.affiliation: Duke University Medical Center, Division of Otolaryngology-Head and Neck Surgery & Communication Sciences, Department of Surgery, 40 Duke Medicine Circle, DUMC 3805, Durham, NC 27710, USA. Electronic address: marisa.a.ryan@gmail.com.
authors.forename: Marisa A
authors.initials: MA
authors.lastname: Ryan
authors.affiliation: Duke University School of Medicine, 8 Duke University Medical Center Greenspace, Durham, NC 27703, USA. Electronic address: vaibhav.ramprasad@duke.edu.
authors.forename: Vaibhav H
authors.initials: VH
authors.lastname: Ramprasad
authors.affiliation: Duke University Medical Center, Division of Otolaryngology-Head and Neck Surgery & Communication Sciences, Department of Surgery, 40 Duke Medicine Circle, DUMC 3805, Durham, NC 27710, USA. Electronic address: anatoli.karas@duke.edu.
authors.forename: Anatoli F
authors.initials: AF
authors.lastname: Karas
authors.affiliation: Duke University Medical Center, Division of Otolaryngology-Head and Neck Surgery & Communication Sciences, Department of Surgery, 40 Duke Medicine Circle, DUMC 3805, Durham, NC 27710, USA. Electronic address: eileen.raynor@duke.edu.
authors.forename: Eileen M
authors.initials: EM
authors.lastname: Raynor
mesh_terms: D017115:Catheter Ablation / Q000379:methods*; D002648:Child; D002675:Child, Preschool; D004724:Endoscopy / Q000009:adverse effects; D005260:Female; D006099:Granuloma / Q000209:etiology / Q000601:surgery*; D006801:Humans; D007223:Infant; D008297:Male; D011183:Postoperative Complications / Q000209:etiology; D012189:Retrospective Studies; D014132:Trachea / Q000601:surgery*; D014139:Tracheostomy / Q000009:adverse effects* / Q000379:methods
keywords: Coblation; Pediatric suprastomal granuloma; Radiofrequency plasma ablation; Tracheostomy