Early endoscopic dilation and mitomycin application in the treatment of acquired tracheal stenosis.

Abstract

INTRODUCTION:

Acquired airway stenosis is a common complication in children after periods of tracheal intubation. We reviewed our experience in the endoscopic treatment of these lesions.

PATIENTS AND METHODS:

We performed a retrospective review of patients who presented acquired tracheal-subglottic stenosis (SGS) treated at our center from 2005 to 2012. We reviewed the etiology, age, clinical presentation, methods of diagnosis, number of bronchoscopies, angioplasty balloon dilations performed, and long-term results.

RESULTS:

A total of 18 patients (13 M, 5 F) were treated at our institution between 2005 and 2012. Median age at treatment was 3.5 months (range, 1-96 months). Of the 18 children, 16 children had SGS (all cases were postintubation), and 2 children presented tracheal stenosis (1 postintubation, 1 after tracheal surgery). Median intubation time was 30 days (range, 3-120 days). Extubation failure and stridor were the main clinical features. SGS were diagnosed as grade I in three patients, grade II in nine patients, and grade III in six patients. Bronchoscopy allowed diagnostic in all cases, and was followed by angioplasty balloon dilation, with a median of 2.5 (range, 1-5) sessions. In SGS grade I, the relation patient/number of dilations was 1; in SGS grade II 2.6, and in SGS grade III 3.5. Mitomycin was applied in 15 patients. No patients presented intraoperative complications or required reoperation. Median follow-up time was 36 months (range, 5-72 months) and no recurrence was noticed.

CONCLUSIONS:

Early endoscopic dilation with balloon shows as an effective and safe treatment in acquired tracheal and SGS.

• Authors: Ruben Ortiz, Eva Dominguez, Carlos De La Torre, Francisco Hernandez, Jose Luis Encinas, Sergio Lopez-Fernandez, Luis Castro, Juan Jose Menendez, Olga De la Serna, Juan Vazquez, Manuel Lopez Santamaria, Juan Antonio Tovar
• Journal: European journal of pediatric surgery : official journal of Austrian Association of Pediatric Surgery ... [et al] = Zeitschrift fur Kinderchirurgie (Eur J Pediatr Surg) Vol. 24 Issue 1 Pg. 39-45 (Feb 2014) ISSN: 1439-359X [Electronic] United States
• PMID: 24443093 (Publication Type: Journal Article)
• Copyright: Georg Thieme Verlag KG Stuttgart · New York.

Chemical References

• Mitomycin

Topics

• Angioplasty, Balloon
• Bronchoscopy
• Child
• Child, Preschool
• Combined Modality Therapy
• Early Medical Intervention
• Female
• Humans
• Infant
• Infant, Newborn
• Intubation, Intratracheal (adverse effects)
• Laryngostenosis (classification, diagnosis, therapy)
• Male
• Mitomycin (administration & dosage)
• Postoperative Complications (diagnosis, therapy)
• Retreatment
• Tracheal Stenosis (classification, diagnosis, therapy)