Subglottic Stenosis in Wegener???s Granulomatosis and the Nitinol Stent

The efficacy of submucosal corticosteroid injection and dilatation in subglottic stenosis of different aetiology

Objective:

To determine the long-term efficacy of submucosal corticosteroid injection plus dilatation for subglottic stenosis as a single modality treatment in granulomatosis with polyangiitis and relapsing polychondritis, as compared with idiopathic subglottic stenosis and traumatic subglottic stenosis.

Method:

Patients who underwent dilatation for autoimmune causes were identified. Corticosteroid injection into the submucosa of a stenotic segment was followed by serial dilatation. Definitive improvement was defined as good airway patency for more than 24 months with no further procedures needed. Clinical, demographic and procedural data were recorded.

Results:

Patients (n = 45) were divided into three subglottic stenosis groups: traumatic (n = 24), idiopathic (n = 9) and autoimmune (n = 12). Patients were treated with dilatations, with a median follow-up time of 76 months. Six patients were tracheostomy-dependent. There were no statistical differences in the number of final improvements between autoimmune, idiopathic and traumatic groups, with values of 75, 56 and 71 per cent, respectively. There was no statistical difference between granulomatosis with polyangiitis plus relapsing polychondritis and idiopathic subglottic stenosis in terms of decannulation rates.

Conclusion:

Granulomatosis with polyangiitis and relapsing polychondritis patients have better improvement rates than patients with other subglottic stenosis types.

New treatment of subglottic stenosis due to Wegener's granulomatosis

CONCLUSIONS

The presented new endoscopic surgical technique offers a safe and successful approach for treatment of subglottic stenosis due to Wegener's granulomatosis.

OBJECTIVE

Subglottic stenosis is a potentially limiting and complex condition among patients with Wegener's granulomatosis. It causes various symptoms and often requires interventional therapy. The purpose of this study was to evaluate a new endoscopic submucosal technique.

METHODS

Altogether 13 consecutive patients with subglottic stenosis due to Wegener's granulomatosis were treated with a new endoscopic technique. The procedure was carried out endoscopically, removing the stenotic part submucosally, sealing back the raised mucosal flap, and the bare areas were soaked with mitomycin-C. Follow-up telephone interviews were carried out and hospital records were reviewed.

RESULTS

Patients included 3 males and 10 females, with an average age of 37.5 years. A total of 37 procedures were performed, with an average of 2.8 procedures per patient. There was a statistically significant reduction in the all symptoms related to the stenoses (p < 0.05). Mean follow-up period was 3.5 years (range 1.5-6.5 years). Overall success rate was 85%. Only one patient relapsed following adequate medical and surgical treatment. No perioperative mortality was recorded.

Intralesional corticosteroid injection and dilatation provides effective management of subglottic stenosis in Wegener's granulomatosis

OBJECTIVES/HYPOTHESIS

To describe our experience with the use of intralesional corticosteroid injection and dilatation (ILCD) in the management of subglottic stenosis (SGS).

STUDY DESIGN

Retrospective chart review.

METHODS

A retrospective chart review was performed of all patients with SGS requiring ILCD, from 2003 to 2008, at the Department of Otolaryngology-Head and Neck Surgery, Mount Sinai Hospital, Toronto, Canada.

RESULTS

Twelve patients with SGS underwent 36 ILCD operations with a mean of three procedures per patient. We identified eight patients with Wegener's granulomatosis (WG) and four patients without WG. The eight WG patients received an average of 3.37 procedures, whereas non-WG patients required an average of 2.25 procedures. This maintained airway patency and symptom control for an average of 11.9 and 8.1 months, respectively. Only one complication was identified, and no long-term sequelae were found. No patients required new tracheotomies and one patient with a previous tracheotomy was successfully decannulated.

CONCLUSIONS

Our data supports the use of ILCD as a safe and effective treatment of SGS in both WG and non-WG patients.

Surgical interventions and local therapy for Wegener's granulomatosis

PURPOSE OF REVIEW

This review discusses the use of interventional procedures to treat manifestations of Wegener's granulomatosis caused by tissue damage and scarring. These manifestations include nasal and paranasal sinus disease, middle ear inflammation, nasolacrimal duct obstruction, orbital inflammatory masses, subglottic stenosis, tracheobronchial disease, and end-stage renal disease.

RECENT FINDINGS

Tissue damage caused by inflammation or a cicatricial process represents one of the major sources of morbidity for patients with Wegener's granulomatosis. Some of these manifestations require special interventions used alone or in combination with conventional medical treatment. These interventional procedures may include surgical or endoscopic repair of altered tissue, replacement of damaged organs, or the delivery of topical or injectable medications directly to the site of disease. Distinguishing symptoms caused by active disease from symptoms caused by tissue scarring is challenging and may play a critical role regarding the use of systemic immunosuppressive medications in combination with interventional therapy.

SUMMARY

Interventional procedures are indicated in certain manifestations of Wegener's granulomatosis. Distinguishing active Wegener's granulomatosis from inactive Wegener's granulomatosis and recognizing disease manifestations that may be amenable to local interventions can greatly improve the quality of life of patients. However, the evidence supporting the use of many of these interventions is based on small case series or individual reports.