Early and Late Dilatation for Acquired Subglottic Stenosis

Abstract

There has been widespread use of periodic dilatations in the management of subglottic stenosis. However, some authorities have questioned the value in the overall rehabilitation of patients affected by this disorder. The first phase of this study included fourteen large dogs in which acute subglottic lesions were created by use of a high-speed electric drill and electrocautery. Twelve animals served as the experimental group and two animals were controls. Obstructing lesions developed in all the animals within 7 to 21 days. When at least a 50% obstruction developed in an animal, a treatment plan was instituted that included at least weekly dilatation, removal of granulations, and administration of intralesional steroids and/or systemic steroids and antibiotics. The two control animals became totally obstructed and were killed. Varying degrees of subglottic stenosis developed in all twelve experimental animals after 8 weeks of dilatation, but none required a tracheotomy. These twelve animals were then subjected to 8 additional weeks of dilatation and antibiotics, and supplemental steroids were used in some animals from this study. It can be concluded that (1) early periodic dilatation and granulation removal in the acutely injured subglottis is effective in prevention of severe stenosis, (2) late periodic dilatations in chronic subglottic stenosis are not helpful in further alleviation of obstruction, (3) the concomitant use of antibiotics and systemic steroids did not appreciably prevent or alter the development of subglottic stenosis, and (4) the concomitant use of intralesional steroids appeared to be of benefit in the management of chronic acquired subglottic stenosis.