Idiopathic Subglottic Stenosis: An Institutional Review of Outcomes With a Multimodality Surgical Approach
Christopher D. Dwyer, Mehdi Qiabi, Dalilah Fortin, Richard Inculet, Anthony C. Nichols, S. Danielle MacNeil, Richard Malthaner, John Yoo, Kevin Fung
Abstract
Objectives This article reports on a unique cohort of patients with idiopathic subglottic stenosis spilt fairly equally between endoscopic and open surgical approaches. Patients’ sequence of operations and reinterventions over time are outlined, offering insight to improve surgical counseling and allow for informative, autonomous patient decision making. Study Design Retrospective cohort study. Setting Tertiary care academic center. Methods Cases of consecutive adults with idiopathic subglottic stenosis managed surgically over a 12‐year period (January 2006–December 2017) were retrospectively reviewed. Surgical workflow, complications, and outcomes, including reinterventions and tracheotomy dependence, are reported. Results Seventy‐two patients (71 women; mean age, 50.4 years) with idiopathic subglottic stenosis requiring surgical airway intervention were identified. Six patients underwent tracheotomy prior to attempt at airway stenosis surgery. Initial surgical approach thereafter included endoscopic (73.5%, n = 53) and open (26.4%, n = 19) procedures. Thirty‐one patients underwent cricotracheal resection; the reintervention rate was 22.5%. Sixty patients underwent 147 endoscopic procedures; the reintervention rate was 75.5%, and the mean time between dilations was 83 weeks (range, 5‐402). Two (2.8%) patients remain tracheotomy dependent. Adverse events were significantly higher in the cricotracheal group, especially with respect to dysphonia and temporary gastrostomy tube placement ( P <. 01). Conclusions Endoscopic and open surgical airway intervention can be employed successfully to avoid tracheotomy dependence and maintain airway patency; however, multiple procedures are usually required, regardless of surgical approach. Cricotracheal reintervention rates are lower than endoscopic dilation but with increased morbidity. Quality‐of‐life outcomes should be clearly discussed with patients before deciding on a surgical management strategy.