Drury Emily, Anderson Brian, Haupert Michael, Thottam Prasad John
Department of Otolaryngology, Ascension Macomb-Oakland Hospital, Madison Heights, MI, USA.
Department of Pediatric Otolaryngology, Beaumont Hospital-Royal Oak, Royal Oak, MI, USA.
Ann Otol Rhinol Laryngol. 2024 Feb;133(2):244-248. doi: 10.1177/00034894231202067. Epub 2023 Sep 30.
The primary objective is to describe a case in which a steroid-eluting implant was utilized to help prevent postoperative granulation and restenosis in a patient who underwent double-stage laryngotracheal reconstruction (dsLTR) for subglottic stenosis.
This case presents a 3-year-old female who underwent dsLTR with anterior cartilage graft placement and posterior sagittal split for subglottic stenosis. A silicone stent was placed at the time of the dsLTR. After stent removal, direct laryngoscopy and bronchoscopy (DLB) was performed at 4 to 5 week intervals. These visits revealed a significant amount of supraglottic and glottic edema, and granulation tissue at the proximal aspect of the graft contributing to airway obstruction and restenosis. This was treated twice with CO laser excision, balloon dilation, and triamcinolone injection. On the third treatment with these modalities, a mometasone furoate implant was inserted as an adjunctive therapy. The implant was inserted to lateralize the vocal folds, prevent webbing, and to extend to the narrowed area within the subglottis to prevent granulation and restenosis. These same treatments were repeated at the fourth visit with another mometasone furoate implant of a smaller size placed in the same location.
Findings on DLB since treatment with the steroid-eluting implants have shown persistent granulation tissue limited to the tracheostomy stoma site. Treatments with CO laser, balloon dilation, and triamcinolone injection have continued, with occasional use of silver nitrate cautery at the external stoma site. There has not been any significant evidence of edema, granulation, or stenosis in the glottis or subglottis to require another steroid-eluting implant.
Steroid-eluting implants appear to be a safe and effective adjunctive therapy in the routine surveillance of pediatric patients with a tracheostomy who have undergone dsLTR. They may help combat granulation formation and restenosis seen in some dsLTR patients.
主要目的是描述一例在接受声门下狭窄双阶段喉气管重建术（dsLTR）的患者中使用类固醇洗脱植入物来帮助预防术后肉芽组织形成和再狭窄的病例。
该病例为一名3岁女性，因声门下狭窄接受了dsLTR手术，术中放置了前软骨移植和后矢状劈开。在dsLTR手术时放置了硅胶支架。支架取出后，每隔4至5周进行一次直接喉镜和支气管镜检查（DLB）。这些检查发现声门上和声门有大量水肿，移植片近端有肉芽组织，导致气道阻塞和再狭窄。对此进行了两次二氧化碳激光切除、球囊扩张和曲安奈德注射治疗。在第三次采用这些方法治疗时，插入糠酸莫米松植入物作为辅助治疗。植入该植入物是为了使声带向外侧移位、防止粘连，并延伸至声门下狭窄区域以预防肉芽组织形成和再狭窄。在第四次就诊时，在同一位置再次植入一枚尺寸较小且相同的糠酸莫米松植入物，并重复相同的治疗。
自使用类固醇洗脱植入物治疗以来，DLB检查结果显示肉芽组织持续存在，仅限于气管造口部位。继续进行二氧化碳激光、球囊扩张和曲安奈德注射治疗，偶尔在外部造口部位使用硝酸银烧灼。声门或声门下没有明显的水肿、肉芽组织或狭窄迹象，无需再植入类固醇洗脱植入物。
在对接受dsLTR手术的小儿气管造口患者进行常规监测时，类固醇洗脱植入物似乎是一种安全有效的辅助治疗方法。它们可能有助于对抗一些dsLTR患者中出现的肉芽组织形成和再狭窄。
