Subglottic Stenosis in Adults Workup

  • Author: James D Garnett, MD; Chief Editor: Arlen D Meyers, MD, MBA   more...
 
Updated: Mar 29, 2012
 

Laboratory Studies

  • In the absence of a history of prior trauma or when suggested by other findings, evaluate for inflammatory or infectious causes, including the following:
    • Wegener granulomatosis
    • Relapsing polychondritis
    • Syphilis
    • Tuberculosis
    • Sarcoidosis
    • Leprosy
    • Diphtheria
    • Scleroma
Next

Imaging Studies

  • Radiography
    • Standard chest radiographs can often provide a great deal of information regarding the tracheal air column.
    • Anteroposterior filtered tracheal views and lateral soft tissue views of the neck provide specific information regarding the glottic/subglottic air column.
  • MRI is useful in evaluating length and width of the stenotic region by means of coronal and sagittal views.
  • CT scan
    • CT scanning is not as helpful as MRI because its views are generally only in the axial plane.
    • Thin cuts (1 mm) with sagittal and/or coronal reconstructions may be helpful, however. This is the preferred initial imaging study of the author.
    • New software allows virtual bronchoscopy, which may be helpful in assessing the airway and surgical planning prior to actually performing a procedure.
Previous
Next

Other Tests

  • Flow-volume loops do not offer more specific information regarding stenosis than what is gained from imaging. However, flow-volume loops may be helpful in monitoring for restenosis after intervention.
Previous
Next

Diagnostic Procedures

  • Videostrobolaryngoscopy is extremely helpful in evaluating the glottic and supraglottic larynx for possible concomitant injury.
  • Visualization of the larynx by flexible fiberoptic or rigid telescopic (90- or 70-degree scopes) in the clinic is crucial to the evaluation of airway lesions.
Previous
Proceed to Treatment & Management
 
 
Contributor Information and Disclosures
Author

James D Garnett, MD  Director of Voice and Swallowing Center, Associate Professor, Department of Otolaryngology-Head and Neck Surgery, University of Kansas Medical Center

James D Garnett, MD is a member of the following medical societies: American Academy of Otolaryngic Allergy and American Academy of Otolaryngology-Head and Neck Surgery

Disclosure: Nothing to disclose.

Specialty Editor Board

Anthony P Sclafani, MD  Director of Facial Plastic Surgery and Surgeon Director, New York Eye and Ear Infirmary; Professor of Otolaryngology, New York Medical College

Anthony P Sclafani, MD is a member of the following medical societies: American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, and American College of Surgeons

Disclosure: Contura None Board membership; Aesthetic Factors, Inc. Salary Consulting; Aesthetic Factors, Inc. Grant/research funds Independent contractor

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Robert M Kellman, MD  Professor and Chair, Department of Otolaryngology and Communication Sciences, State University of New York Upstate Medical University

Robert M Kellman, MD is a member of the following medical societies: American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, American College of Surgeons, American Medical Association, American Neurotology Society, American Rhinologic Society, American Society for Head and Neck Surgery, Medical Society of the State of New York, and Triological Society

Disclosure: Revent Medical Honoraria Review panel membership; Synthes Nursing Education Honoraria Other

Christopher L Slack, MD  Private Practice in Otolaryngology and Facial Plastic Surgery, Associated Coastal ENT; Medical Director, Treasure Coast Sleep Disorders

Christopher L Slack, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, and American Medical Association

Disclosure: Nothing to disclose.

Chief Editor

Arlen D Meyers, MD, MBA  Professor of Otolaryngology, Dentistry, and Engineering, University of Colorado School of Medicine

Arlen D Meyers, MD, MBA is a member of the following medical societies: American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, and American Head and Neck Society

Disclosure: Covidien Corp Consulting fee Consulting; US Tobacco Corporation Unrestricted gift Unknown; Axis Three Corporation Ownership interest Consulting; Omni Biosciences Ownership interest Consulting; Sentegra Ownership interest Board membership; Medvoy Ownership interest Management position; Cerescan Imaging Consulting; Headwatersmb Consulting fee Consulting; Venturequest Royalty Consulting

References

  1. McQueen CT, Wellendorf TG, Henrich D, et al. Subglottic stenosis: A complication of percutaneous tracheotomy. Otolaryngol Head Neck Surg. 1999;120(4):543-5. [Medline].

  2. Andrews MJ, Pearson FG. Incidence and pathogenesis of tracheal injury following cuffed tube tracheostomy with assisted ventilation: analysis of a two-year prospective study. Ann Surg. Feb 1971;173(2):249-63. [Medline].

  3. Arola MK, Inberg MV, Puhakka H. Tracheal stenosis after tracheostomy and after orotracheal cuffed intubation. Acta Chir Scand. 1981;147(3):183-92. [Medline].

  4. Cooper JD, Grillo HC. The evolution of tracheal injury due to ventilatory assistance through cuffed tubes: a pathologic study. Ann Surg. Mar 1969;169(3):334-48. [Medline].

  5. Correa AJ, Reinisch L, Sanders D, et al. Inhibition of subglottic stenosis with mitomycin-C in the canine model. Ann Otol Rhinol Laryngol. 1999;108(11):1053-60. [Medline].

  6. Dedo HH, Sooy CD. Endoscopic laser repair of posterior glottic, subglottic and tracheal stenosis by division or micro-trapdoor flap. Laryngoscope. Apr 1984;94(4):445-50. [Medline].

  7. Esclamado R, Cummings CW. Management of the impaired airway in adults. In: Cummings CW, et al, eds. Otolaryngology-Head and Neck Surgery. Singular Publishing Group;1993:2001-19.

  8. Kurrus JA, Gray SD, Elstad MR. Use of silicone stents in the management of subglottic stenosis. Laryngoscope. 1997;107(11 pt 1):1553-8. [Medline].

  9. Langford CA, Sneller MC, Hallahan CW, et al. Clinical features and therapeutic management of subglottic stenosis in patients with Wegener's granulomatosis. Arthritis Rheum. 1996;39(10):1754-60. [Medline].

  10. Ossoff RH, Duncavage JA, Toohill RJ, Tucker GF Jr. Limitations of bronchoscopic carbon dioxide laser surgery. Ann Otol Rhinol Laryngol. Sep-Oct 1985;94(5 Pt 1):498-501. [Medline].

  11. Ossoff RH, Tucker GF Jr, Duncavage JA, Toohill RJ. Efficacy of bronchoscopic carbon dioxide laser surgery for benign strictures of the trachea. Laryngoscope. Oct 1985;95(10):1220-3. [Medline].

  12. Pearson FG, Andrews MJ. Detection and management of tracheal stenosis following cuffed tube tracheostomy. Ann Thorac Surg. Oct 1971;12(4):359-74. [Medline].

  13. Rosenbower TJ, Morris Jr JA, Eddy VA, et al. The long-term complications of percutaneous dilatational tracheostomy. Ann Surg. 1998;64(1):82-6. [Medline].

  14. Shapshay SM, Beamis JF Jr, Dumon JF. Total cervical tracheal stenosis: treatment by laser, dilation, and stenting. Ann Otol Rhinol Laryngol. Nov 1989;98(11):890-5. [Medline].

  15. Shapshay SM, Beamis JF Jr, Hybels RL, Bohigian RK. Endoscopic treatment of subglottic and tracheal stenosis by radial laser incision and dilation. Ann Otol Rhinol Laryngol. Nov-Dec 1987;96(6):661-4. [Medline].

  16. Simpson GT, Strong MS, Healy GB. Predictive factors of success or failure in the endoscopic management of laryngeal and tracheal stenosis. Ann Otol Rhinol Laryngol. Jul-Aug 1982;91(4 Pt 1):384-8. [Medline].

  17. Soni NK. Scleroma of the larynx. J Laryngol Otol. 1997;111(1):70-2. [Medline].

  18. Spector GJ. Respiratory insufficiency, tracheostenosis, and airway control. In: Ballenger JJ, ed. Diseases of the Nose, Throat, Ear, Head and Neck. Lippincott Williams & Wilkins;1991:530-69.

  19. Strome M. Subglottic stenosis: therapeutic considerations. Otolaryngol Clin North Am. Feb 1984;17(1):63-8. [Medline].

  20. Sulek M, Miller RH, Mattox KL. The management of gunshot and stab injuries of the trachea. Arch Otolaryngol. Jan 1983;109(1):56-9. [Medline].

  21. Wanamaker JR, Eliachar I. An overview of treatment options for lower airway obstruction. Otolaryngol Clin North Am. Aug 1995;28(4):751-70. [Medline].

  22. Whited RE. A prospective study of laryngotracheal sequelae in long-term intubation. Laryngoscope. Mar 1984;94(3):367-77. [Medline].

 
Previous
Next
 
Preoperative view of subglottic stenosis via an endoscopic approach.
Postoperative view of subglottic stenosis after 4-quadrant carbon dioxide laser division and endoscopic balloon dilation. Note the excellent view of distal airway.
 
 
 
All material on this website is protected by copyright, Copyright © 1994-2012 by WebMD LLC.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.