American journal of otolaryngology · 2018
Office-based retrograde transtracheal application of mitomycin C.
СтатьяНазвание и аннотация: Перевод в очереди
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Silva Merea Valeria, Bryson Paul C
Аннотация
OBJECTIVES: The utility of topical mitomycin C (MMC) as an adjuvant treatment in the management of laryngeal and tracheal stenosis has been studied; however, the ideal timing of MMC application has not been fully elucidated. There is a paucity of studies evaluating the timing of MMC application after surgical airway intervention for stenosis. The purpose of this study is to describe a novel technique for MMC application that allows for delayed application in the unsedated, office-based setting, approximately one week following endoscopic airway dilation.
METHODS: A technique for retrograde transtracheal application of MMC was developed and utilized in 3 tracheostomy-dependent patients with subglottic stenosis and glottic stenosis with bilateral vocal fold immobility. After administration of topical anesthesia, a MMC (0.4 mg/ml) coated pledget was advanced via a transtracheal approach and directed to the area of stenosis in retrograde fashion using endoscopic frontal sinus instruments. Appropriate positioning of the pledget was confirmed via transnasal flexible fiberoptic laryngoscopy.
RESULTS: All 3 patients underwent successful in-office retrograde application of MMC onto the area of laryngeal stenosis 7-9 days after their preceding surgery. There were no complications. Two patients achieved decannulation while the third patient's management was interrupted due to cancer treatment.
CONCLUSIONS: We present a novel and well tolerated technique for delayed in-office application of MMC in tracheostomy-dependent patients with laryngeal stenosis. This approach can facilitate the study of the ideal timing of topical MMC use in airway stenosis.
METHODS: A technique for retrograde transtracheal application of MMC was developed and utilized in 3 tracheostomy-dependent patients with subglottic stenosis and glottic stenosis with bilateral vocal fold immobility. After administration of topical anesthesia, a MMC (0.4 mg/ml) coated pledget was advanced via a transtracheal approach and directed to the area of stenosis in retrograde fashion using endoscopic frontal sinus instruments. Appropriate positioning of the pledget was confirmed via transnasal flexible fiberoptic laryngoscopy.
RESULTS: All 3 patients underwent successful in-office retrograde application of MMC onto the area of laryngeal stenosis 7-9 days after their preceding surgery. There were no complications. Two patients achieved decannulation while the third patient's management was interrupted due to cancer treatment.
CONCLUSIONS: We present a novel and well tolerated technique for delayed in-office application of MMC in tracheostomy-dependent patients with laryngeal stenosis. This approach can facilitate the study of the ideal timing of topical MMC use in airway stenosis.