Scientific Session VII - Laryngotracheal Injury/Stenoss
ALA063 - Proximal scar progression and increasing scar length in idiopathic subglottic stenosis after laser wedge excision: does it happen?
Saturday, April 30, 2022
3:33 PM – 3:39 PM CT
Location: Landmark D
Katherine Z. Xie, BS; Andrew J. Bowen, MD; Bradley A. Richards, BS; Eric S. Edell, MD; Amy Rutt, MD; Semirra L. Bayan, MD; Robert Vassallo, MD; Joshua P. Wiedermann, MD; Jan L. Kasperbauer, MD; Dale C. Ekbom, MD
Mayo Clinic Alix School of Medicine Rochester, Minnesota
Background/Objectives: Proximal migration of scar to the glottis in patients with idiopathic subglottic stenosis (ISS) is possibly iatrogenic. Data quantifying scar progression due to endoscopic laser wedge excision (LWE) and comparison to balloon dilation (BD) are limited. Investigation of glottic involvement or long stenosis after each technique was performed.
Methods:A retrospective case of patients with ISS who underwent LWE between 2002-2020 was performed. Groups were divided into patients having undergone initial BD for their ISS (GroupBD, n=82) and those with no previous operations (GroupLWE-only, n=139) prior to LWE. Comparisons of baseline intra-operative findings including length of scar, distance from glottis to superior-most aspect of scar (DGS), and involvement of glottis were performed. Progression (in mm) per procedure was calculated for patients with increase in scar length (PL) and proximal migration of scar (PM).
Results: 221 ISS patients underwent LWE procedure. Higher incidence of scars involving the glottis was seen in GroupBD (n=6, 7.3%), in which patients had undergone a median (IQR) of 2 (3) procedures prior to LWE than GroupLWE-only (n=6, 4.3%). When patients with baseline glottic involvement were excluded, no cases were observed in which LWE procedures resulted in new glottic involvement of the scar. The rate for PM specifically reflected migration or decrease in DGS of 9.5% with each procedure with respect to the patient’s initial DGS.
Conclusions: Patients undergoing LWE procedure for management of their ISS appear to be at comparable or lesser risk for glottic involvement or long stenosis than those who have undergone BD.