ALA030 - The Evolution and Early Results of Subepithelial Resection and Relining of the Subglottis (Or “Maddern Procedure”) for the Treatment of Subglottic Stenosis
Executive Medical Director Market & Network Services Cleveland Clinic Cleveland, Ohio
Background/Objectives: A novel technique to treat subglottic stenosis has been gaining acceptance in US academic centers. This study describes the “Maddern” technique in detail, as well as its evolution over the first 28 patients performed at a single academic center, as well as post-operative outcomes.
Methods: A prospective, consecutive series with descriptive analysis of technique modifications over the first 28 cases towards the establishment of a procedure with reproducible results. Inclusion criteria included all patients undergoing subepithelial resection of the subglottic stenosis with relining of the area with an epithelial graft. Modifications of the procedure were cataloged throughout the 6 years included within the follow-up period (11/2015-11/2021).
Results: Etiology included either idiopathic or autoimmune-related causes. Main outcomes examined included changes to surgical indications, intra-operative and post-operative complications, post-operative outcomes as measured by validated measures of voice and breathing, as well as refinements to the technique and operative approach. While subglottic patency was achieved in all participants, including successful decannulation of the 3 patients with previously existing tracheotomies, 4 patients did subsequently required treatment of the lowest segment of disease, involving the upper trachea. This was accomplished by a limited tracheal resection, with preservation of the entire cricoid ring.
Conclusions: Subepithelial resection and relining of the subglottis is a safe, yet technically challenging procedure which addresses the recurrent nature of the disease process with durable subglottic patency.