The management of subglottic stenosis in patients with wegener's granulomatosis
Wegener's granulomatosis (WG) is a multisystem inflammatory disease characterized by vasculitis, granuloma formation, and necrosis. Among 158 patients treated at the National Institutes of Health during the past 24 years, 145 (92%) had an otolaryngologic manifestation of their disease and 25 (1...
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| Veröffentlicht in: | The Laryngoscope 1992-12, Vol.102 (12), p.1341-1345 |
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| container_title | The Laryngoscope |
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| creator | Lebovics, Robert S. Hoffman, Gary S. Leavitt, Randi Y. Kerr, Gail S. Hallahan, Claire Rottem, Menachem Fauci, Anthony S. Travis, William D. Kammerer, William |
| description | Wegener's granulomatosis (WG) is a multisystem inflammatory disease characterized by vasculitis, granuloma formation, and necrosis. Among 158 patients treated at the National Institutes of Health during the past 24 years, 145 (92%) had an otolaryngologic manifestation of their disease and 25 (16%) had subglottic stenosis (SGS). SGS varied from asymptomatic to life‐threatening. Sixteen (80%) of 20 patients with fixed SGS required surgical intervention, including manual dilations, carbon‐dioxide laser resections, and laryngotracheoplasty (LTP). LTP was performed with and without microvascular reconstruction. Thirteen of the patients required tracheostomy and all 13 were ultimately decannulated. Five patients who repeatedly failed dilations and/or endoscopic laser surgery underwent LTP. Since 1987, two patients have undergone LTP with microvascular free flaps. Both patients were subsequently decannulated. The authors' experience demonstrates that management of SGS in WG is complex, requiring individualized frequent multimodality interventions to achieve satisfactory results. Microvascular laryngotracheal reconstruction should be considered in the surgical armamentarium for patients with persistent stenoses. |
| doi_str_mv | 10.1288/00005537-199212000-00005 |
| format | Article |
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Among 158 patients treated at the National Institutes of Health during the past 24 years, 145 (92%) had an otolaryngologic manifestation of their disease and 25 (16%) had subglottic stenosis (SGS). SGS varied from asymptomatic to life‐threatening. Sixteen (80%) of 20 patients with fixed SGS required surgical intervention, including manual dilations, carbon‐dioxide laser resections, and laryngotracheoplasty (LTP). LTP was performed with and without microvascular reconstruction. Thirteen of the patients required tracheostomy and all 13 were ultimately decannulated. Five patients who repeatedly failed dilations and/or endoscopic laser surgery underwent LTP. Since 1987, two patients have undergone LTP with microvascular free flaps. Both patients were subsequently decannulated. The authors' experience demonstrates that management of SGS in WG is complex, requiring individualized frequent multimodality interventions to achieve satisfactory results. Microvascular laryngotracheal reconstruction should be considered in the surgical armamentarium for patients with persistent stenoses.</description><identifier>ISSN: 0023-852X</identifier><identifier>EISSN: 1531-4995</identifier><identifier>DOI: 10.1288/00005537-199212000-00005</identifier><identifier>PMID: 1453838</identifier><language>eng</language><publisher>Hoboken, NJ: John Wiley & Sons, Inc</publisher><subject>Adolescent ; Adult ; Cartilage - transplantation ; Child ; Combined Modality Therapy ; Dilatation ; Female ; Glottis ; Glucocorticoids - therapeutic use ; Granulomatosis with Polyangiitis - drug therapy ; Granulomatosis with Polyangiitis - surgery ; Humans ; Laryngostenosis - drug therapy ; Laryngostenosis - surgery ; Larynx - surgery ; Laser Therapy ; Male ; Middle Aged ; Reoperation ; Surgical Flaps - methods ; Trachea - surgery ; Tracheal Stenosis - drug therapy ; Tracheal Stenosis - surgery ; Tracheostomy</subject><ispartof>The Laryngoscope, 1992-12, Vol.102 (12), p.1341-1345</ispartof><rights>Copyright © 1992 The Triological Society</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c4885-ff2219d1522b44ce6e71867b6e3a14cde3d19081823a5f783d73bcb0fa66a9be3</citedby><cites>FETCH-LOGICAL-c4885-ff2219d1522b44ce6e71867b6e3a14cde3d19081823a5f783d73bcb0fa66a9be3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,776,780,27901,27902</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/1453838$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Lebovics, Robert S.</creatorcontrib><creatorcontrib>Hoffman, Gary S.</creatorcontrib><creatorcontrib>Leavitt, Randi Y.</creatorcontrib><creatorcontrib>Kerr, Gail S.</creatorcontrib><creatorcontrib>Hallahan, Claire</creatorcontrib><creatorcontrib>Rottem, Menachem</creatorcontrib><creatorcontrib>Fauci, Anthony S.</creatorcontrib><creatorcontrib>Travis, William D.</creatorcontrib><creatorcontrib>Kammerer, William</creatorcontrib><title>The management of subglottic stenosis in patients with wegener's granulomatosis</title><title>The Laryngoscope</title><addtitle>The Laryngoscope</addtitle><description>Wegener's granulomatosis (WG) is a multisystem inflammatory disease characterized by vasculitis, granuloma formation, and necrosis. Among 158 patients treated at the National Institutes of Health during the past 24 years, 145 (92%) had an otolaryngologic manifestation of their disease and 25 (16%) had subglottic stenosis (SGS). SGS varied from asymptomatic to life‐threatening. Sixteen (80%) of 20 patients with fixed SGS required surgical intervention, including manual dilations, carbon‐dioxide laser resections, and laryngotracheoplasty (LTP). LTP was performed with and without microvascular reconstruction. Thirteen of the patients required tracheostomy and all 13 were ultimately decannulated. Five patients who repeatedly failed dilations and/or endoscopic laser surgery underwent LTP. Since 1987, two patients have undergone LTP with microvascular free flaps. Both patients were subsequently decannulated. The authors' experience demonstrates that management of SGS in WG is complex, requiring individualized frequent multimodality interventions to achieve satisfactory results. Microvascular laryngotracheal reconstruction should be considered in the surgical armamentarium for patients with persistent stenoses.</description><subject>Adolescent</subject><subject>Adult</subject><subject>Cartilage - transplantation</subject><subject>Child</subject><subject>Combined Modality Therapy</subject><subject>Dilatation</subject><subject>Female</subject><subject>Glottis</subject><subject>Glucocorticoids - therapeutic use</subject><subject>Granulomatosis with Polyangiitis - drug therapy</subject><subject>Granulomatosis with Polyangiitis - surgery</subject><subject>Humans</subject><subject>Laryngostenosis - drug therapy</subject><subject>Laryngostenosis - surgery</subject><subject>Larynx - surgery</subject><subject>Laser Therapy</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Reoperation</subject><subject>Surgical Flaps - methods</subject><subject>Trachea - surgery</subject><subject>Tracheal Stenosis - drug therapy</subject><subject>Tracheal Stenosis - surgery</subject><subject>Tracheostomy</subject><issn>0023-852X</issn><issn>1531-4995</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>1992</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqNkElPwzAQhS0EKqXwE5B8glPASxw7R8RSQFWRoGwny0kmwZClxIkK_56EFLjiy8hv3nsjfQhhSo4oU-qYdE8ILj0ahoyy7ud9SxtoTAWnnh-GYhONCWHcU4I9baMd514JoZILMkIj6guuuBqjm8UL4MKUJoMCygZXKXZtlOVV09gYuwbKylmHbYmXprGdw-GVbV7wCjIooT50OKtN2eZVYZreuYu2UpM72FvPCbq_OF-cXnqzm-nV6cnMi32lhJemjNEwoYKxyPdjCEBSFcgoAG6oHyfAExoSRRXjRqRS8UTyKI5IaoLAhBHwCToYepd19d6Ca3RhXQx5bkqoWqcl536guuAEqcEY15VzNaR6WdvC1J-aEt2z1D8s9S_LQeqi--sbbVRA8hcc4HX7s2G_sjl8_rtXz05un4XwKenV_ow31NgO98dvjanfdCC5FPpxPtVnZK4egus7fc2_AHoAka8</recordid><startdate>199212</startdate><enddate>199212</enddate><creator>Lebovics, Robert S.</creator><creator>Hoffman, Gary S.</creator><creator>Leavitt, Randi Y.</creator><creator>Kerr, Gail S.</creator><creator>Hallahan, Claire</creator><creator>Rottem, Menachem</creator><creator>Fauci, Anthony S.</creator><creator>Travis, William D.</creator><creator>Kammerer, William</creator><general>John Wiley & Sons, Inc</general><scope>BSCLL</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><scope>8BM</scope></search><sort><creationdate>199212</creationdate><title>The management of subglottic stenosis in patients with wegener's granulomatosis</title><author>Lebovics, Robert S. ; 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Among 158 patients treated at the National Institutes of Health during the past 24 years, 145 (92%) had an otolaryngologic manifestation of their disease and 25 (16%) had subglottic stenosis (SGS). SGS varied from asymptomatic to life‐threatening. Sixteen (80%) of 20 patients with fixed SGS required surgical intervention, including manual dilations, carbon‐dioxide laser resections, and laryngotracheoplasty (LTP). LTP was performed with and without microvascular reconstruction. Thirteen of the patients required tracheostomy and all 13 were ultimately decannulated. Five patients who repeatedly failed dilations and/or endoscopic laser surgery underwent LTP. Since 1987, two patients have undergone LTP with microvascular free flaps. Both patients were subsequently decannulated. The authors' experience demonstrates that management of SGS in WG is complex, requiring individualized frequent multimodality interventions to achieve satisfactory results. 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| language | eng |
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| subjects | Adolescent Adult Cartilage - transplantation Child Combined Modality Therapy Dilatation Female Glottis Glucocorticoids - therapeutic use Granulomatosis with Polyangiitis - drug therapy Granulomatosis with Polyangiitis - surgery Humans Laryngostenosis - drug therapy Laryngostenosis - surgery Larynx - surgery Laser Therapy Male Middle Aged Reoperation Surgical Flaps - methods Trachea - surgery Tracheal Stenosis - drug therapy Tracheal Stenosis - surgery Tracheostomy |
| title | The management of subglottic stenosis in patients with wegener's granulomatosis |
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