Successful treatment of post-intubation tracheal stenosis with balloon dilation, argon plasma coagulation, electrocautery and application of mitomycin C

• Published in: The Southwest respiratory and critical care chronicles Vol. 3; no. 9; pp. 14 - 18
• Main Authors: Audra Fuller, Mark Sigler, Shrinivas Kambali, Raed Alalawi
• Format: Journal Article
• Language: English
• Published: Southwest Respiratory and Critical Care Chronicles 15-01-2015
• Subjects: airway obstruction; bronchoscopy; post-intubation; post-tracheostomy; topical mitomycin C; Tracheal stenosis
• ISSN: 2325-9205; 2325-9205
• DOI: 10.12746/swrccc2015.0309.113

Tracheal stenosis is an uncommon but known complication of endotracheal intubation and tracheostomy. Surgery is currently the definitive treatment for tracheal stenosis but carries a significantly higher risk for adverse events as it often involves complex procedures.  Here we present our experience using topical application of mitomycin C, along with various bronchoscopic interventions, as a treatment for tracheal stenosis. The patients in our series developed tracheal stenosis post-intubation or post-tracheostomy. Each patient in our series underwent the same basic procedures involving rigid bronchoscopy and balloon dilation, ablation of granulation tissue with cryotherapy and argon plasma coagulation, and finally application of topical mitomycin C. Our experience with these four cases shows a good initial success rate with topical mitomycin C application for the treatment of tracheal stenosis. Most patients required a repeat intervention a few weeks later. Our results suggest that success with topical mitomycin C is more likely in post-intubation rather than post-tracheostomy tracheal stenosis. Bronchoscopic therapy and topical application of mitomycin C may work better as a bridge to definitive surgery rather than as a stand-alone therapy.