Author(s)
Emily E. Drury, D.O
Brian P. Anderson, D.O.
Michael S. Haupert, D.O.
Prasad J. Thottam, D.O.
Affiliation(s)
Otolaryngology, Ascension Macomb-Oakland Hosp., Warren, MI, Pediatric Otolaryngology, Beaumont Hosp.- Royal Oak, Royal Oak, MI.;
Abstract:
Introduction: Steroid-eluting implants have been used in the sinuses to help with prevention of restenosis and adhesions. Here, a case is described in which a mometasone furoate implant was utilized as an adjunct to help prevent granulation and restenosis in a patient who underwent double-stage laryngotracheal reconstruction (dsLTR) for subglottic stenosis. Case Description: This case presents a 3-year-old female with a history of Beckwith-Wiedemann syndrome, subglottic stenosis, and tracheostomy. She underwent dsLTR with anterior graft placement and posterior split. A stent was placed at the time of the dsLTR. After stent removal, routine surveillance was performed at 4-5 week intervals with direct laryngoscopy and bronchoscopy. These visits revealed a significant amount of granulation tissue at the proximal aspect of the graft contributing to airway obstruction and restenosis. This required two treatments with CO2 laser excision, balloon dilation, and triamcinolone injection. While there was overall improvement with each treatment, there was still significant supraglottic and glottic edema, as well as persistent areas of granulation and restenosis at the proximal portion of the graft. On the third visit, a mometasone furoate implant was used in conjunction with the other treatments. The implant was inserted to lateralize the vocal folds, prevent webbing, and to extend to the narrowed area within the subglottis to prevent granulation and restenosis. Findings at the next visit demonstrated significantly less supraglottic and glottic edema, and a much-improved small area of remaining granulation-associated stenosis at the anterior proximal graft site just inferior to the true vocal folds. This was again treated with CO2 laser, balloon dilation, and triamcinolone injection. Another mometasone furoate implant of a smaller size was placed in the glottis, extending to the subglottis. There will be continued surveillance in the coming months. Discussion: Steroid-eluting implants are safe, bioabsorbable, and have been effective in preventing restenosis and adhesions in the sinuses. This appears to be a safe and effective adjunct to therapy in the routine surveillance of patients with a tracheostomy who have undergone dsLTR, and may help combat granulation formation and restenosis seen in some LTR patients.