Endoscopic management of subglottic stenosis

Abstract

Subglottic stenosis (SGS) is a narrowing of the airway below the vocal cords that can lead to respiratory distress and in severe cases, airway obstruction. Endoscopic surgical management of SGS has been established as a safe and effective treatment option. The aim of this manuscript is to provide an overview of the current state of the art in endoscopic surgical management of SGS. Endoscopic management of SGS typically utilizes laser (CO₂ or Nd:YAG) or cold knife incision or wedge excision in combination with rigid or balloon dilation. Topical antifibrotic therapies and steroid injections are frequently employed intraoperatively. The choice of technique depends on the location and severity of the stenosis, and a multimodal approach is common. For patients with extensive stenosis or who have failed previous endoscopic treatments, open surgery may be necessary. Preoperative assessment of the airway is critical for identifying the extent of the stenosis and ensuring appropriate treatment planning. Postoperative care includes close monitoring for complications such as bleeding, infection, and airway edema and adjuvant medical therapies such as proton pump inhibitors, inhaled corticosteroids, and antibiotics are used frequently. In conclusion, endoscopic surgical management of SGS has become an important treatment option for patients with subglottic stenosis, and new techniques such as endoscopic resection with adjuvant medical therapy (ERMT) have been employed effectively in some patients. With proper patient selection, technique selection, and postoperative care, this approach can provide effective relief of symptoms and improve patient outcomes.