Primary Treatment of Thin Subglottic Stenosis with Laser Excision and Topical Mitomycin C

Abstract Objectives: Subglottic stenosis (SGS) is the most common complication of endotracheal intubation in the pediatric age group, with an incidence of approximately 2%. These patients require numerous procedures, and the poor success rates are reflected by the multitude of treatment strategies that are available. Mitomycin C, a chemotherapeutic agent has been used topically to prevent scar formation but never as a primary treatment. Methods: A retrospective review of 3 patients tracheotomized for thin (1 cm long stenotic segment) subglottic stenosis who were treated primarily with serial laser excision and application of mitomycin C was performed. The charts were reviewed for initial Cotton grade, Cotton grade after each procedure, number of procedures required for decannulation, time from first operation until decannulation, operation performed, and concentration of mitomycin C used. Results: Two patients with an initial Cotton grade III were decannulated, one 9 months after tracheotomy and the other 1 year after tracheotomy, with grade I stenoses. These patients required 5 and 6 procedures, respectively. The third patient had an initial Cotton grade II and was decannulated 9 months after tracheotomy with a grade I stenosis after 3 procedures. None of the patients had any complications. Conclusion: Although laser excision and dilation of subglottic stenosis has historically failed due to restenosis, use of mitomycin C may improve the outcome in selected patients. Patients who require tracheotomy for thin segment (less than 1 cm) stenosis may benefit from this minimally invasive treatment.