Use of Cryoablation in Treatment of Subglottic Tracheal Stenosis in Pediatric Patients with Wegener's Granulomatosis
Amie Kent1, Lee Smith2, Jeffrey Cheng3, David Zeltsman1, 1Northwell Health Long Island Jewish Hospital, New Hyde Park, NY, USA, 2Northwell Health Cohen’s Children's Medical Center, New Hyde Park, NY, USA, 3 Duke University Medical Center, Durham, NC
OBJECTIVE: Subglottic stenosis is a potentially life threatening challenge for patients with Wegener €™s granulomatosis. Unlike many other types of airway stenosis, these patients present a very high risk of recurrence after traditional bronchoscopic assisted dilatation or resection procedures. As an alternative, we present our experience using cryoablation to resect subglottic stenosis in a series of pediatric patients with Wegener €™s granulomatosis.
METHODS: Three patients underwent bronchoscopy with cryoablation of subglottic stenosis. Patients were taken to the operating room and placed in suspension laryngoscopy under conditions of intermittent apnea. A six millimeter flexible bronchoscope with a two millimeter working channel was used for the ablation of the stenosis.
RESULTS: All patients experienced immediate and symptomatic relief of subglottic stenosis. Two patients were discharged home the same day. One patient had an intraoperative pneumothorax. This child required a chest tube for 36 hours and was discharged home on postoperative day three with no further complications. Interval follow up surveillance bronchoscopy was performed six to twelve weeks later for all three patients and it showed no significant recurrence and demonstrated widely patent subglottic airways.
CONCLUSIONS: Cryoablation may be more effective than traditional techniques for managing subglottic stenosis in pediatric patients with Wegener €™s granulomatosis. Cryoablation may be used as a stand-alone therapy or in conjunction with other modalities. Despite our best efforts, one of our patients had a pneumothorax which was appropriately recognized and treated. Surgeons who regularly perform procedures using cryoablation should be able to recognize and manage this complication.