Effective role of diode laser in the management of acquired subglottic and tracheal stenoses.

Abstract

Objective: To assess the efficacy of Diode Laser-assisted Transoral Laser Microsurgery (TLM) in the management of acquired subglottic and tracheal stenoses. Study Design: Descriptive Case Series. Setting: Department of ENT Surgery, KRL Hospital Islamabad. Period: 01.07.2021 to 30.01.2023. Methods: Subglottic and tracheal stenosis represent a major therapeutic challenge. Minimally invasive endoscopic treatment strategies including trans-oral laser surgery and pneumatic dilatation, with or without temporary stenting, yield good results. In this unique study, 62 patients were included via non-probability consecutive sampling. They underwent transoral endoscopic laser surgery. Clinical findings in outpatient tracheoscopy were recorded and all data was analyzed using SPSS. Results: Half of the patients were <25 years, with significant male predominance. Percentage frequency of stenosis was 8.1%, 38.7%, 33.8% and 19.4% for Myer Cotton grade I, II, III and IV respectively. The glottis to lesion distance ranged from 1.5 to 11 cm with a mean of 2.7±1.71 cm while the length of the stenotic segment ranged from 1 to 6 cm with a mean of 1.28±0.95 cm. Successful decannulation of the tracheostomy tube was achieved in 85.48% patients. Time between first surgery and decannulation ranged from 0 to 18 months with a mean of 9.78±5.52 months as many patients, particularly Myer and Cotton grade I and II stenosis were extubated at the time of primary surgery. Conclusion: We conclude that trans-oral endoscopic treatment with diode laser has highly successful outcomes in expert hands. This minimally invasive technique has advantages of no skin incisions, expedited recovery and improved quality of life for tracheostomy dependent patients.