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Endoscopic Grade 4 Subglottic Stenosis

We describe the management of a grade 4 subglottic stenosis, which was successfully performed endoscopically. This is the case of a 17 year-old female, tracheostomy dependent, with a complex history of failed open airway surgeries. Patient was referred to our center for a second opinion for decannulation. We found a grade 4 subglottic stenosis at her initial evaluation with a prolapsed anterior graft. Patient and family requested an endoscopic procedure, trying to avoid another open surgery.  It was decided that an endoscopic procedure would be attempted. Patient was placed into suspension, and using alligator forceps, the stenotic area was probed until communication could be made with the distal tracheal.  Using a series of balloon dilations and the microdebrider, a suprastomal stent could be endoscopically placed. Stent was removed 6 weeks later and showed a patent airway. Patient then underwent a series of 4 dilations and was successfully decannulated, just before graduating from college.

Endoscopic grade 4 subglottic stenosis repair
Grade 4 subglottic stenosis with easy exposure endoscopically for surgeon with high degree of expertise in airway surgery. Grade 4 stenosis is usually repair as an open airway surgery
Patients that cannot be easily exposed
Suspension with Zeitels laryngoscope. Use of endoscopic suction, D-knife, microdebrider, airway balloon and Rutter suprastomal stent.
Microlaryngoscopy and bronchoscopy to confirm the grade and location of the stenosis MRSA screening
Vocal folds Subglottis Suprastomal area
Endoscopic procedure with no neck incision.
False passage in the distal airway Loss of the airway Failure to keep the airway patent
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