Management of subglottic stenosis with endoscopic stent placement

History of airway stenosis, s/p laryngotracheal reconstruction. Developed restenosis, and balloon dilated three times.

In this video we describe our technique for airway stent insertion and its securing to the neck skin.

Balloon dilation of the airway expanded the airway to its appropriate size. After sizing, a modified Mehta laryngeal stent (8mm) is inserted in the airway with laryngeal forceps. The scope is inserted into the stent to verify its position. Then a 2.0 prolene stitch is taken through the neck, trachea, stent, and taken out through the contralateral skin. This is performed under visualization with a 2.3mm endoscope through the stent. The needle is then re-inserted through the exit puncture and again taken out next to the entry puncture after passing through a subcutaneous tunnel, without re-entering the stent. A small skin incision is performed between the two prolene threads. Multiple knots are taken over an angiocath, which is then buried under the skin.

The stent is taken out 2-6 weeks after the procedure. A neck incision is performed, the angiocath is identified, the knot is cut and the stent is removed under the vision of the endoscope.

Subglottic stenosis

Mature and thick high-grade stenosis, which would not accommodate the stent.

N/A

Patient in supine position. Neck extension as needed, typically not necessary. Laryngeal suspension with Lindholm laryngoscope. Neck should be prepped and draped.

Direct laryngoscopy and bronchoscopy for airway assessment.

The neck and the laryngeal landmarks should be palpated. The cricoid and the upper trachea should be grasped between the fingers of one hand and have the needle inserted into the airway with the other. Confirmation of entrance into the airway and through the stent is done under visualization of the endoscope, through the stent. Care is taken not to enter through the glottis, but through the subglottis or the upper trachea.

Possible risk of stent migration.
Risk of failure and restenosis.
Risk of prolene stitch and angiocath to be extruded through skin.

Dr. Mehta designed the Modified Mehta Airway Stent, but has no financial relations with the manufacturer.

1. www.hoodlabs.com