The Use of Intraoperative Mitomycin-C In The Treatment and Prevention of Glottic and Subglottic Stenosis

Abstract

The management of laryngeal and tracheal stenosis remains difficult, requiring accurate disagnosis and a proper treatment plan. The goal of any treatment is the restoration of an adequate airway, the provision of a competent larynx for protection against aspiration, and the achievement of a satisfactory voice. Endoscopic management of laryngeal and tracheal lesions has undergone tremendous advancement in the past two decades. The development of microlaryngoscope, and adaptation of the binocular operating microscope, the introduction of endolaryngeal CO2 laser surgery, the coupling of an endoscopic adapter to a ventilating bronchoscope, and the development of the microspot manipulator allow microprecision and hemostatic ability, which were lacking with the standard instrumentation of conventional endoscopic techniques. Multiple endoscopic techniques have been described: microcauterization, dilation with local and systemic steroids, and cryosurgery have all had some success. The CO2 laser appears to be the most effective means for treating mild to moderate stenosis of the larynx and trachea endoscopically With the advancement in endoscopic surgical techniques and a better understanding of the wound healing process, and even with the introduction of mucosa -preserving laser surgery such as the micro-trapdoor flap technique and radial incision and dilation, there is still a high risk of scar formation and restenosis.