Hostname: page-component-cd9895bd7-8ctnn Total loading time: 0 Render date: 2024-12-24T01:40:46.366Z Has data issue: false hasContentIssue false
  • English
  • Français

Surgical management of airway stenosis by radiofrequency coblation

Published online by Cambridge University Press:  18 November 2014

C L Chan ,
C A Frauenfelder ,
A Foreman ,
T Athanasiadis ,
E Ooi  and
A S Carney
C L Chan
Affiliation:
Department of Otolaryngology – Head and Neck Surgery, Flinders Medical Centre and Flinders University, Adelaide, South Australia, Australia
C A Frauenfelder
Affiliation:
Department of Otolaryngology – Head and Neck Surgery, Flinders Medical Centre and Flinders University, Adelaide, South Australia, Australia
A Foreman
Affiliation:
Department of Otolaryngology – Head and Neck Surgery, Flinders Medical Centre and Flinders University, Adelaide, South Australia, Australia
T Athanasiadis
Affiliation:
Department of Otolaryngology – Head and Neck Surgery, Flinders Medical Centre and Flinders University, Adelaide, South Australia, Australia
E Ooi
Affiliation:
Department of Otolaryngology – Head and Neck Surgery, Flinders Medical Centre and Flinders University, Adelaide, South Australia, Australia
A S Carney*
Affiliation:
Department of Otolaryngology – Head and Neck Surgery, Flinders Medical Centre and Flinders University, Adelaide, South Australia, Australia
*
Address for correspondence: Prof A Simon Carney, Suite 200, Flinders Private Hospital, Bedford Park, Adelaide, South Australia 5042, Australia Fax: +61-8-8219-9908 E-mail: [email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

Background:

Acquired airway stenosis can be challenging to manage endoscopically because of difficult field visualisation, instrument limitations and the risk of laser fire. At our institution, radiofrequency coblation has been successfully used for the resection of subglottic and tracheal stenosis in adults. This paper presents our experience with this technique.

Method:

A retrospective case note analysis of all cases of airway stenosis in adults from 2007 to 2012 was performed.

Results:

Ten adult patients underwent coblation resection for airway stenosis. All lesions were classified as McCaffrey stage I (i.e. less than 1 cm long). Causes of stenosis included: idiopathic stenosis (40 per cent), previous tracheostomy (30 per cent) and endotracheal intubation (20 per cent). Six patients (60 per cent) required a single procedure and 4 (40 per cent) required multiple interventions. All patients reported significant improvement in their symptoms following treatment. All patients were alive at the time of writing and none have required open resection.

Conclusion:

Radiofrequency coblation is an attractive alternative technique for the treatment of idiopathic or acquired airway stenosis in adults.

Keywords

CoblationAirway ManagementAirway ObstructionLarynxTracheaStenosisEndoscopy
Type
Main Articles
Information
The Journal of Laryngology & Otology , Volume 129 , Issue S1 , January 2015 , pp. S21 - S26
Copyright
Copyright © JLO (1984) Limited 2014 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Footnotes

Presented at the Australian Society for Otolaryngology Head and Neck Surgery Annual Scientific Meeting, 16–20 March 2013, Perth, Western Australia, Australia.

References

1Pitkin, L. Laryngeal trauma and stenosis. In: Gleeson, M, Browning, GG, Burton, MJ, Clarke, R, Hibbert, J, Jones, NS et al. , eds. Scott-Brown's Otorhinolaryngology, Head and Neck Surgery, 7th edn.London: Hodder Arnold, 2008;2271–85Google Scholar
2Andrews, BT, Graham, SM, Ross, AF, Barnhart, WH, Ferguson, JS, McLennan, G. Technique, utility, and safety of awake tracheoplasty using combined laser and balloon dilation. Laryngoscope 2007;117:2159–62CrossRefGoogle ScholarPubMed
3Carney, AS, Evans, AS, Mirza, S, Psaltis, A. Radiofrequency coblation for treatment of advanced laryngotracheal recurrent respiratory papillomatosis. J Laryngol Otol 2010;124:510–14CrossRefGoogle ScholarPubMed
4Gonik, N, Smith, LP. Radiofrequency ablation of pediatric vallecular cysts. Int J Pediatr Otorhinolaryngol 2012;76:1819–22Google Scholar
5Magdy, EA, Elwany, S, el-Daly, AS, Abdel-Hadi, M, Morshedy, MA. Coblation tonsillectomy: a prospective, double-blind, randomised, clinical and histopathological comparison with dissection-ligation, monopolar electrocautery and laser tonsillectomies. J Laryngol Otol 2008;122:282–90Google Scholar
6Kezirian, EJ, Powell, NB, Riley, RW, Hester, JE. Incidence of complications in radiofrequency treatment of the upper airway. Laryngoscope 2005;115:1298–304Google Scholar
7Carney, AS, Timms, MS, Marnane, CN, Krishnan, S, Rees, G, Mirza, S. Radiofrequency coblation for the resection of head and neck malignancies. Otolaryngol Head Neck Surg 2008;138:81–5Google Scholar
8McCaffrey, TV. Classification of laryngotracheal stenosis. Laryngoscope 1992;102:1335–40Google Scholar
9Lorenz, RR. Adult laryngotracheal stenosis: etiology and surgical management. Curr Opin Otolaryngol Head Neck Surg 2003;11:467–72Google Scholar
10Sarper, A, Ayten, A, Eser, I, Ozbudak, O, Demircan, A. Tracheal stenosis after tracheostomy or intubation: review with special regard to cause and management. Tex Heart Inst J 2005;32:154–8Google Scholar
11Stauffer, JL, Olson, DE, Petty, TL. Complications and consequences of endotracheal intubation and tracheotomy: a prospective study of 150 critically ill adult patients. Am J Med 1981;70:65–76Google Scholar
12Halum, SL, Ting, JY, Plowman, EK, Belafsky, PC, Harbarger, CF, Postma, GN et al. A multi-institutional analysis of tracheotomy complications. Laryngoscope 2012;122:38–45Google Scholar
13Herrington, HC, Weber, SM, Andersen, PE. Modern management of laryngotracheal stenosis. Laryngoscope 2006;116:1553–7Google Scholar
14Melkane, AE, Matar, NE, Haddad, AC, Nassar, MN, Almoutran, HG, Rohayem, Z et al. Management of postintubation tracheal stenosis: appropriate indications make outcome differences. Respiration 2010;79:395–401Google Scholar
15Yamamoto, K, Kojima, F, Tomiyama, K, Nakamura, T, Hayashino, Y. Meta-analysis of therapeutic procedures for acquired subglottic stenosis in adults. Ann Thorac Surg 2011;91:1747–53CrossRefGoogle ScholarPubMed
16Jatho, K. Elastic hollow-groove bougies for bougie treatment of laryngeal and tracheal stenosis [in German]. HNO 1955;5:222–3Google ScholarPubMed
17Strong, MS, Jako, GJ. Laser surgery in the larynx: early clinical experience with continuous CO2 laser. Ann Otol Rhinol Laryngol 1972;81:791–8Google Scholar
18Koufman, JA, Rees, CJ, Frazier, WD, Kilpatrick, LA, Wright, SC, Halum, SL et al. Office-based laryngeal laser surgery: a review of 443 cases using three wavelengths. Otolaryngol Head Neck Surg 2007;137:146–51Google Scholar
19Belafsky, PC, Kuhn, MA. Office airway surgery. Otolaryngol Clin North Am 2013;46:63–74CrossRefGoogle ScholarPubMed
20Cohen, MD, Weber, TR, Rao, CC. Balloon dilatation of tracheal and bronchial stenosis. AJR Am J Roentgenol 1984;142:477–8Google Scholar
21Lee, KH, Rutter, MJ. Role of balloon dilation in the management of adult idiopathic subglottic stenosis. Ann Otol Rhinol Laryngol 2008;117:81–4CrossRefGoogle ScholarPubMed
22Bakthavachalam, S, McClay, JE. Endoscopic management of subglottic stenosis. Otolaryngol Head Neck Surg 2008;139:551–9Google Scholar
23Stimpson, P, Kotecha, B. Histopathological and ultrastructural effects of cutting radiofrequency energy on palatal soft tissues: a prospective study. Eur Arch Otorhinolaryngol 2011;268:1829–36Google Scholar
24Smith, LP, Roy, S. Operating room fires in otolaryngology: risk factors and prevention. Am J Otolaryngol 2011;32:109–14CrossRefGoogle ScholarPubMed
25Ilgner, J, Falter, F, Westhofen, M. Long-term follow-up after laser-induced endotracheal fire. J Laryngol Otol 2002;116:213–15CrossRefGoogle ScholarPubMed
26Leemann, B, Heidegger, T, Grossenbacher, R, Schnider, T, Gerig, HJ. A severe complication after laser-induced damage to a transtracheal catheter during endoscopic laryngeal microsurgery. Anesth Analg 2004;98:1807–8CrossRefGoogle ScholarPubMed
27Rezaie-Majd, A, Bigenzahn, W, Denk, DM, Burian, M, Kornfehl, J, Grasl, M et al. Superimposed high-frequency jet ventilation (SHFJV) for endoscopic laryngotracheal surgery in more than 1500 patients. Br J Anaesth 2006;96:650–9CrossRefGoogle ScholarPubMed
28Hu, A, Weissbrod, PA, Maronian, NC, Hsia, J, Davies, JM, Sivarajan, GK et al. Hunsaker Mon-Jet tube ventilation: a 15-year experience. Laryngoscope 2012;122:2234–9Google Scholar
29Bourgain, JL, Desruennes, E, Fischler, M, Ravussin, P. Transtracheal high frequency jet ventilation for endoscopic airway surgery: a multicentre study. Br J Anaesth 2001;87:870–5Google Scholar
30Divi, V, Benninger, M, Kiupel, M, Dobbie, A. Coblation of the canine vocal fold: a histologic study. J Voice 2012;26:811.e9–13Google Scholar
31Matt, BH, Cottee, LA. Reducing risk of fire in the operating room using coblation technology. Otolaryngol Head Neck Surg 2010;143:454–5Google Scholar
32Lee, DK, Warne, B, Mulder, G, Amiel, D. Plasma-Mediated Radiofrequency Debridement Stimulates Healing Mediators in Chronic Wounds: A Multi-Center Retrospective Case Series. Dallas: SAWC, 2009Google Scholar
33Kao, HK, Li, Q, Flynn, B, Qiao, X, Ruberti, JW, Murphy, GF. Collagen synthesis modulated in wounds treated by pulsed radiofrequency energy. Plast Reconstr Surg 2013;131:490e–8eGoogle Scholar
34Nouraei, SA, Nouraei, SM, Randhawa, PS, Butler, CR, Magill, JC, Howard, DJ et al. Sensitivity and responsiveness of the Medical Research Council dyspnoea scale to the presence and treatment of adult laryngotracheal stenosis. Clin Otolaryngol 2008;33:575–80CrossRefGoogle Scholar