Flexible bronchoscopic balloon dilation following microlaryngoscopy guided-radiofrequency ablation guided as post tracheostomy tracheal stenosis treatment: A rare case report
L. Madison*a (Dr), D. Soehardimana (Dr), Y. Djamilb (Dr)
a Department of Pulmonology and Respiratory Medicine, Faculty of Medicine Universitas Indonesia - Persahabatan General Hospital, Jakarta, INDONESIA ; b Department of Otorhinolaryngology, Head and Neck Surgery - Persahabatan General Hospital, Jakarta, INDONESIA
Background: Both post tracheostomy (PT) and post intubation (PI) are tracheal stenosis risk factors. The most common sites are tracheal wall which has in contact by endotracheal tube cuff and tracheal stoma site at post tracheostomy state. The reported incidence of PI and PT tracheal stenosis range is 10-22% but only 1-2% of the patients are symptomatic or have severe stenosis. In tracheal stenosis, microlaryngoscopy-guided radiofrequency ablation (RFA) success rate is 89%, while flexible bronchoscopic balloon dilation success rate is 85-95%. Those combinations are hopefully increase an outcome improvement. Case Report: A man, 54 years old, had a hoarseness worsening to voice loss as a chief complaint. Patient has been inserted tracheostomy for 4 months with previous prolonged intubation history. Cervical computerized tomography (CT) performed a lumen narrowing as high as C5-C7 level. Patient had advised for cryotherapy with bronchoscopy-guided procedure but he had chosen second opinion and admitted to Persahabatan General Hospital. Interventional pulmonology and otorhinolaryngology joining procedures were designed in intraoperative setting and they had divided to four steps. The first was early flexible bronchoscopy capturing a pinpoint subglottic stenosis with 2 mm in diameter. The second was a trial of guide wire insertion and balloon dilator, but only guide wire can be inserted through stenosis. The third was RFA following microlaryngoscopy for optimal dilation. Last, balloon dilator had immediately inserted with 8-10 mm dilation so the lumen was opened and scope could be inserted until tracheostomy balloon was visible. The patient could be discharged from hospital in two days postoperative treatment. The plan is postoperative bronchoscopy so tracheostomy closing can be considered. Conclusion: Bronchoscopic balloon dilation following microlaryngoscopy-guided RFA is safe procedure due to minimal invasive and they can be recommended as definitive treatment for tracheal stenosis.
Disclosure of funding source(s): none