Treatment of Subglottic Stenosis, Due to Wegener's Granulomatosis, with Intralesional Corticosteroids and Dilation

GARY S. HOFFMAN, COLLEEN K. THOMAS-GOLBANOV, JAMES CHAN, LEE M. AKST, and ISAAC ELIACHAR

ABSTRACT.

Objective. To determine the longterm efficacy of intralesional long-acting corticosteroid injection plus dilatation (ILCD) for subglottic stenosis (SGS) in Wegener's granulomatosis (WG).

Methods. Since November 1994, all patients with WG who presented with SGS of more than 50% or symptoms of airway compromise were treated with intralesional injection of methylprednisolone acetate, injected directly into the stenotic segment, followed by microsurgical lysis of the stenotic ring and serial dilatation with Maloney bougies or Fogarty catheter balloon. The procedure was repeated at a later date if re-stenosis occurred. Patient outcome was evaluated over a period of 7 years.

Results. Twenty-one patients underwent 64 procedures. Mean followup was 40.6 months. Patients who did not have scarring from prior procedures required a mean of 2.4 procedures at mean intervals of 11.6 months to maintain subglottic patency. Patients with established laryngotracheal scarring required a mean of 4.1 procedures at mean intervals of 6.8 months to maintain patency. None of the 21 patients required a new tracheostomy. Only 2 significant complications occurred, both pneumothoraces. There were no adverse longterm sequelae.

Conclusion. ILCD is effective therapy for SGS due to WG. Best results are obtained when these endoscopic techniques are performed prior to other forms of surgery, which may produce extensive scar formation. Based on this experience, the authors recommend ILCD as the preferred therapy in WG-SGS. (J Rheumatol 2003;30:1017-21)

Key Indexing Terms:

WEGENER'S GRANULOMATOSIS
SUBGLOTTIC STENOSIS
TREATMENT

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From the Department of Rheumatic and Immunologic Diseases, and the Department of Otolaryngology and Communicative Disorders, The Cleveland Clinic Foundation, Cleveland, Ohio, USA.

Supported by the Center for Vasculitis Care and Research, Cleveland Clinic Foundation, and The David Barakat Fund for Wegener's Granulomatosis Research. Dr. Thomas-Golbanov was supported in part by a fellowship grant from Amgen Inc.

G.S. Hoffman, MD, Harold C. Schott Chairman; C.K. Thomas-Golbanov, MD, Department of Rheumatic and Immunologic Diseases; J. Chan, MD; L.M. Akst, MD; I. Eliachar, MD, Department of Otolaryngology and Communicative Disorders.

Address reprint requests to Dr. G.S. Hoffman, Rheumatic and Immunologic Diseases, The Cleveland Clinic Foundation A50, 9500 Euclid Avenue, Cleveland, OH 44195.

Submitted July 29, 2002; revision accepted October 28, 2002.

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