Subglottic and proximal tracheal stenosis in adults has three main aetiologies: (a) prolonged endotracheal intubation; (b) idiopathic; (C) rheumatologic related. Endoscopic dilation is the mainstay treatment strategy for subglottic and proximal tracheal stenosis. Its major limitation is restenosis requiring repeated surgery. Intralesional steroid injection is a promising adjunctive treatment aimed at prolonging the effects of dilation. But are serial in-office intralesional steroid injections effective in reducing the surgical burden in patients with subglottic and proximal tracheal stenosis? In this case series, 24 patients with subglottic and proximal tracheal stenosis of multiple aetiologies underwent serial in-office ISI either alone or following endoscopic dilation.

Mean surgery-free interval compared favourably with those reported by others. Patients with previous dilations underwent fewer dilations after intralesional corticosteroids injections than before, and overall had longer surgery-free interval. Most patients did not require surgery after intralesional corticosteroids injections.

Serial in-office intralesional corticosteroids injections are safe and well-tolerated in adults with subglottic and proximal tracheal stenosis. It is effective both as a primary treatment and as an adjunct to dilation. This technique can reduce the surgical burden on these patients and may obviate the need for future airway intervention.

Serial in-office intralesional steroid injections in airway stenosis.
Bertelsen C, Shoffel-Havakuk H, O’Dell K, Johns MM III, Reder LS.
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Shabbir Akhtar

Department of Surgery, The Aga Khan University and Hospital, Karachi, Pakistan.

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