Endoscopic Laser Treatment of Subglottic and Tracheal Stenosis

摘要

The ideal laser produces discrete wounds in a reproducible manner. The CO_2 Laser with its 10.5 micron wavelength is highly absorbed by water, its energy concentrated at the point of impact and the longer wavelength creates less scatter in tissue. The development of binocular endoscopic delivery systems for use with binocular microlaryngoscopes have aided in using CO_2 laser to treat patients with subglottic and tracheal stenosis. Often, patients with these disease processes require multiple endoscopic or open reconstructive procedures and may ultimately become tracheotomy dependent. The canine model of subglottic stenosis that has been developed allows testing of new agents as adjuncts to laser treatment. Mitomycin-C is an antibiotic with antitumor activity used in chemotherapy and also in ophthalmologic surgery due to its known inhibition of fibroblast proliferation. Current studies indicate this drug to have significant potential for improving our current management of this disease process.