© Borgis - New Medicine 3/2005, s. 43-44
Lidia Zawadzka-Głos, Mieczysław Chmielik, Anna Kaczmarczyk
Use of argon plasma coagulation in the treatment of subglottic stenosis in children
Department of Paediatric Otorhinolaryngology, Medical University of Warsaw, Poland
Head: Prof. Mieczysław Chmielik MD, PhD
Subglottic laryngeal stenosis develops in most cases as a result of prolonged intubation. The selection of the treatment method depends on the degree of stenosis. In the present paper, authors present their own method for the treatment of post-intubation laryngeal stenosis by argon plasma coagulation (APC).
Subglottic laryngeal stenosis develops in most cases as a result of prolonged intubation. Other causes of stenosis include: trauma, thermal or chemical burns, congenital stenosis and tracheotomy made at too high a level in the trachea. Multiple methods for post-intubation stenosis treatment are known, both classic methods for reconstruction of the larynx by external approach, and endoscopic methods for dilation of the larynx (2). The selection of the treatment method depends on the degree of stenosis and the nature of interventions performed earlier. Dilation of the larynx is usually preceded by tracheotomy. The authors present their own method for the treatment of post-intubation laryngeal stenosis by argon plasma coagulation (APC). The purpose of this study was to assess the effectiveness of the treatment of post-intubation laryngeal stenosis with APC.
Material and method
Sixteen children (eight boys and eight girls) aged from 6 months to 10 years, with post-intubation laryngeal stenosis degree I through IV according to the Myer-Cotton grading system, were qualified for treatment of laryngeal stenosis with APC. Six children were found to have degree IV stenosis, five children were found to have degree III stenosis, four children with degree II stenosis, and one child had degree I stenosis. All children had had prolonged intubation for different reasons. The post-intubation stenoses were located in the subglottic region and only laryngeal soft tissue was involved in all children. The chondroskeleton of the larynx was intact.
APC was applied to treat laryngeal stenosis. Parents of the treated children were informed about applications of APC and had the possibility to ask questions. The informed consent form was dated and signed by parents and appended to medical file. Our equipment consisted of an argon gas source and high-frequency surgical unit (APC 300 ERBOTOM ICC 350-ERBE Electromedizine GmbH) and a rigid probe with ceramic nozzle fitted at 0o or 90o relative to the axis of the probe. Different coagulation times were used, ranging from 1 to 3 s repeated a few times. The flow rate of argon gas during coagulation was set at 1,0-1,2 l/min. All procedures were performed under general anaesthesia. The effects of treatment were assessed on subsequent endoscopic measurements of the larynx, which were performed at 6-8 weeks intervals.
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