Return to: Subglottic stenosis protocol

Sequence Preceding Balloon Dilation

1. Dedo Laryngoscope in place with jet anesthesia (after custom guards placed, mask anesthesia leading to full relaxation)
2. 4% lidocaine spray to larynx and subglottis
3. Long 0 degree telescope to image larynx, subglottis and trachea to carina
4. Inject stenosis with 'kenalog 10' (mixture of kenalog 40 with 1% lidocaine, 1: 100,000 epinephrine in 1:3 dilution)
5. Scissors incision of mucosa at 12:00, 3:00 and 9:00; biopsy 12:00. Consider culture
6. Dilate with Jackson metal laryngeal dilators (avoid larger dilators in small (female) larynges to avoid injury to vocal cords (use of metal dilators see: Subglottic Stenosis - Example Cases)
7. Place 5-0 MLT endotracheal tube and change ventilation from jet to that via ETT
8. Video below of CRE balloon dilation. In this case, with larger larynx, pressure was placed to 3-4 atmospheres with dilation for 4 minutes

Video

References

Roediger FC, Orloff LA, Courey MS. Adult subglottic stenosis: management with laser incisions and mitomycin-C. Laryngoscope 2008 Sep;118(9):1542-6.

Duncavage JA, Ossoff RH, Toohill RJ. Carbon dioxide laser management of laryngeal stenosis. Ann Otol Rhinol Laryngol 1985;94:565-569.

Lee KH, Rutter MJ.Role of balloon dilation in the managment of adult idiopathic subglottic stenosis Ann Otol Rhinol Laryngol. 2008 Feb;117(2):81-4.