輪状軟骨切除および気管輪環状切除術を施行した声門下狭窄症例

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  • A Case of Subglottic Stenosis Treated with Resection of the Cricoid Cartilage and Circumcision of a Tracheal Ring
  • リンジョウ ナンコツ セツジョ オヨビ キカン リン カンジョウ セツジョジュツ オ シコウ シタ セイモン カ キョウサク ショウレイ

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<p>Subglottic stenosis refers to congenital or acquired stenosis of the cricoid cartilage and trachea, and manifests as dyspnea. Acquired subglottic stenosis can be of diverse causation. Tracheotomies are performed in many cases, but long-term insertion of a tracheal cannula is necessary, making treatment difficult.</p><p>A 58-year-old woman presented to a local ENT (ear, nose and throat) hospital complaining of wheezing and dyspnea during exercise. She had visited the local ENT hospital several times during the previous 3 years, and had been diagnosed as having asthma and treated with inhaled steroids. As her symptoms did not improve, she visited the Nara Medical University Hospital for further investigation and treatment.</p><p>She had no dyspnea at rest, but developed wheezing with dyspnea during exercise. Subglottic stenosis was observed throughout the circumference of the tracheal ring. She had no comorbidities or significant medical history, such as of having undergone intubation or tracheostomy, bronchial asthma, or other upper respiratory diseases. Therefore, we diagnosed the patient as having idiopathic subglottic stenosis. We performed tracheoplasty by resection of the arch of cricoid cartilage and circumcision of the tracheal cartilage and implemented a cannula-free observation protocol. She had no dyspnea after the operation. Eight months after the surgery, her dyspnea and wheezing had improved. Moreover, there was no necrosis of the anastomotic part between the cricoid cartilage and the trachea.</p><p>Thus, we avoided the use of a cannula and carefully observed the patient’s course. Based on the findings in this case, we believe that resection of the cricoid cartilage may be useful for treatment and relapse prevention. The limitation of this case study was that this is a report of a single patient and the observation period was short. Further studies are needed to determine the appropriateness of this surgical approach for patients with idiopathic subglottic stenosis.</p>

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