Endoscopic treatment of subglottic stenosis with flexible bronchoscopy via laryngeal mask airway

Objective: To evaluate the safety and efficacy of endoscopic treatment of subglottic stenosis with flexible bronchoscopy via laryngeal mask airway (LMA) approach. Methods: The records of all patients who underwent endoscopic surgery for subglottic stenosis (SGS) from November 2019 to January 2023 at an academic medical center were reviewed with attention to demographics, patient comorbidities, airway stenosis characteristics, operative time details, surgical complications, and post-operative course. All patients, >18 years old, with one or more surgeries for SGS using (LMA) for intraoperative airway management were included. Surgeries with suspension microlaryngoscopy were excluded. Patients with glottic stenosis or tracheotomy were excluded. Results: Thirty-five patients underwent 52 procedures meeting inclusion criteria. Mean age was 55 years (range 31–78, SD 13.3) and 33 patients (94%) were female. Mean BMI was 30.9 (range 18.4–60.5, SD 8.8). The most common etiology of stenosis was intubation injury in 17 patients (49%), followed by idiopathic in 13 patients (37%). Cotton-Meyer grade 3 (71–99% narrowing) was seen in 25 patients (71%). Mean anesthesia and surgical operative times were 75.9 min (SD 13.5 min) and 39.7 min (SD 11.0 min), respectively. Mean SpO₂ nadir was 94.5% (SD 6.3%). No patients required intraoperative change to rigid laryngoscopy, intubation, or tracheotomy. There were no post-operative complications. Mean surgery-free interval was 12.2 months (SD 6.3). Conclusion: Endoscopic treatment of subglottic stenosis with flexible bronchoscopy and spontaneous ventilation via LMA approach is a safe and effective option, especially in patients with limitations for rigid laryngoscopy and elevated BMI. Level of Evidence: Level Four (case series) Laryngoscope, 134:2672–2677, 2024.