Management of suprastomal tracheal fibroma: Introduction of a new technique and comparison with other techniques

Summary 

Objective

Suprastomal tracheal granuloma/fibroma (SSTGF) is a common cause of failure to decannulate following pediatric tracheostomy. Because larger lesions obstruct the trachea, it is necessary to remove them prior to decannulation. Various methods have been described for the management of these obstructing tracheal lesions, including the KTP laser, Nd-YAG laser, sphenoid punch, optical forceps, microsuspension laryngoscopy with an articulated arm (MSLAA), and external excision. A hollow core guide fiber for the CO₂ laser has been developed that can be advanced to better approximate targeted tissues and minimize thermal spread using a near-contact method.

Methods

A retrospective chart review was performed of 30 children under the age of 7 years (21M, 9F) with SSTGF who underwent treatment by either external excision (n=10), MSLAA (n=10), or CO₂ laser vaporization by fiberoptic laser carrier (n=10). The medical charts were reviewed for excision techniques and outcomes.

Results

Mean operative time for external excision was 34.9min (SD=10.2min), for MSLAA was 16.3min (SD=4.8min), and for fiberoptic CO₂ laser carrier was 19.3min (SD=7.1min). Mean hospital time postoperatively for external excision was 24h (SD=510min), for MSLAA was 3.3h (SD=37.7min), and for fiberoptic CO₂ laser carrier was 3.9h (SD=46.3min). Need for additional procedures was seen in 60% of external excision procedures, 70% of MSLAA procedures, and in 30% of fiberoptic CO₂ laser carrier procedures. Immediate postoperative decannulation was possible in 10% of the external excision group, 20% of the MSLAA group, and 40% of the fiberoptic CO₂ laser carrier group.

Conclusions

The new technique of using a fiberoptic carrier for the CO₂ laser to treat children with SSTGF's is comparable to more traditional techniques of SSTGF removal when considering the need for additional procedures, postoperative hospital stay, and percentage of immediate postoperative decannulation and provides another useful tool in the armamentarium of the surgeon in treating SSTGF's.

Keywords: Laser, CO₂ fiber, Suprastomal fibroma, Decannulation, Tracheal granuloma, Pediatric tracheostomy