A 35-year-old female presents with progressive biphasic stridor worsening over 2 years. She has a history of prolonged intubation 3 years ago. Laryngoscopy shows circumferential subglottic narrowing at 1 cm below the vocal cords, with normal cords. The Cotton-Myer grade III subglottic stenosis (71–99% obstruction) is best managed by:
- A Repeat dilations alone with balloon dilation
- B Total laryngectomy with permanent tracheostomy
- C Endoscopic radial incisions with mitomycin C application
- D Laryngotracheal reconstruction (LTR) with anterior costal cartilage graft ✓
Explanation
Cotton-Myer Grade III subglottic stenosis (71–99% lumen obstruction) represents severe stenosis that is unlikely to respond adequately to repeated endoscopic dilations alone due to the extent of circumferential scarring. The standard surgical treatment for Grade III and IV laryngotracheal stenosis is open laryngotracheal reconstruction (LTR) using anterior (and sometimes posterior) costal cartilage grafts to expand the subglottic lumen, with or without stenting. This provides durable results. Mitomycin C is used as an adjunct to endoscopic procedures for milder stenosis (Grade I–II) to reduce fibrous recurrence.
Reference: Dhingra Diseases of Ear, Nose and Throat, 7th ed.
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Written and medically reviewed by the StethoPrep medical team.