Surgical repair with palatal mucosal graft in subglottic stenosis caused by Wegener's granulomatosis

Abstract

A 56-year-old female patient had Wegener's granulomatosis with lung involvement. Patient was being treated with steroids and was directed to our clinic for gradually increasing shortness of breath. The radiological examination showed a 2 cm stenosis in the subglottic area. We decided to operate on the patient according to the bronchoscopic findings which showed dense granulation tissue in the subglottic area which could only be dilated partially. The 15 mm narrow trachea segment under the cricoid level was resected. A palate mucosal graft was applied to the subglottic area. A Montgomery T-tube was inserted with its proximal end reaching the vocal cords from the distal trachea. The ends of trachea were joined through anastomosis. There were no postoperative complications. The T-tube was removed on the sixth postoperative month and the patient is currently in the 12th month of follow-up (after removal of T-tube) without any stenosis. The treatment of Wegener's granulomatosis patients with subglottic stenosis who do not respond to steroid therapy is controversial. We believe that surgical treatment can be successful in appropriate patients.