An encyclopedia about voice, swallowing, airway, coughing, & other head + neck disorders.

BOOK a Zoom Call
Youtube Facebook-f X-twitter Instagram Linkedin
RSS

Dilatation (Dilation)

Dilatation, or dilation, is to stretch an opening to a larger size. When an individual has stenosis of the laryngeal airway or the trachea, a dilation procedure is one option for treatment. The two primary methods of dilation in these cases are to use either a balloon expansion device or successively larger tapered laryngeal dilators.

With tracheal stenosis, a balloon expansion device might be used more often, but for high tracheal stenosis, the tapered laryngeal dilators can also be very effective.

FF-ISS Need Constant Monitoring

This patient has undergone serial endoscopic dilations for inflammatory subglottic stenosis, performed in an ambulatory day-surgery setting without hospitalization. Over approximately 20 years, she has had ~12 dilations, typically at intervals of 12–24 months.

When she develops increased airway noise and exercise limitation, she presents for office evaluation, followed by repeat dilation as indicated. At the time of the present procedure, she was markedly symptomatic and, as with prior interventions, experienced dramatic improvement in breathing with significantly reduced stridor following dilation.

Visual Portfolio, Posts & Image Gallery for WordPress

Needing dilation (1 of 4)

Key to this diagnosis is not only the narrowing (with dotted line indicating expected airway diameter), but also the erythema (arrows). This exam was conducted with topical anesthesia to larynx and subglottis. This permitted passage of the distal chip scope through the narrowing to view the trachea below and also to see if the patient could detect a difference. She instantly noticed the restricted airway and said she could hardly breathe. This response signals a truly marginal airway in need of expeditious dilation.
Operative View, Pre-dilation

Operative View, Pre-dilation (2 of 4)

A Jackson dilator or balloon will expand the airway size.
Dilation is completed, easily doubling the size of the lumen.

Operative View, Post-dilation (3 of 4)

Dilation is completed, easily doubling the size of the lumen.
1 Week after dilation, bruising of the right cord is transient.

Better airway (4 of 4)

1 Week after dilation, bruising of the right cord (left of photo) is transient, due to the recent manipulation. Though its entire circumference is not in view, caliber is estimated at 50% greater than preoperatively. The patient is very pleased with the improvement in her airway.

Subglottic Stenosis, Before and After Dilation

Visual Portfolio, Posts & Image Gallery for WordPress
Subglottic stenosis

Subglottic stenosis, before dilation (1 of 2)

This individual has undergone at least a dozen prior dilations, each of which provides dramatic relief from noisy breathing and exercise intolerance. Here the patient is halfway to needing re-dilation, due to the typical inflammatory stenosis that is seen. Compare with photo 2.
Dilatation

Subglottic stenosis, after dilation (2 of 2)

One week after one of this patient’s dilations (with Kenalog injection and topical Mitomycin C), showing a dramatic widening of her airway; compare with photo 1. After a number of years, inflammatory lesions such as this sometimes “burn out,” and the interval between dilations increases.

Example 2

Visual Portfolio, Posts & Image Gallery for WordPress
Subglottic stenosis

Subglottic stenosis (1 of 5)

Middle-aged woman with unexplained shortness of breath and noisy breathing, due to this idiopathic inflammatory and very high subglottic stenosis. The patient initially declined dilation due to her anxiety. She also had granularity of the nasal septum and a positive ANCA profile for Wegener’s granulomatosis.
Subglottic stenosis

Subglottic stenosis, worsened (2 of 5)

Five months later, the symptoms became intolerable, and the stenosis was noted to be slightly narrower and with a greater posterior component. The patient agreed to dilation.
inflammatory nature of this stenosis

Subglottic stenosis, worsened (3 of 5)

Same exam as photo 2; this close-up view shows more clearly the inflammatory nature of this stenosis.
Subglottic stenosis after dilation

Subglottic stenosis, after dilation (4 of 5)

Five days after outpatient dilation, triamcinolone injection, and topical mitomycin C application. The patient’s symptoms have vanished, the harsh inspiratory noise is no longer heard, and the size of the airway, though still not normal, is more than doubled. Compare with photo 2 of this series.
Intensification of the inflammatory

Subglottic stenosis, after dilation (5 of 5)

Same exam as photo 4, close-up view. Intensification of the inflammatory changes of this stenosis are expected so early after dilation. Compare size of the stenosis with photo 3 of this series.

Airway Stenosis Caused By Wegener’s Granulomatosis, Before and After Dilations

Visual Portfolio, Posts & Image Gallery for WordPress
inflammatory narrowing in the immediate subglottis

Airway stenosis (1 of 5)

Marked inflammatory narrowing in the immediate subglottis. Within the ring of arrows is the inflamed, reddened tissue, which is narrowing the airway into the shape of a slit. This man needs to be active for his work, but notices shortness of breath and noisy breathing with exertion.
Airway stenosis

Airway stenosis, after dilation (2 of 5)

Nine days after a dilation procedure, with local steroid injection and painting with Mitomycin C. The airway has widened, so that it is more oval-shaped and less slit-like. Compare with photo 1. Although a degree of stenosis remains, symptoms have subsided dramatically. For reference, asterisks mark the same points in the subglottis in this photo and the next photo.
Inflammatory areas often trap mucus

Airway stenosis, after dilation (3 of 5)

Same exam, looking beyond the immediate subglottis. There is an inflammatory response that involves several centimeters of the upper trachea. Inflammatory areas often “trap” mucus, as seen here.
Dilatation

Airway stenosis, before another dilation (4 of 5)

Now five months after the dilation procedure mentioned in photos 2 and 3. The patient has been receiving systemic treatment with methotrexate and prednisone. General appearance of the inflammation has decreased. In spite of this, as expected, the stenosis has persisted (dotted oval shows the estimated caliber or width of a normal airway) and symptoms have gradually increased. Thus, another dilation was scheduled for the next day.
immediate postoperative inflammation

Airway stenosis, after another dilation (5 of 5)

A week after photo 4, following the most recent dilation. There is expected immediate postoperative inflammation and an increase in the airway’s caliber or width by an estimated 30% (dotted oval again shows the estimated caliber or width of a normal airway; compare with photo 4). Symptoms are again abolished.

Share this article

What about Dilation along with Botox injection for R-CPD?

R-CPD (the no-burp syndrome) has been clearly described. Thousands of patients have been “cured” by injecting botox into the upper esophageal sphincter (cricopharyngeus muscle).

Still, the question occasionally arises: Is there added value to dilation of the sphincter? Dr. Bastian explains why he thinks the answer is “no.”

Voice, Swallowing, Airway Disorder?

Still have questions? Schedule a call
with Dr. Bastian via Zoom.
Book a Zoom Call

Tags

· ·

Table of Contents

Tagged , ,