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Flexible fiber CO2 laser ablation of subglottic and tracheal stenosis

INTRODUCTION Acquired subglottic and tracheal stenosis is a challenging problem with many treatment options, including tracheostomy, endoscopic, and open surgical techniques. Treatment choice depends on the length, location, degree and quality of stenosis, cartilage integrity, and medical comorbidities. Although the main objective in the management of subglottic and tracheal stenosis is to provide a patent airway, other important secondary goals include avoidance of tracheotomy or early decannulation, and maintaining an adequate voice. Endoscopic laser ablation techniques have been described, including the neodymium-doped yttrium aluminum garnet (Nd:YAG) and microscope-mounted CO2 laser. The development of a flexible fiber CO2 laser delivery system allows for CO2 laser ablation of airway stenosis through a flexible bronchoscope. We present our experience with the CO2 laser via flexible bronchoscopy in two patients who were successfully managed with topical anesthesia and did not require tracheotomy.