Expanding Perspectives in Airway Stenosis

As surgeons, we take pride in our craft and, therefore, are biased toward our preferred techniques. Similarly, our clinical research is often guided by this motivation, steering us to share the outcomes of our favored techniques. This natural bias is evident in the literature. For example, at the time of publication, a PubMed search “Laryngostenosis/surgery[Mesh]” (which includes subglottic stenosis) revealed 1294 articles on surgical approaches to upper airway stenosis. In contrast, the search “Laryngostenosis/drug therapy[Mesh]” (which includes use of mitomycin and other adjuvant therapies) resulted in only 80 articles. The article by Feinstein et al in this issue of JAMA Otolaryngology–Head & Neck Surgery joins several others to reinforce the concept that perhaps it is not the surgical finesse or latest technology used in endoscopic procedures to modify the structural airway anatomy that matters, but rather how we can manipulate the immunologic response and wound healing process afterward. However, this is in contrast to more technically difficult open airway reconstruction, clearly demonstrating improved outcomes and higher “cure rate” in high-volume centers.

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