An integrated approach to the management of patients with laryngeal and tracheal stenosis: from surgical reconstruction to drug prevention of relapses

OBJECTIVE: To evaluate the effectiveness of combination therapy based on triamcinolone and bovhyaluronidase azoximer in the treatment of patients with cicatricial stenosis of the larynx and trachea. MATERIAL AND METHODS: The study included 30 patients with cicatricial stenosis of the larynx and trachea, aged 18-70 years. All patients underwent primary laryngotracheoplasty followed by stenting. In addition to standard postoperative therapy, all patients received adjuvant antifibrotic therapy with triamcinolone and bovhyaluronidase azoximer according to the developed regimen. Efficacy was assessed by visual control of healing, endoscopic monitoring of the airway lumen over 12 months, and the SF-36 quality of life questionnaire before and after treatment. RESULTS: According to visual assessment of the healing process, the exudation phase asted with a mean of 4.2±1.1 days, and postoperative pain subsided on day 5. Fibrin reorganization and epithelialization were achieved by days 9-12. Excessive growth of granulation tissue was observed in only 3 (10%) patients and was successfully controlled with additional injections of triamcinolone. Endoscopic monitoring revealed a low restenosis rate (6.7%), with the lumen remained stably patent in 93.3% of patients. Complete decannulation was achieved in 50% of the cohort. Results of the SF-36 questionnaire showed a significant improvement in quality of life: scores on the physical and social functioning scales increased more than 1.5-fold. This indicates a reduction in psychological distress and the patients' successful reintegration into social life. CONCLUSION: Combined use of adjuvant therapy with triamcinolone and bovhyaluronidase azoximer reduced the incidence of restenosis and significantly improved the postoperative outcomes. Accelerated healing, minimized complication rates, and a significant improvement in quality of life confirm the high clinical efficacy of the developed treatment algorithm for treating patients with cicatricial stenosis of the larynx and trachea.