Balloon Laryngoplasty as a Primary Treatment for Subglottic Stenosis

Abstract

To present our experience with balloon laryngoplasty (BL) as a means of establishing control of the compromised airway and as a definitive alternative to open surgery in infants with acquired subglottic stenosis (SGS). Design:The medical charts of 10 consecutive infants diagnosed as having acquired SGS secondary to a history of intubation and treated initially with BL were reviewed.Setting: Academic tertiary care children's hospital.Patients: A total of 10 patients (3 girls and 7 boys), with a mean age of 4.8 months (range, 2-12 months), met the inclusion criteria for the study. Main Outcome Measures:The medical charts were assessed for the patients' demographics, clinical presentation, and outcomes, which were defined by postoperative symptomatology, endoscopic grading of residual SGS, complications, and the need for subsequent interventions to control SGS.Results: All 10 patients presented with biphasic stridor, and 8 had significant retractions noted on examination. In all patients, control of the airway was established with BL followed by intubation. Four patients were completely asymptomatic after the initial BL. An additional 3 patients had recurrent stridor during the postoperative period and required a second BL before having complete, persistent resolution of symptoms. Balloon laryngoplasty failed in 3 patients, of whom 2 went on to undergo single-staged laryngotracheal reconstruction and 1 required a tracheotomy.Conclusions: Balloon laryngoplasty is a safe means of establishing the airway in infants with obstruction secondary to acquired SGS. It was an effective, stand-alone procedure for the management of SGS in 7 of our 10 patients, obviating the need for tracheotomy or cricoid split.

Balloon laryngoplasty for acquired subglottic stenosis in children: predictive factors for success

“…Thus, it will be possible to establish early diagnoses and procedures aimed at preventing the occurrence of acquired SGS. The success of dilatation for acute stenoses, as shown in this and other studies, 7 , 8 , 9 confirms this need. Unfortunately, the procedure of tracheostomy has been the only alternative for these cases, in the absence of a proper evaluation.…”

Effective Treatment of Cicatricial Airway Stenosis via Flexible Bronchoscopic Intervention

“…Notably, the Ho:YAG laser is associated other lowest rates of morbidity and mortality mortality compared to other laser types has been used successfully employed in the treatment of both malignant and benign intrabronchial diseases. In addition, DF et al demonstrated that utilizing scalpel or laser for annular stenosis before dilation may also reduce the risk of restenosis [4]. This is consistent with our methodology.…”

A pilot study of balloon dilation in an animal model resulting in cricoid cartilage fracture: Implications for the stenotic pediatric airway

“…The consequence of such an event is unknown. Studies have reported the use of balloon sizes between 5.0 mm and 8.0 mm, depending on the degree of airway stenosis, inflated to 2.0 atm to 6.0 atm 3–18. In our study, for a rabbit subglottis with a diameter of 5.4 mm, a size 7.0 mm balloon, at a relatively low pressure of 6.0 atm, was sufficient to cause a gross cricoid fracture.…”