Endoscopic anterior cricoid split and balloon dilation in pediatric subglottic stenosis

Mirabile, Lorenzo; Serio, Paola; Baggi, Roberto; Couloigner, V.

doi:10.1016/j.ijporl.2010.09.020

Cited by 42 publications

(37 citation statements)

References 19 publications

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“…It was not discussed whether any of them were actually intubated prior to their procedure. Thus, the current article differs from this previous study in that we applied endoscopic ACS with BD to a different diagnosis—FE due to less mature SGI than described by Mirabile et al20 Additionally, we performed isolated division of the cricoid cartilage and did not extend the incision to the infraglottic thyroid cartilage or upper tracheal rings as done in the earlier report 20. Future prospective studies are needed to determine the ideal length of endoscopic incision relative to type of pathology and compare outcomes with traditional open procedures and with BD alone.…”

Section: Discussionmentioning

confidence: 81%

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Endoscopic anterior cricoid split with balloon dilation in infants with failed extubation

et al. 2011

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Subglottic injury (SGI) is a known complication of prolonged intubation in neonates and infants and can lead to failed extubation. SGI is a spectrum that includes mucosal edema, ulceration, granulation perichondritis, and mature scar formation. Although medical management aimed at treating mucosal edema and extraesophageal reflux is successful in treating a majority of patients, some require surgical intervention to successfully achieve extubation. The surgical options for these patients include tracheostomy, open anterior cricoid split (ACS), and laryngotracheal reconstruction with cartilage grafting. Open ACS is performed through an external incision requiring placement of a drain for a few days. Extubation success rates in the 70% to 80% range have been widely reported. In this article we describe an endoscopic technique for ACS, in which after an endoscopic airway assessment confirms isolated SGI, the cricoid cartilage is divided transluminally with cold steel. Balloon dilation (BD) is then performed with an appropriately sized angiography balloon. We describe preliminary results in which two of three patients were successfully extubated after endoscopic ACS with BD. We believe that this novel technique is a promising alternative to open ACS with similar indications. In addition to the avoidance of a skin incision, endoscopic ACS with BD may enable extubation with comparably shorter lengths of postprocedure intubation than open ACS. Larger series will be required to further establish outcomes of this procedure, including success and complication rates.

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Section: Discussionmentioning

confidence: 81%

“…In 2010, Mirabile and colleagues were the first to describe combining endoscopic ACS with BD as a treatment for mature SGS 20. In their series, six of eight infants with congenital or acquired stenoses, who were not previously tracheotomized, successfully avoided tracheostomy.…”

Section: Discussionmentioning

confidence: 99%

Endoscopic anterior cricoid split with balloon dilation in infants with failed extubation

et al. 2011

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“…Primary balloon dilation allowed avoiding open laryngotracheal reconstruction or tracheotomy in 60% to 100% of children [5, 14, 15]. Secondary balloon dilation, the use of balloon dilation as an adjunct to laryngotracheal reconstruction and endoscopic cricoid split, resulted in decannulation of 50% to 80% of children with acquired laryngotracheal stenosis [14–17]. Presence of concomitant airway lesion, such as tracheomalacia, laryngomalacia, subglottic cyst, vocal cord paralysis, subglottic granulation tissue, or complete tracheal ring, increased the likelihood of treatment failure.…”

Section: Discussionmentioning

confidence: 99%

Long-Term Outcomes of Balloon Dilation for Acquired Subglottic Stenosis in Children

Filiz

Ulualp

2014

Case Reports in Otolaryngology

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Objectives. Balloon dilation laryngoplasty has been suggested as an alternative treatment to open surgical treatment of acquired subglottic stenosis in children. We describe long-term outcomes of balloon dilation for acquired subglottic stenosis in children. Methods. The medical charts of children who had balloon dilation for subglottic stenosis secondary to intubation were reviewed. Data included demographics, relevant history and physical examination, diagnostic workup, and management. Outcomes of balloon dilation were assessed based on improvement in preoperative symptoms, grading of stenosis, complications, and need for additional procedures. Results. Three children (2 male, 1 female, age range: 14 weeks–1 year) underwent balloon dilation for acquired subglottic stenosis. Patients presented with stridor and increased work of breathing. Duration of intubation ranged from 2 days to 3 weeks. Patients became symptomatic 5 days to 6 weeks after extubation. Grade of subglottic stenosis was II in 2 patients and III in one. Subglottic stenosis patients had 2-3 dilations within 2–10 weeks. All patients were asymptomatic during 14–21-month follow-up. Conclusions. Serial balloon dilation was safe and successful method to manage acquired subglottic stenosis in this group of children. No recurrence was noted in a follow-up more than a year after resolution of symptoms.

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“…Nevertheless, some authors used balloon dilation procedures for patients with congenital stenosis with good results. In 2010, Mirabile et al, in a series of 18 children, showed successful results for six of eight patients with congenital subglottic stenosis. The surgical technique was different from ours; patients were stented with a nasotracheal tube for 7 days.…”

Section: Discussionmentioning

confidence: 99%

Management specificities of congenital laryngeal stenosis

Blanchard¹,

Leboulanger²,

Thierry³

et al. 2013

The Laryngoscope

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Endoscopic anterior cricoid split and balloon dilation in pediatric subglottic stenosis

Cited by 42 publications

References 19 publications

Endoscopic anterior cricoid split with balloon dilation in infants with failed extubation

Endoscopic anterior cricoid split with balloon dilation in infants with failed extubation

Long-Term Outcomes of Balloon Dilation for Acquired Subglottic Stenosis in Children

Management specificities of congenital laryngeal stenosis

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