Endoscopic management of posttraumatic supraglottic stenosis in the pediatric population

Paediatric Blunt Laryngeal Trauma: A Review

“…A high index of suspicion and a low threshold for investigation are, therefore, required if the potentially fatal consequences of these injuries are to be avoided. Furthermore, it has been reported that early recognition and treatment of these injuries improves the long-term prognosis [3, 7]. On physical examination, particular attention should be paid to any of the following signs: anterior neck ecchymoses, loss of laryngeal landmarks, oedema, surgical emphysema, and palpable cartilage fractures [5, 10].…”

“…Once the airway is secured, a surgical tracheotomy can then be performed over the bronchoscope [1]. Patients with a stable airway should be evaluated with flexible laryngoscopy in the first instance after which, microlaryngoscopy and bronchoscopy can be performed if indicated [3]. …”

“…This ranges from minor endolaryngeal haematoma formation or laceration without detectable fractures in group 1 to complete laryngotracheal separation observed in group 5 [2]. Traditional management of patients in groups 1 and 2 consists of conservative measures including voice rest, humidification, prophylactic antibiotics, proton pump inhibitor therapy, and steroids [3]. Surgical intervention is reserved for patients falling into groups from 3 to 5.…”

“…If surgical exploration is to be undertaken, historical teaching considered it prudent to wait for 3–5 days [12]. Recent evidence would, however, suggest that earlier intervention improves the long-term outcome [3, 8, 9]. The long-term sequelae of paediatric blunt laryngeal trauma include persistent dysphonia, subglottic and rarely supraglottic stenosis, tracheotomy dependence, and the development of a tracheooesophageal fistula [2, 3, 9, 13].…”

“…This is believed to be due to behavioural factors as well as anatomic differences between these two groups [2]. The management of this clinical entity poses a particular challenge to the managing physician due to the fact that these patients often have very little signs and symptoms on initial presentation as well as the significant risk of concomitant injury to other vital structures in close proximity to the larynx [3]. Therefore, a high index of suspicion and a low threshold for investigation and intervention are required if the significant morbidity and potentially fatal consequences of these injuries are to be avoided.…”