Laringoplastia com balão em crianças com estenose subglótica em evolução: experiência de um hospital terciário

Abstract

Management of subglottic stenosis (SGS) in children is still a challenge to Otorhinolaryngologists.Balloon laryngoplasty (BLP) is an endoscopic procedure, first described in 1984 for the treatment of airway stenosis. It shows promising results and seems to be more effective than other procedures.Aim: To present our experience with BLP in children with SGS. Material and Method:Prospective study of children diagnosed with acute subglottic stenosis ,i.e., stenosis with granulation tissue. They underwent direct laryngoscopy under general anesthesia and dilatation of the stenotic segment with angioplasty balloon. They were followed up and a second laryngoscopy was performed one week later.Results: Eight children were included in this study between June 2009 and October 2010. Four had Grade 3 SGS, three had Grade 2 SGS and one had Grade 1 SGS. By the second examination, two children presented with asymptomatic Grade 1 SGS, while the other six presented with normal airway and remained asymptomatic.Conclusion: BLP seems to be an effective treatment for acute SGS. We need more studies to refine our knowledge concerning efficacy rates, safety and indications for balloon dilatation. Braz J Otorhinolaryngol. 2011;77(6):711-5. ORIGINAL ARTICLE

Ongoing Laryngeal Stenosis: Conservative Management and Alternatives to Tracheostomy

“…After review of the full-length articles, 14 were excluded, due to its use for chronic stenoses (15,(17)(18)(19)(20), due to its lack of differentiation between acute or chronic stenosis (16,19,(21)(22)(23)(24)(25)(26)(27), and/or because the paper did not differentiate between rigid or balloon dilations (27,28). The 10 remaining papers were selected for this review (3,(29)(30)(31)(32)(33)(34)(35)(36)(37).…”

“…Some authors used the INSPIRA AIRTM balloon (Acclarent Inc., CA, U.S.A.) (33,37). Other authors do not mention the brands of their balloons and/or use many different brands (3,(29)(30)(31)(32)(34)(35)(36). The balloon size was selected according to the ideal subglottic diameter for the patient's age (3, 29, 32-34, 36, 37).…”

“…The balloon size was selected according to the ideal subglottic diameter for the patient's age (3, 29, 32-34, 36, 37). An inflation/deflation handle mounted with a syringe and gauge assembly designed to monitor and maintain the pressure was used by all authors (29)(30)(31)(32)(33)(34)(35)(36)(37)(38). The balloon was inflated to rated burst pressure by some authors (33,36,37).…”

“…The balloon was inflated to rated burst pressure by some authors (33,36,37). Other authors specifically mentioned pressures between 2 and 15 atm, (3) 2 atm, (29,31,34), 4 atm, (32), 7 atm (30). The balloon was maintained inflated for 30-60 s or until the patient's oxygen saturation level dropped below 90-92% (3,(29)(30)(31)(32)(33)(34)(35)(36)(37).…”

“…Other authors specifically mentioned pressures between 2 and 15 atm, (3) 2 atm, (29,31,34), 4 atm, (32), 7 atm (30). The balloon was maintained inflated for 30-60 s or until the patient's oxygen saturation level dropped below 90-92% (3,(29)(30)(31)(32)(33)(34)(35)(36)(37). Some authors repeated the procedure 2-3 times during each session (31)(32)(33)(34)(35)(36)(37).…”