Pediatric laryngotracheal stenosis

Cotton, Robin T.

doi:10.1016/s0022-3468(84)80355-3

Cited by 232 publications

(117 citation statements)

References 23 publications

Supporting

Mentioning

101

Contrasting

Unclassified

Order By: Relevance

“…The success rate of treatment of LS with endoscopic procedures is of the range of 66-80 %. Open surgical procedures are indicated in cases with mature and hard tissue, loss of cartilage framework (especially cricoid), scar tissue of more than 1 cm length and in cases with associated tracheal stenosis [5]. In a meta analysis of studies describing various modalities of treatment for sub glottis stenosis it was concluded that the rate of success of laryngotracheal resection was higher than that of endoscopic procedures but endoscopic procedures are worth trying in early and small lesions [6].…”

Section: Discussionmentioning

confidence: 99%

Challenges in the Management of Laryngeal Stenosis

Nair

Nilakantan

Sood

et al. 2015

Indian J Otolaryngol Head Neck Surg

View full text Add to dashboard Cite

Laryngeal stenosis is one of the most complex and challenging problems in the field of head and neck surgery. The management involves a multidisciplinary approach with multiple complex procedures. In this study we discuss our experience of laryngeal stenosis with regards to patient characteristics, cause and management. A retrospective analysis of 35 patients of laryngeal stenosis treated at a tertiary care centre was evaluated. Inclusion criteria were all patients with laryngeal stenosis who required surgical intervention. Exclusion criteria were patients with associated tracheal stenosis and laryngeal stenosis due to cancer. Demographic data was recorded and findings relating to aetiology, characteristics of stenosis and the various aspects of therapeutic procedures performed are discussed with review of literature. Among 35 patients, 24 were males and 11 females of the age group 2-79 years. 2 (5.7 %) patients had supraglottic stenosis, 11 (31.4 %) had glottis stenosis, 16 (45.7 %) had subglottic stenosis and 6 (17.1 %) had combined multiple sites stenosis. Each patient underwent an average of 3.22 surgical procedures like microlaryngoscopy and excision with cold instrument, CO2 laser excision or open procedures like laryngofissure and excision and laryngoplasty. Montgomery t tube insertion was a common procedure in 17 patients (48.6 %). Of the total 35 patients with severe LS, 27 (77.1 %) patients were successfully decanulated. The results of glottic (100 %) and supraglottic stenosis (100 %) are excellent as compared to subglottic (68.8 %) and combined stenosis (50 %) of multiple sites. Laryngeal stenosis with airway compromise causes significant morbidity to the patients and is a difficult condition to treat in both adult and pediatric population. The need for multiple surgical procedures is common in the treatment of laryngeal stenosis with the t-tube being an important aid in the management of this condition. Trauma especially post intubation trauma is the commonest cause of laryngeal stenosis and the involvement of subglottis has poor outcome as compared to other subsites.

show abstract

Section: Discussionmentioning

confidence: 99%

Challenges in the Management of Laryngeal Stenosis

Nair

Nilakantan

Sood

et al. 2015

Indian J Otolaryngol Head Neck Surg

View full text Add to dashboard Cite

show abstract

“…Subglotična stenoza definira se kao suženje u području krikoidne hrskavice promjera < 4 mm u terminskog novorođenčeta ili promjera < 3 mm u prematurnog novorođenčeta 2 . Incidencija prirođene subglotične stenoze nije poznata 5 , dok incidencija stečene raste u posljednjim desetljećima s obzirom na sve veće preživlja-vanje djece na prolongiranoj endotrahealnoj intubaciji u sklopu respiratorne potpore u jedinicama intenzivnog liječenja 8 . Prirođena subglotič-na stenoza nastaje kao rezultat nepotpune rekanalizacije larinksa tijekom embriogeneze, a patohistološki razlikujemo membransku i hrskavičnu.…”

Section: Raspravaunclassified

“…Poznato je da endotrahealna intubacija u slučaju prirođene subglotične stenoze predisponira razvoj stečene stenoze 2,5,11 . Simptomi su kod prirođene subglotične stenoze obično manje izraženi nego kod stečene, te se tipično poboljšavaju rastom djeteta 4,8,9 . Kod stečene subglotične stenoze često je i oštećenje glasnica posljedično endotrahealnoj intubaciji koje dovodi do promuklosti i afonije 5 .…”

Section: Raspravaunclassified

“…U slučaju pogoršanja simptoma zbog infekcije gornjih diš-nih putova najčešće se primjenjuju kortikosteroidi sistemski i adrenalin inhalacijski 6 . U liječenju je katkad dovoljno odvajanje od endotrahealnog tubusa te traheotomija, čime se omogućuje oporavak laringealne sluznice te rast larinksa 8 . Laringealna stenoza je najčešći uzrok opstrukcije u gornjem respiratornom sustavu koji zahtijeva postavljanje trahoestome 12 .…”

Section: Raspravaunclassified

“…anterior cricoid split), endoskopski laserski tretman ili endoskopsko razdvajanje hrskavice balonskom dilatacijom 4 . Kirurške tehnike su izazovne, ali ne postoji usuglašen pristup oko endoskopske ili otvorene operacije 8,13 . U prikazanom slučaju moguće je da se u novorođenčeta ponavljanim intubacijama membranski prsten u subglotičnoj regiji mehanički dilatirao ili lacerirao.…”

Section: Raspravaunclassified

See 2 more Smart Citations

An unusual clinical course of congenital subglottic stenosis – case report

et al. 2016

View full text Add to dashboard Cite

Sažetak. Cilj: Prikazati slučaj neuobičajenog kliničkog tijeka prirođenog laringealnog stridora i razmotriti indikacije za endoskopskim pregledom u takvim slučajevima. Prikaz slučaja: Terminsko eutrofično muško novorođenče je po porodu zbog akutnog skrotuma te respiratornih teš-koća u vidu tahipneje i hipoksemije primljeno u Kliniku za pedijatriju. Neposredno nakon kirurškog zahvata dijete je rutinski ekstubirano. No vrlo brzo nakon odvajanja od tubusa ponovno je naglo razvilo respiratorne teškoće obilježene stridorom i hipoksemijom. Dijete je ponovno intubirano i vraćeno na strojnu ventilaciju. U daljnjem tijeku se u više navrata pokušavao provesti postupak ekstubacije. Nije ga bilo moguće učiniti jer bi se nakon odvajanja od tubusa vrlo brzo vratili znakovi respiratornih teškoća pod kliničkom slikom akutnog laringotraheobronhitisa. S obzirom na probleme otežane ekstubacije i ovisnosti o tubusu te na perzistentne atipične simptome krupa i neučinkovitost farmakoterapije, dijete je u dobi od mjesec dana podvrgnuto endoskopskom pregledu dišnih putova. Vizualizirana je koncentrična subglotična stenoza membranskog tipa. U pripremama za liječenje endoskopskom laserskom ablacijom stridor je bivao sve manje izražen. Dva tjedna nakon prvog endoskopskog pregleda učinjen je kontrolni na kojem je vizualni nalaz sugerirao značajnu regresiju subglotičnog membranskog suženja. Odustalo se stoga od planirane intervencije laserom, a stridor se u dojenčeta spontano povukao. Zaključak: Iako je laringomalacija daleko najčešća etiološka podloga prirođenog stridora i ne predstavlja apsolutnu indikaciju za endoskopijom dišnog puta, on može biti izazvan nizom drugih rijetkih stanja, uključujući prirođenu subglotičnu stenozu. U prikazanom slučaju zabilježena je neuobičajena spontana regresija subglotične stenoze membranskog tipa.Ključne riječi: laringomalacija; novorođenče; stenoza larinksa; stridor Abstract. Aim: To report an unusual clinical course of an infant with congenital laryngeal stridor. Indications for endoscopic examination of airways in such cases have also been discussed. Case report: A full-term male newborn was admitted to the Department of Paediatrics because of the symptoms of acute scrotum as well as because of breathing difficulties and severe hypoxemia. Soon after surgery the child was extubated but breathing difficulties persisted. A loud inspiratory stridor together with rapid respiratory deterioration occurred. The infant was intubated and underwent mechanical ventilation again. In the following period several trials of extubation were repeatedly unsuccessful despite favourable weaning parameters. Just few hours after each trial of extubation symptoms of acute laryngotracheobronchitis were apparent. Because of extubation failure, tube dependency and persistent atypical symptoms of croup unresponsive to standard pharmacotherapy, endoscopic assessment was performed at the age of one month. Concentric central membranous subglottic stenosis was visualized. While preparing for the endoscopic laser ablation treatment, ...

show abstract