Surgery of Subglottic Stenosis in Neonates and Children

Abstract

The excellent management of patients in the different Intensive Care Units has decreased mortality but, as a side effect, we have to treat an increasing number of patients with airway problems secondary to prolonged intubation. The clinical records of patients diagnosed of acquired or congenital subglottic stenosis (SE) between 1990 and 1995 were retrospectively reviewed. Types of treatment included conservative, endoscopic, and open surgery: anterior cricoid split (ACS), anterior laryngotracheoplasty (ALTP) and anteroposterior laryngotracheoplasty (APLTP). 46 patients had SE: 7 congenital and 39 acquired. According to Cotton's classification 13 had grade I, 16 grade II, 12 grade III and none grade IV. Eleven of twelve cases treated conservatively did well (92%); one out of six patients managed endoscopically required further surgery (7%); good results were obtained in 5 of 7 cases treated by ACS (71 %); 8 out of 9 patients treated by ALTP did well (89%) and 7 out of 8 managed by APLTP had good results (87.5%). One iatrogenic suture dehiscence required further surgery. There is no statistical difference in the complication rate between patients treated conservatively and those treated by open surgery, while the mean hospital stay was higher in the latter (p < 0.05). An appropriate surgical technique should be offered to those patients with SE who do not do well with conservative management, since these techniques have yielded good results with a low rate of complications. Long-term follow-up shows the absence of recurrence.

Incidence of severe acquired subglottic stenosis in newborns

“…However, tracheostomy and ACS are both established and accepted treatments for SGS [17][18][19]. At our institution, the choice between ACS and tracheostomy is based on many factors including but not limited to the likelihood of comorbidities necessitating prolonged ventilatory support, presence of established SGS or posterior glottic stenosis (as based on laryngoscopy and endoscopic manipulation), and weight <1500 g. Those who failed extubation following an ACS underwent tracheostomy and the need for a LTP was determined at follow-up airway endoscopies.…”

Endoscopic anterior cricoid split and balloon dilation in pediatric subglottic stenosis

“…Some of them, such as cricoid split [1] or partial cricotracheal resection [2], can be successfully proposed during infancy. However, they often require several surgical procedures, prolonged intensive care admission, prolonged intubation, or tracheotomy, and they have the potential for serious complications [2][3][4][5]. Their vocal outcome is often not very satisfactory [6] and they create unappealing cervical scars.…”

Balloon Laryngoplasty as a Primary Treatment for Subglottic Stenosis

“…Both ssLTR and partial cricotracheal resection are effective proce- dures in the appropriate patient; however, there is often the need for secondary procedures, prolonged intensive care admission, prolonged intubation, or tracheotomy, and both techniques have the potential for serious complications. 5,6 Tracheotomy to bypass the obstructed subglottis is acceptable, and occasionally the only reasonable option, but is associated with significant morbidity and potential mortality from plugging or inadvertent decannulation.…”