The treatment of subglottic stenosis in children by prolonged dilatation

Kotton, Bernard

doi:10.1288/00005537-197912000-00011

Cited by 14 publications

(5 citation statements)

References 5 publications

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“…It is known that steroids decrease the inflammatory response3 11 and may lead to regression and even resolution of granulation tissue. 1 729 On the other hand, once granulation tissue has become epithelialised, the effect of steroids is disappointing.7 29 Moreover, steroids may even be harmful in retarding the ingrowth of epithelium and therefore healing,3 12 or in increasing the absorption of cartilage in the presence of cartilage destruction.29 Nevertheless, the use of steroids is defendable, provided that the possible side effects are controlled carefully. It is clear, however, that further evaluation of the role of steroid treatment in acquired tracheal or bronchial stenosis is required.…”

Section: Methods Of Treatmentmentioning

confidence: 99%

Endoscopic balloon dilatation of acquired airway stenosis in newborn infants: a promising treatment.

Elkerbout¹,

Lingen²,

Gerritsen³

et al. 1993

Archives of Disease in Childhood

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Acquired stenosis of the trachea or bronchus in newborn infants is a possible complication of perinatal intubation and mechanical ventilation. Although the exact pathophysiology is unknown, stenosis formation seems to be initiated by pressure necrosis. Prematurity is thought to be an important risk factor for acquired airway stenosis. Management of stenotic lesions may be conservative, surgical, or endoscopic. Four patients were treated with endoscopic balloon dilatation with satisfactory results. Endoscopic balloon dilatation is the method of choice in most newborn infants with acquired bronchial or tracheal stenosis. (Arch Dis Child 1993;68:37-40) Acquired tracheal or bronchial stenosis may cause severe respiratory problems in newborn infants ventilated because of respiratory distress. In its most serious form it may result in prolonged mechanical ventilation, because all attempts to wean the affected neonate from the ventilator will fail. Four newborn infants with these problems are presented. A noninvasive endoscopic procedure for dilatation of acquired tracheal or bronchial stenosis is discussed, as are some recommendations for prevention.Case reports PATIENT 1 This patient was a newborn infant of 30 weeks' gestation. Owing to perinatal asphyxia, she was intubated and mechanically ventilated for one week. Within a few days after extubation, however, she developed respiratory insufficiency for which she was reintubated and again mechanically ventilated. Chest radiographs showed recurring atelectasis on both sides, hyperlucent areas, and a variable mediastinal shift. Despite intensive treatment, these severe abnormalities persisted.Bronchoscopy performed at the age of 4 weeks showed a right and left main bronchus which were too narrow to introduce the bronchoscope into the lumen. Bronchography showed a relatively long bilateral segmental stenosis in the main bronchi as well as an obstruction of the bronchus of the right lower lobe. We performed bronchoscopic balloon dilatation of the left main bronchus three times at one week intervals. At follow up bronchography an almost normal lumen of the left main bronchus was seen. In the nondilated right main bronchus, a stenosis, though less serious, persisted. One day after the final dilatation, the girl was definitively extubated.Respiratory infections with inspiratory stridor and wheezing often occurred during her first year and again after an interval of two years without symptoms. Recently bronchoscopic balloon dilatation of the right main bronchus has been performed, with good results.PATIENT 2 A newborn infant of 30 weeks' gestation developed a respiratory distress syndrome associated with hyaline membrane disease stage 3/4, for which she was intubated and mechanically ventilated for one week. Ten days after the first extubation she was reintubated because of respiratory insufficiency, now associated with an aspiration pneumonia. She had recurring atelectasis, mainly on the right side. Bronchoscopy showed a swollen, inflamed tracheal mucosa, which...

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Section: Methods Of Treatmentmentioning

confidence: 99%

Endoscopic balloon dilatation of acquired airway stenosis in newborn infants: a promising treatment.

Elkerbout¹,

Lingen²,

Gerritsen³

et al. 1993

Archives of Disease in Childhood

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“…In the literature, healing rates of about 70% -similar to those of reconstructive surgeryare reported [1,3,4,5,8]. A closer look, however, reveals that a number of patients surely would have regained health with drugs only or even without any therapy.…”

Section: Discussionmentioning

confidence: 93%

Dilatation of Laryngeal and Tracheal Stenoses

Ganzer¹

1987

ORL

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21 patients suffering from laryngeal or tracheal stenosis have been treated by dilatation. Of these, 9 regained health and needed no reconstructive surgery after dilatation. With regard to these results and those presented in the literature, the dilatation technique is a suitable method especially in infancy and if the stenosis is situated between the vocal cords or within the trachea. Yet, satisfactory results are only available if dilatation has been strictly indicated.

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“…four to 30 per cent (Bryce 1975;Elkerbout et al, 1993). Various endoscopic procedures have been developed for this purpose, including laser surgery and dilatation, but the results of these are often disappointing (Kotton, 1979;Groff and Allen, 1985;Brown et al, 1987;Paris et al, 1990). The anterior cricoid split is an open technique which is also an established method of avoiding tracheostomy in many cases (Cotton, 1985).…”

Section: Discussionmentioning

confidence: 99%

“…This has led to multiple dilatations being performed in an attempt to prevent re-stenosis, with limited success (Hood and Sloan, 1959;Gomez-Engler er al., 1980). Alternatively, stenting (and therefore tracheostomy), may be used in conjunction with dilatation techniques (Kotton, 1979). In view of the limited success, many authors regard dilatation, along with other endoscopic means, as a temporizing measure only, particularly when the stenosis is established (Cotton, 1984;Couraud et al, 1985).…”

Section: Discussionmentioning

confidence: 99%

Endoscopic balloon dilatation of subglottic stenosis

1995

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Children with subglottic stenosis present a challenging problem to otolaryngologists. In many cases, a tracheostomy is necessary to safeguard the airway, but morbidity and mortality in the tracheostomized child may be significant. Therefore attempts to improve the airway by endoscopic means are often made; unfortunately, these have a variable success rate. Recent encouraging results in the use of balloon dilatation for subglottic stenosis led us to the successful use of this technique in a child whose stenosis had not responded to conventional endoscopic techniques. The reasons for the success are discussed.

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The treatment of subglottic stenosis in children by prolonged dilatation

Cited by 14 publications

References 5 publications

Endoscopic balloon dilatation of acquired airway stenosis in newborn infants: a promising treatment.

Endoscopic balloon dilatation of acquired airway stenosis in newborn infants: a promising treatment.

Dilatation of Laryngeal and Tracheal Stenoses

Endoscopic balloon dilatation of subglottic stenosis

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