Diagnosis and treatment of pediatric subglottic stenosis: evaluation of our treatment protocol
Keywords:Evaluation, Pediatric, Subglottic stenosis, Treatment
Background: The aim was to describe our experience in management of pediatric subglottic stenosis and formulate a management scheme based on our experience.
Methods: A prospective study and follow-up was conducted in children diagnosed with subglottic stenosis (SGS) (both congenital and acquired) from January 2016 to January 2019 (36 months). We have proposed further subcategorization of each grade of SGS into mild and severe depending on absence or presence of the described “hard signs” respectively.
Results: A total of 28 patients with SGS were identified. 8 had congenital while 20 had acquired SGS. There were 16 cases of grade II, 7 cases of grade III and 5 cases of grade I stenosis. None had grade 4 stenosis. Most common surgical intervention was microlaryngoscopy and bronchoscopy which had both diagnostic and therapeutic role (in conjunction with other intervention). Other interventions were balloon dilatation, combined laser and balloon dilatation, anterior cricoid split, laryngotracheal reconstruction and Partial cricotracheal resection. As of July 2019, overall recovery rate was 89.2% and decannulation rate was 81.2%. One patient succumbed to death due to because unrelated to SGS. Two patients are still under follow-up.
Conclusions: Number of procedures increases with increasing severity of stenosis. Further subcategorization of SGS as mild or severe guides in selecting endoscopic or open surgical management scheme. The type of procedure for each patient needs to be tailored according to requirement.
Choi SS, Zalzal GH. Changing trends in neonatal subglottic stenosis. Otolaryngol Head Neck Surg. 2000;122(1):61-3.
Rutter MJ, de Alarcon A, Hart CK. Acquired laryngotracheal stenosis. In: Walkinson JC, Clarke RW, eds. Scott Brown’s Otorhinolaryngology Head & Neck Surgery. 8th ed. Boca Raton London New York: CRC Press Taylor & Francis Group; 2018: 347-365.
Bajaj Y, Cochrane LA, Jephson CG, Wyatt ME, Bailey CM. Laryngotracheal reconstruction and cricotracheal resection in children: Recent experience at Great Ormond Street Hospital. Int J Pediatr Otorhinolaryngol. 2012;76:507-11.
Myer III CM, O’Connor DM, Cotton RT. Proposed grading system for subglottic stenosis based on endotracheal tube sizes. Ann Otol Rhinol Laryngol. 1994;103:319-23.
Leung R, Berkowitz RG. Incidence of severe subglottic stenosis in newborns. Int J Pediatr Otorhinolaryngol. 2007;71:763-8.
Choo KKM, Tan HKK, Balakrishnan A. Subglottic stenosis in infants and children. Singapore Med J. 2010;51(11):848-52.
Schweiger C, Smith MM, Kuhl G, Manica D, Marostica PJC. Balloon laryngoplasty in children with acute subglottic stenosis: experience of a tertiary –care hospital. Braz J Otorhinolaryngol. 2011;77(6):711-5.
Maunsell R, Avelino MA. Balloon laryngoplasty for acquired subglottic stenosis in children: predictive factors for success. Braz J Otorhinolaryngol. 2014;80:409-15.
Palme CE, Buchanan MA, Jyothi S, Riffat F, Gullane RW. Contemporary management of laryngotracheal trauma. In: John C Walkinson, Raymond W Clarke, Scott Brown’s Otorhinolaryngology Head & Neck Surgery. 8th ed Boca Raton London New York: CRC Press Taylor & Francis Group; 2018: 1023-1035.
Jang CH, Song CH, Pak SC. Effect of exposure to mitomycin C on cultured tympanic membrane fibroblasts. Int J Pediatr Otolaryngol. 2003;67:173-6.
Eliasher R, Eliachar I, Esclamado R, Gramlich T,Strome M. Can topical mitomycin prevent laryngotracheal stenosis? Laryngoscope. 1999;109:1594-600.
George M, Jaquet Y, Ikonomidis C,Monnier P. Management of severe pediatric subglottic stenosiswith glottis involvement. J Thorac Cardiovasc Surg. 2010;139(2):411-17.