Balloon laryngoplasty in children with acute subglottic stenosis: experience of a tertiary-care hospital

Gabriel Kuhl,Mariana Magnus Smith,Claudia Schweiger,Denise Manica,Paulo José Cauduro Marostica

doi:10.1590/s1808-86942011000600006

Gabriel Kuhl, Mariana Magnus Smith + Show 3 more

Open Access

https://doi.org/10.1590/s1808-86942011000600006

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Abstract

AbstractManagement 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. AimTo present our experience with BLP in children with SGS. Material and MethodProspective 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. ResultsEight 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. ConclusionBLP 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.

Highlights

Starting in the 1950’s, prolonged endotracheal intubation (ETI) started to play an important role in the management of respiratory disorders in critically ill adults and children, and it became the main cause of laryngeal stenosis
Eight children were included in this study between June 2009 and October 2010
balloon laryngoplasty (BLP) seems to be an effective treatment for acute subglottic stenosis (SGS)

Summary

Introduction

Starting in the 1950’s, prolonged endotracheal intubation (ETI) started to play an important role in the management of respiratory disorders in critically ill adults and children, and it became the main cause of laryngeal stenosis. The treatment of subglottic stenosis (SGS) in children continue to be a challenge for otorhinolaryngologists, and numerous open and endoscopic surgical techniques have been reported. Among the endoscopic options for treatment, we found the CO2 or yag laser being used to resect the stenosis and dilatation using dilatation rods and stiff bronchoscopes and; more recently, angioplasty balloons. The balloon laryngoplasty (BLP) is an endoscopic procedure, first described in 19842, used to treat stenosis of the upper airways. Such technique is being used, since to treat stenosis secondary to prolonged intubation, re-stenosis after laryngotracheal reconstructions and after cricotracheal resections with end-to-end anastomosis, with promising results[3,4,5]. A large variety of balloons have already being tested, among them we have the Fogarty embolectomy catheter and a number of angioplasty balloons[2,6,7]

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