Diagnosis and treatment of pediatric subglottic stenosis: evaluation of our treatment protocol

Abstract

<p class="abstract"><strong>Background:</strong> The aim was to describe our experience in management of pediatric subglottic stenosis and formulate a management scheme based on our experience.</p><p class="abstract"><strong>Methods:</strong> 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. </p><p class="abstract"><strong>Results:</strong> 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.</p><p class="abstract"><strong>Conclusions:</strong> 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.</p>