Abstract
Subglottic stenosis (SGS) in children can be a congenital condition or acquired through injury such as from prolonged intubation. Surgeons face challenges in choosing the best SGS treatment for a particular patient because of variability in the success rate of each technique. Conventional open surgical resection and reconstruction have been proven effective but, in recent years, endoscopic surgery has become more prevalent as it eliminates the incision and reduces the surgery time and subsequent hospital stay. The purpose of this retrospective case study was to report on an endoscopic technique using a CO2 laser for cricotracheal stenosis resection (CTSR) for high-grade congenital SGS. From forty-five paediatric patients who underwent endoscopic intervention as a primary modality of treatment for high-grade SGS in a tertiary referral centre, a total of eight patients who met the inclusion criteria have been included in our study. This small patient series is the first to use a CO2 laser alone as a single excision tool to eliminate complex congenital SGS and restore airway patency. The procedure's goal was to return the airway to an early stage of postintubation injury prior to scar formation; therefore, surgical sessions at intervals of 2–3 weeks were performed to ensure natural epithelization, to remove any granulation tissue, and manage fibrosis. Successful treatment was defined as a resolution of symptoms, restoration of a normal patent airway with no stenosis, and decannulation. The success rate was 75%. Two outcomes need to be highlighted. First, the CO2 laser should be reconsidered as an excision tool for congenital SGS because of its low risk of exacerbating preexisting stenosis. It allows the surgeon to restore and augment the airway without the need for open surgery or dilatation. Second, the shorter interval between procedures is crucial for controlling the healing process and making sure that it is proceeding properly.
Highlights
Division of Otolaryngology Head & Neck Surgery, King Abdullah Specialized Children Hospital (KASCH), King Abdulaziz Medical City (KAMC), National Guard Health Affairs (NGHA), Riyadh, Saudi Arabia
Conventional open surgical resection and reconstruction have been proven effective but, in recent years, endoscopic surgery has become more prevalent as it eliminates the incision and reduces the surgery time and subsequent hospital stay. e purpose of this retrospective case study was to report on an endoscopic technique using a CO2 laser for cricotracheal stenosis resection (CTSR) for high-grade congenital Subglottic stenosis (SGS)
After applying our inclusion criteria, eight patients with congenital SGS out of 45 SGS cases managed by CO2 laser-assisted endoscopic CTSR at our institution were included in this study. e patients had been referred from different secondary hospitals in Saudi Arabia and were tracheostomized with a diagnosis of SGS based on direct laryngobronchoscopy (DLB) findings
Summary
Laser-Assisted Endoscopic Cricotracheal Stenosis Resection (CTSR) in Paediatric Congenital Cartilaginous Subglottic Stenosis. E purpose of this retrospective case study was to report on an endoscopic technique using a CO2 laser for cricotracheal stenosis resection (CTSR) for high-grade congenital SGS. Treatment of SGS in the paediatric population with less-invasive surgical procedures has advanced over time Several endoscopic procedures such as stent placement, microdissection, endoscopic laser resection, and endoscopic dilation are applied either as a primary treatment strategy, or to compliment an open reconstructive procedure. E objective of this study was to describe an endoscopic technique using a CO2 laser for cricotracheal stenosis resection (CTSR) to manage high-grade complex SGS and to assess this technique in high-grade congenital SGS without open procedure. To the best of our knowledge, this is the first study to discuss the use of an endoscopic CO2 laser as a single excision tool to eliminate high-grade congenital SGS and restore airway integrity
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