Lyell’s syndrome as a factor which escalates the risk of laryngotracheal stenosis and atresia after intubation

Abstract

Toxic epidermal necrolysis (TEN) also known as Lyell’s Syndrome is a rare, acute hypersensitivity reaction characterized by cutaneous and mucosal necrosis. Lyell’s syndrome is self limited, but potentially recurrent disease. The mortality for toxic epidermal necrolysis is approaching to 30%.[1] Subglottic stenosis is the most common anomaly of larynx and trachea requiring tracheostomy in pediatric population. Subglottic part of larynx is the narrowest section of laryngotracheal area of airways in childhood.[5] It is estimated that most of subglottic stenosis cases is acquired and developed as a result of injury caused by long-term use of endotracheal tube. A 2-year-old patient admitted to our Clinic of Children’s Otolaryngology after long treatment for TEN because of problems with breathing without tracheostomy tube. Because of the results of bronchofiberoscopy patient has been sent to our Clinic of Children’s Otolaryngology. We performed laryngotracheoscopy which showed transglottic, subglottic and proximal part of tracheal stenosis and complete atresia of trachea above tracheostomy tube. Result of MRI examination was described as complete atresia of trachea which was 4 mm long and located above tracheostomy tube. Our patient was classified for open surgery intervention- partial cricotracheal resection with reconstruction (CTR). Latest improvements about construction of endotracheal tube and rules of procedures reduced frequency of subglottic stenosis to less than 1%.[11] There are no statistics or medical reports about tracheal atresia caused by intubation or Lyell’s syndrome. This situation forced us to recognise Lyell’s syndrome and endotracheal intubation overlapping on each other as a cause of medical state of our patient.