Subglottic Cysts Research Articles

A rare cause of respiratory distress in preterm infants: a case report of acquired subglottic cysts

BackgroundThe Subglottic Cysts (SGCs) are a rare cause of respiratory distress in infants. Typical risk factors include male gender, extreme prematurity, gastro-oesophageal reflux and invasive ventilation, the latter being associated with mucosal damage and blockage of the subglottic cysts’ ducts. We describe a case of acquired subglottic cysts in a premature infants presented with respiratory distress.Case presentationA premature male infant was born at 25 weeks + 2 days with a history of monochorionic diamniotic twin pregnancy with twin-to-twin transfusion syndrome. During hospitalization, invasive mechanical ventilation was necessary for a total of 18 days; the patient was discharged at postmenstrual age of 40 weeks + 1 day in good condition. At 43 weeks post-menstrual age, he presented to our department with mixed stridor and worsening of respiratory dynamics. A laryngotracheoscopy evaluation was performed. The exam showed the presence of multiple SGCs causing an almost complete obstruction of the airway. Because of the significant reduction of the airway’s patency, the child underwent a tracheotomy and thereafter cysts’ removal using cold steel microinstruments. A better airway patency was restored although a slight glottic edema persisted. The histopathology confirmed the benign nature of the lesions. Successive controls showed a completely patent airway and absence of SGCs.ConclusionIn conclusion, SGCs should be considered in preterm infants with respiratory distress previously intubated, which cannot be explained by the most common causes. Early diagnosis and treatment are fundamental to reducing the morbidity and mortality associated with this disease.

Case Report of a Congenital Subglottic Cyst.

This article presents the case of a full-term newborn who underwent tracheal intubation after birth due to rapid breathing and cyanosis of the lips. Ultrasonography, computer tomography (CT), and magnetic resonance imaging revealed the presence of a subglottic cyst. The patient underwent cyst marsupialization via endoscopy under general anesthesia, with successful extubation on the second postoperative day. In the later follow-up, it was shown that the cyst recurred quickly. However, the special feature of this case is that during the follow-up, the size of the cyst remained unchanged, but suddenly disappeared spontaneously in the third year. As for the reason for the disappearance of the cyst, we can only make theoretical speculations. Whether other recurrent cases will also resolve spontaneously, there are currently no relevant reports.

Balloon dilation as an alternative to tracheotomy for acquired subglottic stenosis in children of the first year of life

To study the efficacy and safety of balloon dilation as the first choice method in the treatment of children of the first year of life with acquired subglottic stenosis. A retrospective analysis of the treatment of 25 patients aged 27 days to 11 months of life (average age 5.3±3.76 months) with subglottic stenosis caused by prolonged intubation, in whom balloon dilation was the first method of treatment. Grade III Cotton-Myer stenosis was preoperatively detected in 22 children, the remaining 3 had grade II stenosis. The success rate of balloon dilation was 100%; tracheotomy was not required in any case, the absence of stenosis during a follow-up examination in the catamnesis was recorded in 14 (56%) children, the remaining 11 (44%) had grade 0-I stenosis and did not cause respiratory disorders. In 1 child (1.5 years old), a subglottic cyst was removed after balloon dilation. One dilation was required in 18 (72%) children, two - in 5 (20%), three and four - respectively for 1 patient. If additional intervention was necessary, the operation was repeated 10 days - 3 months after the previous one. There were no postoperative complications. Balloon dilation is a highly effective and safe alternative to traditional surgical interventions for acquired subglottic stenosis in children of the first year of life and can be recommended as a method of first choice.

Acquired subglottic cysts: a case-control study

Acquired subglottic cysts: a case-control study

Anesthetic management of inguinal hernia in an ex-premature infant with subglottic stenosis: a case report

BackgroundWe report the anesthetic management of inguinal hernia repair for an infant with subglottic stenosis. A previously scheduled operation had been cancelled due to unexpected airway trouble during the induction.Case presentationA boy was born at 24 weeks of gestation and his trachea was intubated for 45 days. At 16 months old, surgery for inguinal hernia was planned, but cancelled due to unexpected narrow airway, and subglottic stenosis was first suspected. At 17 months old, he was transferred to us for inguinal hernia surgery. After careful discussion between the surgical team and the anesthesiologists, a strategy to manage this patient was developed. He underwent open hernia surgery under spinal anesthesia and diagnostic rigid bronchoscopy under tubeless general anesthesia separately, which revealed low-grade stenosis and some subglottic cysts. The postoperative course was uneventful.ConclusionInterdepartmental discussion weighing risks and benefits may deduce the safest and most appropriate anesthesia method.

The Clinical Features and Risk Factors of Subglottic Cysts in Children: A Clinical Experience Using the Spontaneous Respiration Technique.

Subglottic cysts (SGCs) are a rare cause of respiratory distress resulting from upper airway obstruction in infants and young children. Risk factors other than prematurity with a history of endotracheal intubation have not yet been well elucidated. Therefore, we aimed to describe the clinical features and analyze the risk factors of SGCs. We conducted a retrospective review of medical records of pediatric patients who underwent marsupialization for SGCs between January 2017 and March 2022. These records were then compared with those of controls with a history of neonatal intubation, with a case-to-control ratio of 1:3. Eleven patients (eight boys and three girls) diagnosed with SGCs and 33 control patients (26 boys and seven girls) were included. All patients had a history of premature birth and neonatal intubation. Symptoms of SGCs appeared at a mean age of 8.2 months (range, 1-14 months) after extubation. The mean duration of intubation was 21.5 days (range, 2-90 days), and the intubation period was longer in patients with SGCs than in controls (21.5±24.8 days vs. 5.3±7.1 days; P<0.001). Furthermore, gestational age (28.3±4.2 weeks vs. 33.8±4.4 weeks; P=0.001) and birth weight (1,134.1±515.1 g vs. 2,178.2±910.1 g; P=0.001) were significantly lower in patients with SGCs than in controls. Multivariable analysis identified the intubation period as an independent risk factor. This study showed that gestational age, birth weight, and the intubation period were significantly associated with the development of SGCs. Pediatric patients presenting with progressive dyspnea who have the corresponding risk factors should undergo early laryngoscopy for the differential diagnosis of SGC.

Microlaryngobronchoscopy Without Tracheostomy in Large Subglottic Cyst Obliterating Airway

Extended endotracheal intubation in infancy causes various complications. Upper airway disruption is very rare but reversible cause of respiratory insufficiency. Tracheostomy may not be avoidable in severe upper respiratory tract lesions especially in large subglottic cysts and severe subglottic stenosis; however, avoiding it is a priority when possible. A 7-month-old child who had a history of newborn respiratory distress syndrome and extended endotracheal intubation developed respiratory symptoms including stridor. A subglottic cyst was found by bronchoscopy and surginally removed with the tubeless anesthesia technique without tracheostomy. This method was successful even on infants. We report this case with a review of literature.

Unexpected difficult airway caused by subglottic cyst. Clinical case

Unexpected difficult airway caused by subglottic cyst. Clinical case

An infant with subglottic cysts presenting as abruptly-progressed stridor and respiratory distress 2 months after extubation

An infant with subglottic cysts presenting as abruptly-progressed stridor and respiratory distress 2 months after extubation

Subglottic cysts in preterm infants: superficially located cysts versus deeply buried cysts in the mucosa.

To analyze the reason for the diversity of the clinical course of subglottic cysts and discuss their pre- and coexistence with subglottic stenosis. The medical records of patients who were treated for subglottic cysts between 2003 and 2020 were retrospectively reviewed and direct laryngoscopy videos were analyzed to assess the healing patterns of their disease. Of the 15 patients, 10 had a history of intubation in the neonatal period. In 11 patients, the cysts were transparent and well defined, and no recurrence of subglottic cysts occurred after the initial surgery. In four patients, the cysts were located deep in the mucosa and did not have the typical appearance of a cyst, but rather of a stenotic segment; all of them had a history of intubation and three of them required laryngotracheal reconstruction. Transparent, thin-walled superficial subglottic cysts with healthy surrounding mucosa can easily be treated with endoscopic marsupialization; however, the treatment of deep subglottic cysts can be challenging. The coexistence of subglottic cysts and subglottic stenosis is not rare. We point out the need for considering the possibility of a missed deep submucosal cyst in a seemingly refractory case of pediatric subglottic stenosis with atypical endoscopic findings and with a background history of prior intubation.

Endoscopic technologies in treatment 7-month-old child with multiple laryngeal cysts

Introduction. Subglottic cysts are a rare clinical entity among infants and children. The annual incidence of congenital laryngeal cysts is quoted as 1,82 per 100,000 live births. The majority of cases present in neonates born at the extremes of prematurity and invariably have been intubated and managed in neonatal intensive care units. Clinically, the pathology manifested as upper airway obstruction, stridor, and dysphonia. Various surgical techniques have been proposed for the treatment of patients with laryngeal cysts. In a large percentage of cases, tracheostomy is required, especially in patients with large cysts due to the development of symptoms of respiratory failure.&#x0D; Purpose. The aim of this study is to demonstrate that endoscopic technologies in the treatment of laryngeal cysts in children can be useful to avoid tracheostomy and lead to an uneventful recovery.&#x0D; Materials and methods. We present a clinical case of managing a 7-month-old child with multiple laryngeal cysts from the Department of Thoracic Surgery in the National Medical Research Center for Childrens Health Federal state autonomous institution of the Russian Federation Ministry of Health.&#x0D; Conclusion. In the presented case, we demonstrate that modern minimally invasive techniques to treat laryngeal cysts restore the lumen of the respiratory tract. facilitate the course of the postoperative period, achieve complete patient recovery, and avoid tracheostomy.

A Case of Subglottic Cysts in a Premature Infant with a History of Endotracheal Intubation

A Case of Subglottic Cysts in a Premature Infant with a History of Endotracheal Intubation

A Case of Subglottic Cyst Showing Discrepancy Findings Between Bronchoscopy and Computed Tomography

A Case of Subglottic Cyst Showing Discrepancy Findings Between Bronchoscopy and Computed Tomography

A case of subglottic cyst treated with tracheostomy

A case of subglottic cyst treated with tracheostomy

Strategy for Subglottic Cysts for Pediatric Patients: Single-Center Experience of Diagnosis and Surgical Management

Strategy for Subglottic Cysts for Pediatric Patients: Single-Center Experience of Diagnosis and Surgical Management

Subglottic cysts: The Great Ormond Street experience in 105 patients.

The aim of the study was to assess the contemporary presentation and management of subglottic cysts and make recommendations on the treatment of these patients. Retrospective case series of 105 patients between October 1999 and November 2017 from a paediatric teaching hospital. Ninety-one percentage (n = 96) had a history of prematurity, with a mean gestation of 27.2weeks (SD ± 4.1). A history of intubation was found in 99% (n = 104) of cases [median 18days (range = 1-176)]. Presenting symptoms were: Stridor 57.1%, (n = 60), difficult intubation 14% (n = 15), recurrent croup 11.4% (n = 12), failed extubation 7.6%, (n = 8), hoarseness/weak cry 10.5% (n = 10). Ninety percentage (n = 94) underwent intervention for management of SGCs with 86% (n = 81) treated with cold steel marsupialisation and 14% (n = 13) with CO2laser. Recurrent cysts occurred in 56% (n = 53) of cases. Treatment modality did not affect recurrence (p = 0.594Δ). Sixty-six percentage (n = 69/105) of patients had one or more concurrent airway pathology at MLB. Most frequent was subglottic stenosis 47% (n = 49), with 16% (n = 8) subsequently requiring open reconstructive airway surgery. Mean duration of follow-up was 47.6months (SD ± 38.3). SGC are an uncommon, reversible cause of upper airway obstruction and should be considered in the list of differential diagnoses in patients with a history of prematurity and perinatal intubation, presenting with stridor. While concurrent SGS is common, adequate symptom improvement in such cases may be achieved with SGC removal alone. Management is by surgical marsupialisation. Recurrence and additional airway pathologies are common and may necessitate longer-term treatment in centres with paediatric airway expertise.

Diagnostic considerations prior to pediatric tracheocutaneous fistula closure

IntroductionAn airway assessment often occurs prior to tracheocutaneous fistula (TCF) closure in children. Bronchoscopy (MLB) with or without fistula-occluded polysomnography (PSG) helps determine candidacy and localize potential obstruction. To date, little has been published on MLB or PSG findings in children before surgically closing a TCF. MethodsA case series with chart review of children between 2017 and 2020 who underwent repair of a TCF after tracheostomy decannulation. ResultsThirty-six children were included for review. Mean age was 5.9 years (95% CI: 4.5–7.3), 58.3% were male, and 50% had chronic lung disease. Surgery occurred 13.3 months (95% CI: 11.9–14.8) after decannulation, with 80.6% by primary closure and 19.4% by secondary intention. There was one unsuccessful closure and two patients (5.6%) presented with a postoperative complication. An MLB was performed in 97.2% of children, where 22.9% identified supraglottic pathology, 11.4% had grade 2 subglottic stenosis, and 11.4% had difficult exposure of the larynx. Further, one child had a non-obstructing subglottic cyst, one had a supraglottoplasty for redundant arytenoid mucosa, and two children had suprastomal granulomas requiring removal. A PSG was obtained in 36.1%, with a mean Apnea-Hypopnea Index of 2.4 events/hour (95% CI: 0.9–3.9), nadir Oxygen saturation of 90.5% (95% CI: 87.9–93.0), and peak end-tidal CO2 of 46.1 mmHg (95% CI: 43.7–48.5). ConclusionThe selection of candidates for pediatric TCF closure requires careful evaluation of the airway. Surgeons should be familiar with the potential findings on MLB and PSG prior to closure.

Sub-glottic cysts causing upper airway obstruction

&lt;p class="abstract"&gt;Wigger and Tang reported the first case of a sub-glottic cyst (SGC) in 1968. SGC are rare but potentially reversible causes of upper airway obstruction, in previously intubated children. These children present with respiratory distress and stridor, and the diagnosis is confirmed by direct laryngoscopy. The management depends on the size of the cysts and the severity of the symptoms. We are presenting two cases of SGCs who were born prematurely and were intubated for a prolonged period. They presented with stridor and were diagnosed to have sub-glottic cysts at bronchoscopy.&lt;/p&gt;

Pediatric airway surgery under spontaneous respiration using high-flow nasal oxygen

ObjectivesIn pediatric airway surgery, SponTaneous Respiration using IntraVEnous anesthesia and Hi-flow nasal oxygen (STRIVE Hi) has not been well explored. Here, we report our experience of using STRIVE Hi in endoscopic evaluations and surgeries of the pediatric airway. MethodsThis retrospective review was based on 45 airway procedures conducted under STRIVE Hi, performed by a single surgeon at a single institute from May 2017 to September 2018. After induction of anesthesia, continuous infusion with propofol and remifentanil was provided to ensure an adequate level of anesthesia and supply of humidified oxygen via a nasal cannula. Monitoring was conducted using a transcutaneous CO2 sensor and a pulse oximeter, and the oxygen reserve and bispectral indexes were measured. No muscle relaxant was administered. ResultsThe median age of the patients was 16.0 months (range: 1–215 months) and the median weight was 10.2 kg (range: 2.4–38.5 kg). The median duration of spontaneous respiration was min 40 (range: 10–140 min). The airway procedures included diagnostic microlaryngoscopy, tracheocutaneous fistula excision, balloon dilation, supraglottoplasty, laryngeal cleft repair, injection laryngoplasty, papilloma excision, and subglottic cyst removal. During these procedures, STRIVE Hi facilitated evaluation of dynamic obstruction of the airway and the immediate outcome of surgical treatment and provided a good surgical view. Intubation and the termination of spontaneous respiration were required in only five patients. ConclusionsSTRIVE Hi is an effective and feasible anesthesia option in pediatric airway surgery. It provides unobstructed surgical access and is applicable to a wide range of procedures.

A Case of Pediatric Subglottic Cyst Treated by Open Fenestration without Endotracheal Intubation

A Case of Pediatric Subglottic Cyst Treated by Open Fenestration without Endotracheal Intubation