Subglottic Stenosis In Infants Research Articles

Laryngoplasty with T-tube stenting in the treatment of subglottic stenosis in children

Introduction. Laryngeal stenosis is a congenital or acquired narrowing of the larynx that causes airway obstruction. Approximately 90% of cases of acquired subglottic stenosis in infants and children are due to endotracheal intubation. Laryngotracheoplasty with T-tube placement is a method for treating laryngotracheal stenosis.
 Aim. To demonstrate our experience of treating children with stenosis of the subglottic space using laryngoplasty with T-tube placement.
 Materials and methods. 53 patients with postintubation laryngeal stenosis are treating in the surgical thoracic department of the National Medical Research Center for Children's Health for the period from 2019 until now. All children were examined. 33 patients underwent laryngoplasty with T-tube stenting.
 Results. Nowadays, 18 children have been decannulated after laryngoplasty with T-tube stenting, the rest of the patients continue their treatment.
 Conclusion. According to our materials, T-tube stenting is safe and can be an alternative method for treating children with severe acquired laryngeal stenosis.

Use of Airway Ultrasound in Infants With Unexpected Subglottic Stenosis During Anesthesia Induction: A Case Report

Point-of-care ultrasound has been integrated into airway management because it allows for rapid and noninvasive assessments. We present 2 cases of unexpected subglottic stenosis in infants during induction of anesthesia. Intubation failed even with endotracheal tubes that were small for patients' age. Airway ultrasound was used to measure the subglottic airway diameters, which were 2.0 and 3.0 mm in first and second cases, respectively. The severity of subglottic stenosis in the first case was grade III, requiring emergent tracheostomy. In conclusion, airway ultrasound helps to assess possibility of intubation and plan further airway management in children with unexpected difficult airway.

Malformed cricoid cartilage causing congenital subglottic stenosis: A rare case report

Subglottic stenosis (SGS) may be congenital or acquired and is described as narrowing of the airway beneath the vocal cords up to the lower border of the cricoid cartilage. The acquired SGS is usually due to airway trauma following prolonged intubations while congenital SGS is caused by a developmental defect or may occur as an association with other congenital anomalies. Manifestation of congenital SGS in infants ranges from asymptomatic to frank stridor and the anaesthetic management of these infants is challenging. We report one such case which emphasises the nature of such rare lesions-silent yet life threatening.

Subglottic Stenosis Following Cardiac Surgery With Cardiopulmonary Bypass in Infants and Children

To determine the 1) incidence of subglottic stenosis in infants and children following cardiac surgery with cardiopulmonary bypass and 2) risk factors associated with its development. Retrospective cohort study. Tertiary children's hospital in California. Infants and children who underwent cardiac surgery with cardiopulmonary bypass. Diagnosis of subglottic stenosis by tracheoscopy. The incidence of subglottic stenosis at our institution during the study period was 0.7%. Young age (p = 0.014), prolonged cardiopulmonary bypass (p = 0.03), and prolonged mechanical ventilation (p < 0.01) were associated with the development of subglottic stenosis. Gender, chromosomal anomaly, presence of a cuffed endotracheal tube, and lowest core temperature during cardiopulmonary bypass were not associated with the development of subglottic stenosis. The incidence of subglottic stenosis was less than that previously reported in this population. Although the incidence is relatively low, subglottic stenosis is a serious complication of tracheal intubation and all measures to prevent subglottic stenosis should be undertaken.

Hypopharyngeal, Supraglottic and Subglottic Stenosis after 1 Week Intubation

Hypopharyngeal, Supraglottic and Subglottic Stenosis after 1 Week Intubation

Management of Multiple-Level Airway Obstruction with Extended Cricotracheal Resection

Until recently, cricotracheal resection (CTR) has not been commonly accepted as a treatment modality for severe subglottic stenosis in the pediatric age group. The reasons have included the risk of a possible dehiscence at the site of the anastomosis, the likelihood of injury to the recurrent laryngeal nerves, and the interference with normal growth of the larynx. Thirty-eight infants and children with a severe subglottic stenosis underwent a partial cricoid resection with primary thyrotracheal anastomosis. Thirty-three patients were tracheotomy-dependent at the time of surgery and 34 were referred cases; 27 were classified as grade III, and 10 as grade IV stenoses according to new Cotton’s classification. Nineteen patients were younger than 3 years of age at the time of surgery. The tracheotomy was resected during the surgical procedure in 21 cases. Decannulation was achieved in 36/38 cases after an open procedure. There is one complete restenosis and one good result awaiting decannulation after further surgery for a Pierre Robin syndrome. The authors experienced no lesion of the recurrent laryngeal nerves and no fatality. Thirty-one patients show no exertional dyspnea, three a slight stridor while exercising, and two patients are not decannulated. The postoperative follow-up in longer than 10 years in eight cases. All patients show a normal growth of the larynx and trachea. Compared to laryngotracheoplasties, CTR gives better results for severe subglottic stenosis. This operation should become the treatment of choice for severe (grade III and IV) subglottic stenosis in infants and children.

小児声門下狭窄の治療戦略-外科的治療の変遷-

小児声門下狭窄の治療戦略-外科的治療の変遷-

Cricotracheal resection for pediatric subglottic stenosis

Until recently, cricotracheal resection (CTR) has not been commonly accepted as a treatment modality for severe subglottic stenosis in the pediatric age group. The reasons have included the risk of a possible dehiscence at the site of the anastomosis, the likelihood of injury to the recurrent laryngeal nerves, and the interference with normal growth of the larynx. Thirty-eight infants and children with a severe subglottic stenosis underwent a partial cricoid resection with primary thyrotracheal anastomosis. Thirty-three patients were tracheotomy-dependent at the time of surgery and 34 were referred cases; 27 were classified as grade III, and 10 as grade IV stenoses according to new Cotton’s classification. Nineteen patients were younger than 3 years of age at the time of surgery. The tracheotomy was resected during the surgical procedure in 21 cases. Decannulation was achieved in 36/38 cases after an open procedure. There is one complete restenosis and one good result awaiting decannulation after further surgery for a Pierre Robin syndrome. The authors experienced no lesion of the recurrent laryngeal nerves and no fatality. Thirty-one patients show no exertional dyspnea, three a slight stridor while exercising, and two patients are not decannulated. The postoperative follow-up in longer than 10 years in eight cases. All patients show a normal growth of the larynx and trachea. Compared to laryngotracheoplasties, CTR gives better results for severe subglottic stenosis. This operation should become the treatment of choice for severe (grade III and IV) subglottic stenosis in infants and children.

Partial cricotracheal resection for severe pediatric subglottic stenosis: update of the Lausanne experience.

Until recently, severe pediatric subglottic stenosis (SGS) has been treated almost exclusively by laryngotracheoplasty procedures. Even in the most experienced centers, the results of single-stage operations for Cotton's grade III and IV stenoses have been disappointing. This paper reports our experience on 31 partial cricotracheal resections for severe SGS in infants and children. The stenosis was congenital in 6 cases and acquired after prolonged intubation in 25 cases. Twenty-seven patients were tracheotomy-dependent at the time of surgery. Twenty-two cases were classified as grade III and 9 cases as grade IV stenoses according to Cotton. The decannulation rate was 97% (30 of 31 cases) after an open procedure. There were no fatalities and no lesions to the recurrent laryngeal nerves, but there was 1 complete restenosis. Twenty-seven patients show no exertional dyspnea, 3 have a slight stridor with some dyspnea while exercising, and 1 patient is not decannulated. The voice is normal in 21 cases, a dysphonia is present in 9 cases, and the patient with complete restenosis acquired an esophageal voice. Postoperative follow-up is longer than 10 years in 8 cases and longer than 5 years in an additional 6 cases. All patients who reached adulthood show normal growth of the larynx and trachea. Considering the excellent results obtained in this consecutive series of 31 cases, partial cricoid resection with primary thyrotracheal anastomosis should be considered an important treatment option for severe SGS in infants and children.

Partial cricoid resection with primary tracheal anastomosis for subglottic stenosis in infants and children.

Fifteen infants and children with a severe subglottic stenosis underwent a partial cricoid resection with primary tracheal anastomosis. The etiology of the stenosis was congenital in 3 cases and was acquired after prolonged intubation in 12. Fourteen patients were tracheotomy dependent at the time of surgery, and 13 (87%) of the 15 were classified grade III (7 cases) and IV (6 cases) according to Cotton. The resection included the cricoid only in 5 cases and the cricoid and a segment of trachea (1 to 4 rings) in 10 cases. Decannulation was achieved after a single open procedure in 14 (93%) of the cases. The authors encountered no lesion of the recurrent laryngeal nerves and no fatalities. There was, however, 1 restenosis. Twelve cases were decannulated within 6 months, most of them at 2 months. The postoperative voice is normal in 10 cases, and a slight dysphonia is present in 4 cases. Twelve patients show no exertional dyspnea, and 2 exhibit a slight stridor while practicing sports. Ten of 14 cases have been followed for more than 5 years, with the longest follow-up now being 14 years. In all cases, the laryngotracheal development is normal. The results of this small series compare favorably with those of laryngotracheoplasty procedures usually performed for subglottic stenosis in infants and children. In the future, partial cricoid resection with primary tracheal anastomosis should be considered as an important treatment option for severe subglottic stenoses in infants and children.

One-Stage Laryngotracheoplasty

This article documents the evolution of our approach to the repair of subglottic stenosis in infants. With increasing experience in the management of subglottic stenosis using the anterior cricoid split procedure, we extended our procedure to include older children. This then led to the use of the one-stage procedure for repair of severe and mature subglottic stenosis. We present the results of surgical repair in 13 patients. Extubation was accomplished in 12 of 13 patients using one-stage laryngotracheoplasty.

Factors influencing acquired subglottic stenosis in infants: J.M.Sherman, S. Lowitt, C. Stephenson, et al. J Pediatr 109:322–327, (August), 1986

Factors influencing acquired subglottic stenosis in infants: J.M.Sherman, S. Lowitt, C. Stephenson, et al. J Pediatr 109:322–327, (August), 1986

Airway growth following cricotracheal resection in puppies.

A canine animal model was developed to study the effects of cricoid resection on cricoid cartilage growth and subglottic lumen size. Twenty-four healthy, postweanling mongrel puppies, aged 5 to 7 weeks, were randomly divided into two groups. The first group, consisting of 13 puppies, underwent cricotracheal resection with primary anastomosis. A second group, consisting of 11 puppies, served as controls and did not have surgery. Animals from both groups were killed at age 13 weeks. Most of the animals, however, were allowed to mature to adulthood and were killed between age 26 to 28 weeks. Comparative histologic examinations of the laryngotracheal complexes of operated-on and control dogs showed uninterrupted cartilage growth at the anastomosis site after cricotracheal resection. There was no significant difference in the mean area of the cricoid lumen between the two groups when luminal area was adjusted for body weight. The results demonstrate that cricotracheal resection in this animal model does not interrupt cricoid luminal area or cricoid cartilage growth, and provides rationale for further investigation of cricoid resection with primary anastomosis in humans. Cricotracheal resection in growing puppies appears to be an excellent model for further studies in the surgical treatment of acquired subglottic stenosis in infants and children.

Cricoid resection and thyrotracheal anastomosis in the growing primate.

Although many procedures have been described for the correction of subglottic stenosis in the infant and child, none has been universally satisfactory. Cricoid resection and thyrotracheal anastomosis have been successful in adults, and we considered that the same techniques could be applied to correct subglottic stenosis in infants and children. A feasibility study was undertaken using young primates as a surgical model. The operation in each was accomplished uneventfully, although one animal later developed a complication possibly due to the use of a tissue adhesive. In practice, this complication could have been corrected without compromising the surgical outcome.

The anterior cricoid split procedure for the management of subglottic stenosis in infants and children

Severe acquired subglottic stenosis occurs most commonly in infants and children who require long-term ventilatory support with indwelling endotracheal tubes for underlying respiratory disease. A variety of operative and endoscopic procedures have been advocated for this problem including endoscopic fulguration, cryotherapy, direct incision or excision, and several types of extensive direct laryngotracheoplasties. The failure rate with these procedures is high. We have treated 22 patients including 12 neonates and 10 older children with acquired airway injury and obstruction with a simple cricoid split. In 15 patients the airway obstruction was completely relieved and these youngsters were extubated without difficulty. An additional 3 patients failed initial extubation which was subsequently successful, however, after repeat intubation for a short period of time. Endoscopic follow-up shows complete healing of the incised area. In 2 neonates the procedure was unsuccessful, and tracheotomy was needed. One of these had additional severe airway injury in the distal tracheobronchial tree secondary to selective bronchial intubation in the newborn period. Two older children also required tracheotomy because of severe airway scarring unrelieved by this procedure. The cricoid split is a simple and successful way of dealing with subglottic stenosis, especially in the newborn premature infant. A significant advantage is that it disturbs the anatomy very little, allowing for more extensive laryngotracheoplasty in the future should it fail.

Panel discussion: the management of advanced laryngotracheal stenosis. Management of combined advanced glottic and subglottic stenosis in infancy and childhood.

Severe glottic and subglottic stenosis in infants and children is a formidable disease for a child and a difficult reconstructive problem for the surgeon. Twelve consecutive patients are described in this series, 7 of whom had complete airway obstruction; 9 patients have been extubated with satisfactory voices. Long-term follow-up indicates no cases of decreased development of the larynx.

Prosthetic support of laryngotracheoplasty for acquired subglottic stenosis in infants and children

Using readily available materials and familiar techniques, prosthetic stents and T-tubes can be made to provide invaluable support in the treatment of subglottic stenosis in infants and children. A method of constructing these stents and tubes has been described along with an explanation of their surgical purpose and use.

Laryngotracheoplasty for acquired subglottic stenosis in infants and children: George A. Gates and Alberto T. Fernandez. The Laryngoscope 88:1468–1476, (October), 1978

Laryngotracheoplasty for acquired subglottic stenosis in infants and children: George A. Gates and Alberto T. Fernandez. The Laryngoscope 88:1468–1476, (October), 1978

Laryngotracheoplasty for acquired subglottic stenosis in infants and children: experience with six cases.

Six children aged 6-50 months with acquired subglottic stenosis persisting after medical and endoscopic treatment underwent 7 open resections of the stenotic tissue followed by internal stenting. Five were successfully decannulated after an average treatment time of 6.8 months; the sixth died after accidental extubation. All 5 have satisfactory vocal and respiratory function 11 to 36 months postoperatively (6-18 months postextubation). Transcartilaginous open resection of subglottic stenosis is a feasible treatment option which can be used, even in the infant, when expectant observation is not advisable.

Subglottic stenosis in infants and children.

Of 158 cases of subglottic stenosis 115 were congenital and 43 acquired. Current follow-up has been obtained in 146 (92%) which constitutes the determinate group. Although stridor was the most common presenting symptom of the congenital group, 34% presented with recurrent or prolonged episodes of croup. Tracheotomy was required in 47 of the 107 determinate cases (44%). Further management of the congenital cases was based on the experience that children outgrow this disorder; periodic dilatation may augment the natural process. Of those infants and children tracheotomized, all but five have been decannulated, and there was one death - a mortality rate of 2.1%. Acquired subglottic stenosis proved to be a more difficult management problem. Tracheotomy was necessary in 38 of the 39 determinate cases (97%). Repeated active dilatations for prolonged periods were usually required as well as endoscopic removal of granulation tissue. Of those infants and children tracheotomized, all but eight have been decannulated. There were nine deaths; five were due to unrelated underlying disease; four were attributable to complications of long-term tracheostomy. Thus, in the entire series, 85 infants and children required tracheotomy and five deaths may be attributable to long-term tracheostomy complications - a mortality rate of 5.9%.