Endoscopic treatment of subglottic stenosis in children



Cite item

Full Text

Open Access Open Access
Restricted Access Access granted
Restricted Access Subscription or Fee Access

Abstract

Introduction. Subglottic stenosis is one of the most common causes of upper airway obstruction. The incidence of post-intubation stenosis ranges from 0.9% to 3% (Rodríguez H. et al.), or from 0.2% to 20% (Haranal M.Y. et al.). Currently, there is no consensus on the choice of surgical tactics due to a large number of modalities for surgical restoration of the laryngeal lumen.

Material and methods. 44 patients with postintubation laryngeal stenosis were treated in the surgical thoracic department of the National Medical Research Center of Children’s Health subordinate to the Ministry of Health of the Russian Federation during 2019-2021. The average age of patients in this group was 4 years 8 months ± 3 years 8 months. Endoscopic treatment was done to 24 patients (54.5%). Laryngoscopy, fibrobronchoscopy, multispiral computed tomography and, if necessary, barium esophagogram were done for additional diagnostics.

Results. The average number of endoscopic procedures per patient was 2.9 ± 1.5 (range from 1 to 7). Good results were seen in 20 patients (83.3%).

Conclusions. Endoscopic techniques are alternative options to open reconstructive surgery. These techniques give good results in treating stenoses in the subglottic space and give a good chance to avoid tracheostomy in a certain group of patients, which, according to the results of our study, was as large as 79.1%.

About the authors

E. I. Komina

National Medical Research Center of Children’s Health

Author for correspondence.
Email: kominaalena@gmail.com
ORCID iD: 0000-0002-9808-8682

Elena I. Komina, MD, post-graduate student, surgeon at department of thoracic

Moscow, 119991

Россия

A. B. Alkhasov

National Medical Research Center of Children’s Health;
Pirogov Russian National Research Medical University

Email: fake@neicon.ru
ORCID iD: 0000-0003-3925-4991

119991, Moscow,

117997, Moscow

Россия

Yu. Yu. Rusetsky

National Medical Research Center of Children’s Health;
Sechenov First Moscow State Medical University;
Central Clinical Hospital with Outpatient Unit of Department of Presidential Affairs

Email: fake@neicon.ru
ORCID iD: 0000-0001-5574-8292

119991, Moscow,

119991, Moscow,

121359, Moscow

Россия

M. M. Lokhmatov

National Medical Research Center of Children’s Health;
Sechenov First Moscow State Medical University;

Email: fake@neicon.ru
ORCID iD: 0000-0002-8305-7592

119991, Moscow,

119991, Moscow

Россия

S. P. Yatsyk

National Medical Research Center of Children’s Health

Email: fake@neicon.ru
ORCID iD: 0000-0002-0764-1287

119991, Moscow

Россия

S. A. Ratnikov

National Medical Research Center of Children’s Health

Email: fake@neicon.ru
ORCID iD: 0000-0003-2082-3998

119991, Moscow

Россия

E. A. Romanova

National Medical Research Center of Children’s Health

Email: fake@neicon.ru
ORCID iD: 0000-0003-1260-180X

119991, Moscow

Россия

M. S. Savelyeva

National Medical Research Center of Children’s Health

Email: fake@neicon.ru
ORCID iD: 0000-0003-0377-2172

119991, Moscow

Россия

References

  1. Botto H.A. et. al. Diagnosis and treatment of pediatric subglottic stenosis: experience in a tertiary care center. Archivos argentinos de pediatria. 2015; 113(4): 368-72.
  2. Nair S. et. al. Challenges in the management of laryngeal stenosis. Indian Journal of Otolaryngology and Head & Neck Surgery. 2016; 68(3): 294-9.
  3. Caruselli M. et. al. Post intubation tracheal stenosis in children. Pediatric reports. 2014; 6(3): 49-50.
  4. Haranal M.Y. et. al. A simplified approach for the management of post-intubation tracheal stenosis. Indian Journal of Thoracic and Cardiovascular Surgery. 2017; 33(4): 309-15.
  5. Rodríguez H. et al. Post-intubation subglottic stenosis in children. Diagnosis, treatment and prevention of moderate and severe stenosis. Acta Otorrinolaringologica (English Edition). 2013; 64(5): 339-44.
  6. Jefferson N.D., Cohen A.P., Rutter M.J. Subglottic stenosis. Seminars in pediatric surgery. 2016; 25(3): 138-43.
  7. Ashfaque Ansari, Annju Thomas. Multimodality surgical approach in management of laryngotracheal stenosis. Case reports in otolaryngology. 2018; Article ID 4583726, 11 pages, 2018. https://doi.org/10.1155/2018/4583726
  8. Разумовский А.Ю., Митупов З.Б. Хирургическое лечение хронических стенозов гортани у детей. Детская оториноларингология. 2012; 3: 25-30.
  9. Maunsell R., Avelino M.A. G.Balloon laryngoplasty for acquired subglottic stenosis in children: predictive factors for success. Brazilian Journal of otorhinolaryngology. 2014; 80(5): 409-15,.
  10. Remacle M., Eckel H.E., ed. Surgery of larynx and trachea. Berlin: Springer: 2010.
  11. Redondo-Sedano J. et. al. Laryngeal stenosis in children: types, grades and treatment strategies. Journal of pediatric surgery. 2019; 54(9): 1933-7.
  12. Nassif C. et. al. Tracheotomy in children: A series of 57 consecutive cases. European annals of otorhinolaryngology, head and neck diseases. 2015; 132(6): 321-5.
  13. Bakthavachalam S., McClay J.E. Endoscopic management of subglottic stenosis. Otolaryngology – Head and Neck Surgery. 2008; 139(4): 551-9.
  14. Cook R.D. et. al. Subglottic Stenosis: Correlation between Computed Tomography and Bronchoscopy. Annals of Otology, Rhinology & Laryngology. 1999; 108(9): 837-41.
  15. Maeda K., Ono S., Baba K. Management of laryngotracheal stenosis in infants and children: the role of re-do surgery in cases of severe subglottic stenosis. Pediatric surgery international. 2013; 29(10): 1001-6.
  16. Simpson G.T. et. al. Predictive factors of success or failure in the endoscopic management of laryngeal and tracheal stenosis. Annals of Otology, Rhinology & Laryngology. 1982; 91(4): 384-8.
  17. Maksoud-Filho J G. et. al.Early diagnostic and endoscopic dilatation for the treatment of acquired upper airway stenosis after intubation in children. Journal of pediatric surgery. 2008; 43(7): 1254-8.
  18. Quesnel A.M. et. al. Minimally invasive endoscopic management of subglottic stenosis in children: success and failure. International journal of pediatric otorhinolaryngology. 2011;75 (5): 652-6.
  19. Lando T., April M.M., Ward R.F. Minimally invasive techniques in laryngotracheal reconstruction. Otolaryngologic Clinics of North America. 2008; 41(5): 935-46.
  20. Lang M., Brietzke S.E. A systematic review and meta-analysis of endoscopic balloon dilation of pediatric subglottic stenosis. Otolaryngol Head Neck Surg. 2014; 150(2): 174-9.
  21. Hebra A. et. al. Balloon tracheoplasty in children: results of 15-year experience. Journal of pediatric surgery. 1991; 26(8): 957-61.
  22. Nouraei S.A.R., Sandhu G.S. Outcome of a multimodality approach to the management of idiopathic subglottic stenosis. The Laryngoscope. 2013; 123(10): 2474-84.
  23. Leventhal D.D., Krebs E., Rosen M.R. Flexible laser bronchoscopy for subglottic stenosis in the awake patient. Archives of Otolaryngology – Head & Neck Surgery. 2009; 135(5): 467-71.
  24. Cevizci R. et al. Flexible CO2 laser treatment for subglottic stenosis. Journal of Craniofacial Surgery. 2017; 28(4): 983-4.

Supplementary files

Supplementary Files
Action
1. JATS XML

Copyright (c)

This website uses cookies

You consent to our cookies if you continue to use our website.

About Cookies