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Balloon laryngoplasty as a primary treatment for subglottic stenosis
Fredrick Durden1, Steven E Sobol
1Department of Otolaryngology-Head and Neck Surgery, Emory University School of Medicine, Atlanta, Georgia, USA.
Insights
Balloon laryngoplasty (BL) effectively manages acquired subglottic stenosis (SGS) in infants, providing airway control. This minimally invasive procedure resolved symptoms in 70% of patients, avoiding open surgery.
Area of Science:
- Pediatric Otolaryngology
- Respiratory Medicine
- Minimally Invasive Surgery
Background:
- Acquired subglottic stenosis (SGS) in infants often results from prolonged intubation.
- Management of SGS traditionally involves open surgical reconstruction.
- There is a need for less invasive airway management options.
Purpose of the Study:
- To evaluate balloon laryngoplasty (BL) as a primary treatment for acquired subglottic stenosis (SGS) in infants.
- To assess BL's efficacy as an alternative to open surgery.
- To report outcomes including symptom resolution and need for further intervention.
Main Methods:
- Retrospective review of 10 infants with acquired SGS treated with BL.
- Patients had a history of intubation.
- Outcomes assessed included symptom resolution, endoscopic grading, complications, and need for subsequent procedures.
Main Results:
- Balloon laryngoplasty successfully established airway control in all 10 infants.
- Seven out of 10 patients experienced complete and persistent resolution of SGS symptoms after BL (with some requiring a second procedure).
- Three patients required further surgical intervention, including laryngotracheal reconstruction or tracheotomy.
Conclusions:
- Balloon laryngoplasty is a safe and effective initial approach for airway management in infants with acquired SGS.
- BL served as a definitive, stand-alone treatment in 70% of cases, avoiding more invasive procedures.
- BL offers a valuable alternative to tracheotomy or cricoid split for select infants with SGS.
Objective:
To present our experience with balloon laryngoplasty (BL) as a means of establishing control of the compromised airway and as a definitive alternative to open surgery in infants with acquired subglottic stenosis (SGS).
Design:
The medical charts of 10 consecutive infants diagnosed as having acquired SGS secondary to a history of intubation and treated initially with BL were reviewed.
Setting:
Academic tertiary care children's hospital.
Patients:
A total of 10 patients (3 girls and 7 boys), with a mean age of 4.8 months (range, 2-12 months), met the inclusion criteria for the study.
Main Outcome Measures:
The medical charts were assessed for the patients' demographics, clinical presentation, and outcomes, which were defined by postoperative symptomatology, endoscopic grading of residual SGS, complications, and the need for subsequent interventions to control SGS.
Results:
All 10 patients presented with biphasic stridor, and 8 had significant retractions noted on examination. In all patients, control of the airway was established with BL followed by intubation. Four patients were completely asymptomatic after the initial BL. An additional 3 patients had recurrent stridor during the postoperative period and required a second BL before having complete, persistent resolution of symptoms. Balloon laryngoplasty failed in 3 patients, of whom 2 went on to undergo single-staged laryngotracheal reconstruction and 1 required a tracheotomy.
Conclusions:
Balloon laryngoplasty is a safe means of establishing the airway in infants with obstruction secondary to acquired SGS. It was an effective, stand-alone procedure for the management of SGS in 7 of our 10 patients, obviating the need for tracheotomy or cricoid split.
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