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Subglottic stenosis in infants and children
K K Choo1, H K Tan, A Balakrishnan
1Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
Insights
Subglottic stenosis in children often requires intervention, with acquired cases being most common. While recovery rates are moderate, treatment duration is long, and management must be individualized based on stenosis severity.
Area of Science:
- Pediatric Otolaryngology
- Pediatric Airway Disorders
Background:
- Subglottic stenosis (SGS) is a critical airway issue in infants and children.
- Understanding its epidemiology and outcomes is vital for effective management.
Purpose of the Study:
- To analyze the epidemiology and outcomes of pediatric subglottic stenosis.
- To evaluate diagnostic and management techniques for SGS.
Main Methods:
- Retrospective review of pediatric patients diagnosed with SGS from 1997-2008.
- Long-term follow-up to assess treatment outcomes and recovery rates.
Main Results:
- 18 pediatric patients identified; 16 with acquired SGS, mostly Grade I.
- Common interventions included bougie dilation, cricoid split, and reconstruction.
- Overall recovery rate was 66.7% after a median treatment of 4 years.
Conclusions:
- Grade I stenosis may respond to conservative management.
- Surgical intervention complexity increases with stenosis severity.
- Individualized treatment plans are essential for laryngeal framework procedures.
Introduction:
This study aimed to examine the epidemiology and outcome of subglottic stenosis in infants and children, and to evaluate the current techniques used in its diagnosis and management at the KK Women's and Children's Hospital, Singapore.
Methods:
A retrospective review and long-term follow-up was conducted in all infants and children diagnosed with subglottic stenosis between January 1997 and December 2008.
Results:
A total of 18 patients (nine male and nine female) with a median age of 7.5 months were identified. Two patients were diagnosed with definite congenital stenosis and 16 patients with acquired stenosis. The majority had Grade I stenosis (55.6 percent), followed by Grade II (27.8 percent) and Grade III (16.7 percent). None had Grade IV stenosis. 17 patients were intubated, and seven underwent tracheostomy. The most common surgical intervention performed was microlaryngoscopy and bronchoscopy with bougie dilation. The other surgical interventions included cricoid split, laryngotracheal reconstruction and cricotracheal resection. As of December 2008, the median duration of treatment was four years, with an overall recovery rate of 66.7 percent. The successful decannulation rate was 57.1 percent. Two mortalities were reported due to reasons unrelated to subglottic stenosis. Two patients were still undergoing treatment at the time of the study, and two were lost to follow-up.
Conclusion:
Conservative management alone may be required in the majority of Grade I stenosis cases. We observed that the mean number of reconstructive procedures performed per patient increased with the increase in the severity of stenosis. Each laryngeal framework procedure has to be customised to suit the individual.
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