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Minimally invasive endoscopic management of subglottic stenosis in children: success and failure
Alicia M Quesnel1, Gi Soo Lee, Roger C Nuss
1Department of Otolaryngology and Communication Enhancement, Children's Hospital Boston, Boston, MA, USA; Department of Otology and Laryngology, Harvard Medical School, Boston, MA, USA; Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, MA, USA.
Insights
Endoscopic management of pediatric subglottic stenosis shows success as primary or adjunctive treatment. Success rates vary with stenosis severity, with adjunctive use yielding better outcomes.
Area of Science:
- Pediatric Otolaryngology
- Airway Surgery
- Minimally Invasive Procedures
Background:
- Subglottic stenosis (SGS) is a significant airway challenge in children.
- Endoscopic management offers a less invasive alternative to open surgery.
Purpose of the Study:
- To evaluate the efficacy and safety of endoscopic treatment for pediatric subglottic stenosis.
- To compare outcomes when endoscopy is used as primary versus adjunctive therapy.
Main Methods:
- Retrospective review of pediatric patients with SGS undergoing endoscopic airway procedures.
- Systematic assessment of success and failure rates of endoscopic interventions.
Main Results:
- Endoscopic treatment resolved symptoms in 58% of primary cases and 60% of adjunctive cases.
- Primary endoscopic treatment success decreased with higher initial stenosis grades.
- Adjunctive endoscopic use after open surgery showed favorable outcomes.
Conclusions:
- Endoscopic management is effective for selected pediatric subglottic stenosis cases.
- It can be used successfully as initial therapy or adjunctively after open surgery.
- Careful patient selection is crucial for optimal endoscopic outcomes.
Objective:
To assess the efficacy and safety of endoscopic management of subglottic stenosis both as a primary and as an adjunctive treatment in the pediatric population.
Methods:
Retrospective review of pediatric patients with subglottic stenosis undergoing endoscopic airway procedures at a tertiary care pediatric medical center. Outcomes were assessed by systematic review to determine the success and failure of the endoscopic approach.
Results:
Forty patients (22 male, 18 female) underwent endoscopic interventions for a diagnosis of subglottic airway stenosis between 2003 and 2006. Age ranged from 22 days old to 20 years old. Recorded degree of subglottic stenosis ranged from 10% to 99%. Fifty-three percent (21/40) had a history of prematurity, and 40% (16/40) had secondary airway diagnoses. Twenty-four patients underwent an endoscopic intervention initially (including laser or dilation, with or without topical mitomycin treatment), including four patients who underwent tracheostomy prior to the first endoscopic intervention. Sixteen underwent laryngotracheoplasty initially, including ten patients who underwent tracheostomy prior to the laryngotracheoplasty. Endoscopic treatment resulted in resolution of symptoms, and/or decannulation, and no further need for an open procedure in 58% of patients. Of the 24 patients undergoing endoscopic interventions initially, 14 patients underwent two or more endoscopic interventions, and 10 patients subsequently required tracheostomy or laryngotracheoplasty. When endoscopic procedures were used as an adjunct to laryngotracheoplasty, 60% (12/20) had resolution of symptoms, underwent decannulation, and did not require tracheostomy or revision laryngotracheoplasty.
Conclusions:
The endoscopic approach can be successful in the management of properly selected patients with subglottic stenosis, either as the initial treatment modality or as an adjunctive treatment in cases of re-stenosis after open airway surgery. The likelihood of success with a minimally invasive procedure as the primary treatment decreases with worsening initial grade of subglottic stenosis.
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