Endoscopic anterior cricoid split with balloon dilation in infants with failed extubation

Area of Science:

• Otolaryngology
• Pediatric Surgery
• Endoscopic Airway Surgery

Background:

• Subglottic injury (SGI) is a significant complication of prolonged endotracheal intubation in neonates and infants, potentially leading to failed extubation.
• SGI encompasses a range of conditions from mucosal edema to mature scar formation, with surgical intervention sometimes necessary for successful extubation.
• Current surgical options include tracheostomy, open anterior cricoid split (ACS), and laryngotracheal reconstruction, with open ACS reporting 70-80% extubation success rates.

Observation:

• This study introduces a novel endoscopic technique for performing an anterior cricoid split (ACS) transluminally using cold steel instruments.
• The endoscopic ACS procedure is followed by balloon dilation (BD) with an appropriately sized angiography balloon.
• Preliminary results in three patients demonstrated successful extubation in two following endoscopic ACS with BD.

Findings:

• The endoscopic ACS with BD technique was successfully applied in a small cohort of patients with isolated SGI.
• Two out of three patients treated with this novel endoscopic approach were successfully extubated.
• The technique avoids a skin incision and may potentially reduce post-procedure intubation duration compared to open ACS.

Implications:

• Endoscopic ACS with BD presents a promising minimally invasive alternative to open ACS for managing subglottic injury in infants.
• This technique offers the potential benefits of avoiding external scarring and possibly shorter post-procedure intubation times.
• Further larger-scale studies are required to definitively establish the success and complication rates of endoscopic ACS with BD.