Severe glottic stenosis in a parturient with ectodermal dysplasia

Area of Science:

• Obstetrics and Gynecology
• Anesthesiology
• Otolaryngology

Background:

• Airway stenosis during pregnancy presents significant management challenges with limited established guidelines.
• Ectodermal dysplasia can be associated with congenital airway abnormalities, including glottic stenosis.

Observation:

• A 21-year-old nulliparous woman with a history of congenital glottic web and prior tracheostomy presented with severe glottic stenosis (2-3mm aperture) early in pregnancy.
• The patient had fixed vocal cords, indicating a critically narrowed airway incompatible with vaginal delivery or potential airway emergencies.

Findings:

• An elective tracheostomy was successfully performed under local anesthesia at nine weeks gestation.
• The patient subsequently underwent an uncomplicated cesarean delivery utilizing spinal anesthesia.

Implications:

• This case highlights the critical role of early interdisciplinary collaboration between obstetric anesthesia, maternal-fetal medicine, and otolaryngology.
• Proactive airway management, including elective tracheostomy, is essential for ensuring maternal safety in pregnant patients with severe, pre-existing airway stenosis.
• Successful peripartum outcomes are achievable with meticulous planning and individualized anesthetic strategies.