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Subglottic cysts in the premature infant
J D Smith1, R Cotton, C M Meyer
1Department of Otolaryngology-Head and Neck Surgery, Oregon Health Sciences University, Portland.
Insights
Subglottic cysts, rarely reported in newborns, can cause acquired subglottic stenosis after prolonged intubation. Endoscopic marsupialization is a recommended conservative treatment for these cysts.
Area of Science:
- Pediatric Otolaryngology
- Neonatal Intensive Care
- Airway Management
Background:
- Supraglottic cysts are common in newborns, but subglottic cysts are infrequently reported.
- Prolonged intubation in the neonatal intensive care unit is a potential risk factor for subglottic pathology.
Observation:
- Nine neonates with prolonged intubation developed acquired subglottic stenosis.
- Stenosis presented as progressive biphasic stridor weeks to months after extubation.
- Endoscopy revealed irregular subglottic stenosis with smooth mucosal lining, often with apparent cysts.
Findings:
- Subglottic cysts were identified in nine neonates with acquired subglottic stenosis.
- Six patients were successfully treated with endoscopic marsupialization, diathermy, or laser ablation.
- Two patients initially treated for stenosis required tracheostomy before cyst recognition during laryngotracheoplasty.
Implications:
- Subglottic cysts should be considered in neonates with acquired subglottic stenosis post-intubation.
- Conservative endoscopic management, particularly marsupialization, is effective for subglottic cysts.
- Early recognition and conservative treatment can prevent the need for tracheostomy.
Abstract:
Supraglottic cysts in the newborn are a well-recognized entity, but subglottic cysts have been rarely reported. Over the past 6 years we have observed subglottic cysts in nine patients with relatively long intubations from the neonatal intensive care unit of two university hospitals. Most frequently the patients were extubated and did well for weeks or months, but then they had progressive biphasic stridor. On endoscopy the patients had a subglottic stenosis that was irregular but with a smooth mucosal lining. Usually the cysts were apparent, but in two patients the mucosa was thickened and the patients were treated as a subglottic stenosis with tracheostomy. These subglottic cysts were recognized at the time of laryngotracheoplasty. In six patients the cysts were managed either by marsupialization with cup forceps, endoscopic diathermy, or carbon dioxide laser without recurrence. It is our belief that this condition is most likely due to scarring and obstruction of mucus glands of the subglottic area from prolonged intubation. This entity should be recognized and looked for in the neonate who has an acquired subglottic stenosis and should first be treated conservatively with endoscopic marsupialization.