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Endoscopic Septoplasty with Limited Two-line Resection: Minimally Invasive Surgery for Septal Deviation
Published on: June 20, 2018
Respiratory problems and associated factors following endoscopic balloon dilatation procedure in children with
Arzu Tuzuner1, Ceren Bas2, Sabuhi Jafarov1
1Department of Otolaryngology, Baskent University School of Medicine, Yukarı Bahçelievler, No:, 77. Sk. No:11, Çankaya, 06490, Ankara, Turkey.
Insights
Endoscopic balloon dilatation (EBD) for subglottic stenosis is effective, but prompt treatment is crucial. Factors like prematurity and stenosis grade predict complications, necessitating careful patient selection and timely intervention.
Area of Science:
- Otolaryngology
- Pediatric Surgery
- Respiratory Medicine
Background:
- Subglottic stenosis (SGS) is a narrowing of the airway below the vocal cords, often requiring intervention.
- Endoscopic balloon dilatation (EBD) is a minimally invasive surgical option for treating SGS.
- Identifying predictors of complications is vital for optimizing patient outcomes.
Purpose of the Study:
- To identify predictors of postoperative problems and early complications in primary EBD surgeries for acquired subglottic stenosis.
- To evaluate the association between patient factors and adverse outcomes following EBD.
Main Methods:
- Retrospective analysis of patients undergoing EBD for acquired SGS between 2010-2019.
- Data collected included patient demographics, etiology, chromosomal/craniofacial anomalies, duration of prolonged intubation (DPI), and extubation-dilatation timeframe (EDT).
- Intraoperative and postoperative outcomes such as re-intubation, tracheotomy, desaturation, and cardiopulmonary arrest were recorded.
Main Results:
- The study included 64 patients (42 males, 22 females).
- Common causes for prolonged intubation were congenital heart disease (78.1%) and prematurity (21.9%).
- Factors associated with early respiratory complications included prematurity, longer DPI, longer EDT, older age, and higher stenosis grade. Complications observed were desaturation (40.6%), need for intubation (15.6%), tracheotomy (15.6%), and cardiopulmonary arrest (6.25%).
Conclusions:
- Endoscopic balloon dilatation (EBD) is a viable treatment for acquired subglottic stenosis in children.
- Careful patient selection and prompt EBD are recommended to minimize complications.
- Factors such as prematurity, prolonged intubation, and stenosis severity should be considered when planning EBD.
Objectives:
Endoscopic balloon dilatation (EBD) offers a safe and non-invasive surgical option for the treatment of subglottic stenosis. Patient selection is important to achieve good results and to detect which patients are more prone to the development of complications. The aim of this study was to determine predictors of postoperative problems and early complications in primary EBD surgeries.
Methods:
A retrospective analysis was made of patients with acquired subglottic stenosis who were operated on with the EBD technique between January 2010 and December 2019 in the Otolaryngology-Head and Neck Surgery Department of Baskent University Hospital. Demographic data including the age and sex of the patients were collected together with etiology, presence of chromosomal or craniofacial anomaly (C/CA), duration of prolonged intubation (DPI), and extubation dilatation timeframe (EDT). Intra and postoperative follow-up data were recorded of the need for intubation or tracheotomy, development of desaturation, and grade and type of stenosis.
Results:
The male to female ratio was 2:1. The patients comprised 42 males and 22 females with a mean age of 296.52 ± 551.93 days. The cause of prolonged intubation was surgery for congenital heart disease in 50 (78.1%) patients and prematurity in 14 (21.9%). The type of lesion was acute granulation in 44 (72.1%) and chronic granulation in 17 (27.9%) patients. C/CA was determined in 13 patients, the mean grade of stenosis was 76.33 ± 15.21%, mean DPI was 25.25 ± 35.49 days, and mean EDT was calculated as 78.23 ± 373.82 days. Desaturation following endoscopic balloon dilatation developed in 26 (40.6%), orotracheal intubation was required in 10 (15.6%), tracheotomy in 10 (15.6%), and cardiopulmonary arrest occurred in 4 (6.25%). Prematurity, a longer duration of preoperative intubation, longer time from extubation to dilatation, older age, and higher grade of stenosis were determined as factors associated with postoperative early respiratory complications.
Conclusion:
EBD indication should be carefully considered in children with acquired subglottic stenosis. To achieve better results and minimise complications, EBD should be performed without delay.
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