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Subglottic stenosis: a clinicopathological study.

R E Quiney, S J Gould

    Clinical Otolaryngology and Allied Sciences
    |December 1, 1985
    PubMed
    Summary
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    Neonatal subglottic stenosis, a complication of endotracheal intubation, is poorly understood. Severe injury in the first week of intubation may lead to reparative fibrosis and stenosis, with tube placement a potential factor.

    Area of Science:

    • Neonatology
    • Pediatric Surgery
    • Otolaryngology

    Background:

    • Subglottic stenosis is the most frequent serious long-term complication following neonatal endotracheal intubation.
    • The precise pathogenesis of subglottic stenosis remains incompletely understood.

    Purpose of the Study:

    • To describe the clinical experience with 15 cases of neonatal subglottic stenosis requiring surgical intervention.
    • To review the pathology and pathogenesis of subglottic stenosis.
    • To identify potential etiological factors and critical time periods for injury.

    Main Methods:

    • Retrospective case series of 15 neonates undergoing operative intervention for subglottic stenosis over a 3-year period.
    • Review of the existing literature on the pathology and pathogenesis of subglottic stenosis.

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    Main Results:

    • One case successfully treated with operative intervention, avoiding long-term tracheostomy.
    • Insertion of the endotracheal tube's wide shoulder through the vocal cords identified as a possible etiological factor in 2 cases.
    • Subglottic stenosis is hypothesized to result from reparative fibrosis following severe acute intubation injury.
    • Delayed mucosal healing, potentially worsened by cricoid cartilage necrosis, may also contribute.
    • The first week of intubation identified as the most critical period for severe subglottic injury.

    Conclusions:

    • Subglottic stenosis in neonates is a significant complication of endotracheal intubation.
    • Severe intubation injury, particularly within the first week, and specific tube placements may predispose to stenosis.
    • Further research into prevention and management strategies is warranted.