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Bioabsorbable Stenting in a Case of Severe Pediatric Posterior Glottic Stenosis
Sage Feminella1,2, Alyssa J Snyder1,2, Lara Reichert2
1Albany Medical College, NY, USA.
Insights
Steroid-eluting stents show promise in treating pediatric posterior glottic stenosis (PGS) after intubation. This case demonstrates reduced scar tissue and improved airway patency, aiding in decannulation for a young patient with PGS.
Area of Science:
- Otolaryngology
- Pediatric Surgery
- Respiratory Medicine
Background:
- Pediatric patients under 5 are at high risk for laryngeal injury and posterior glottic stenosis (PGS) following prolonged intubation.
- Current management for PGS is unclear, with restenosis being a frequent complication.
- Steroid-eluting stents show potential but are underreported for airway stenosis.
Purpose of the Study:
- To report the off-label use of a steroid-eluting stent in a pediatric patient with posterior glottic stenosis (PGS).
- To evaluate the efficacy of adjunctive steroid-eluting stent therapy in managing complex pediatric laryngeal disorders.
Main Methods:
- A 2-year-old female with transverse myelitis and vocal cord paresis developed PGS after multiple intubations, requiring tracheostomy.
- Endoscopic division of posterior glottic scar tissue was performed.
- A Propel™ steroid-eluting stent was placed in the interarytenoid and arytenoid mucosa.
Main Results:
- Laryngoscopy at 2 weeks showed reduced scar tissue and no restenosis, with resolving granulation tissue and edema.
- Airway patency was maintained despite persistent vocal cord paresis.
- At 3 months, stenosis improved significantly, allowing for tracheostomy capping.
Conclusions:
- This case demonstrates the successful off-label use of a steroid-eluting stent as adjunctive therapy for pediatric posterior glottic stenosis (PGS).
- The treatment led to reduced scar tissue and improved airway patency, facilitating decannulation.
- Further research is necessary to establish the role of steroid-eluting stents in managing complex pediatric laryngeal disorders.
Introduction:
Pediatric patients, especially those under 5 years of age, are at increased risk of laryngeal injury and subsequent posterior glottic stenosis (PGS) after prolonged or repeated intubations. Despite various surgical options, optimal management remains unclear, and restenosis is a common complication. Steroid-eluting stents, such as the Propel™, have shown promise in sinus applications but are underreported in airway stenosis and reconstruction.
Methods:
We present a case of a 2-year-old female with transverse myelitis and neuromuscular respiratory failure with bilateral vocal cord paresis, which led to multiple intubations and subsequent PGS. She ultimately underwent tracheostomy due to recurrent respiratory failure with viral infections and associated failure to thrive. Once stable, preparations for decannulation began. The patient underwent endoscopic division of posterior glottic scar tissue, followed by placement of a Propel™ steroid-eluting stent to the interarytenoid and arytenoid mucosa.
Results:
At 2-week follow-up, laryngoscopy revealed significant reduction in scar tissue without restenosis, with progressive resolution of granulation tissue and edema. Despite persistent vocal cord paresis, airway patency was maintained. At 3-month follow-up, there was marked improvement of stenosis sufficient to allow tracheostomy capping.
Conclusion:
This case highlights the off-label use of a steroid-eluting stent as adjunctive therapy in a pediatric patient with PGS. Outcomes demonstrated reduced scar tissue and improved airway patency, allowing progression toward decannulation. Further studies are needed to evaluate the role of steroid-eluting stents in the management of complex laryngeal disorders.
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