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Intralesional steroids in conservative management of subglottic stenosis of the larynx
Insights
Subglottic stenosis, a complication of prolonged endotracheal intubation, can be managed conservatively. This study reports successful treatment using intralesional steroid injections, dilatation, and bronchoscopy, with limited surgery in one case.
Area of Science:
- Otolaryngology
- Pediatric Pulmonology
- Critical Care Medicine
Background:
- Subglottic stenosis is a recognized complication of prolonged endotracheal intubation, particularly with advanced resuscitation methods.
- Conservative management is recommended initially, especially in pediatric cases, emphasizing prevention as the primary strategy.
Observation:
- This report details the successful treatment of four pediatric patients experiencing subglottic stenosis.
- The treatment protocol involved a multimodal approach.
Findings:
- The treatment regimen included intralesional injection of Triamcinolone Acetonide Aqueous Suspension (Kenacort A), dilatation using gum elastic bougies, and bronchoscopic examination.
- One patient required limited surgical correction in addition to the conservative measures.
Implications:
- The findings suggest that a combination of intralesional steroid injections and endoscopic interventions can effectively manage subglottic stenosis.
- Steroids may play a role in modulating scar tissue formation, offering a less invasive treatment option for this complication.
Abstract:
Subglottic stenosis after prolonged endotracheal intubation is a well recognised complication, especially with the advent of intensive resuscitative techniques. Although prevention is the best cure, once the management has been established it should be conservative in the first instance, especially in the case of children. The successful treatment of four cases with this complication is reported. The treatment consisted of intralesional injection of Triamcinolone Acetonide Aqueous Suspension (Kenacort A), dilatation with gum elastic bougies, bronchoscopy and very limited surgical correction in one case. A brief reference is made to the etiological factors and to the mechanism of action of steroids in scar tissue.