Advances in management of laryngeal and subglottic stenosis

The introduction of cryotherapy and the refinement of surgical techniques has promoted progress in the care of infants and children with previously unresponsive intraluminal lesions of the larynx and subglottic area. Three cases illustrate the pluralistic approach that often must be brought to and individualized for these difficult cases before a measure of success can be assured. One case, stenotic since intubation required when the child was less than 1 k, was treated with fulguration, cryotherapy, and prolonged stenting. The severe stenosis from the tracheotomy site to the vocal cords eventually required open repair with anterior and posterior cricoid splits and a hyoid pedicled bone graft, followed by prolonged stenting. A method of internal stenting through the cords with percutaneous fixation was effective for long-term (3-6 mo) therapy. Another patient with severe stenosis was managed with multiple cryotherapy procedures followed by prolonged internal stenting. A third patient with subglottic stenosis secondary to an inhalation burn, was treated with cryotherapy without stenting. This presentation discusses the techniques of internal stenting with percutaneous fixation, cryotherapy, and open repair with combined anterior and posterior cricoid split, considering the indications and idiosyncracies of each technique.