Subglottic stenosis in infants and children

Area of Science:

• Pediatric Otolaryngology
• Respiratory Medicine
• Pediatric Surgery

Background:

• Subglottic stenosis (SGS) is a narrowing of the airway below the vocal cords.
• It can be congenital or acquired, presenting unique challenges in pediatric patients.
• Stridor and recurrent croup are common symptoms, necessitating prompt diagnosis and intervention.

Purpose of the Study:

• To analyze and compare the outcomes of congenital and acquired subglottic stenosis in children.
• To evaluate the efficacy and complications of tracheotomy and other management strategies.
• To determine the overall mortality rate associated with subglottic stenosis management.

Main Methods:

• Retrospective review of 158 pediatric cases of subglottic stenosis (115 congenital, 43 acquired).
• Analysis of presenting symptoms, management interventions (including tracheotomy and dilatation), and follow-up outcomes.
• Calculation of decannulation rates and mortality rates for both congenital and acquired groups.

Main Results:

• Congenital SGS: 44% required tracheotomy; most decannulated with growth; 2.1% mortality.
• Acquired SGS: 97% required tracheotomy; prolonged management with dilatation and granulation tissue removal often needed; 5.9% overall mortality (4 deaths due to tracheostomy complications).
• 85 children required tracheotomy in total; 5 deaths attributed to long-term tracheostomy complications.

Conclusions:

• Congenital subglottic stenosis is generally outgrown, with periodic dilatation aiding recovery.
• Acquired subglottic stenosis presents a more complex management challenge requiring aggressive, prolonged interventions.
• While tracheotomy is often necessary, long-term complications can contribute to mortality, particularly in acquired cases.