Childhood Wegener's Granulomatosis with Subglottic Stenosis

Abstract

Our aim is to highlight the possibility of subglottic stenosis caused by Wegener's granulomatosis. The incidence of subglottic stenosis in Wegener's granulomatosis is seen five times more often in children.We report a case of a 12-year-old female diagnosed as Wegener's granulomatosis who was on medical treatment since six months. She presented to us with stridor. As rigid laryngoscopy revealed a pinhole opening in the subglottic region, an emergency tracheostomy was performed. This was followed by a planned microlaryngoscopy using cold steel instruments. A triradiate incision with dilatation, local steroid injection and topical application of mitomycin-c was performed. In Wegener's granulomatosis, subglottic stenosis is caused due to vasculitis therefore, the use of laser and stent is contraindicated, as this may lead to a further worsening of the stenosis.Among various causes of subglottic stenosis, the most common cause is use of cuffed tracheostomy tube and endotracheal tube. It is essential to diagnose the etiology of subglottic stenosis to decide on the appropriate modality of treatment.