Proposed Grading System for Subglottic Stenosis Based on Endotracheal Tube Sizes

Abstract

The classification of airway stenoses has been a problem for many years. As a result, both intradepartmental and interdepartmental comparisons of airway sizes remain difficult. It follows that comparisons of therapeutic maneuvers are even more difficult. A system is proposed that is simple, reproducible, and based on a readily available reference standard. Endotracheal tubes, which are manufactured to high standards of precision and accuracy, can be used to determine the size of an obstructed airway at its smallest point. The endotracheal tube that will pass through the lumen, if one exists, and tolerate normal leak pressures (10 to 25 cm H2O), can be compared to the expected age-appropriate endotracheal tube size. By using the outside diameters of the endotracheal tubes, the maximum percentage of airway obstruction can be determined. We present a conversion of tube size to the proposed grading scale: grade I up to 50% obstruction, grade II from 51% to 70%, and grade III above 70% with any detectable lumen. An airway with no lumen is assigned to grade IV.

Supraglotoplastía láser en laringomalacia severa

“…El 73% presentó lesiones concomitantes de vía aérea. La estenosis subglótica fue la más frecuente siendo 5 casos grado I, un caso grado II y un caso grado III, según la clasificación de Cotton-Myer 15 . En otro caso hubo una parálisis de cuerda vocal unilateral con paresia de la cuerda contralateral y traqueomalacia (9%).…”

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“…In 12 (80%) of our cases, the stenosis occurred in the subglot-tic area at the cricoid ring level, at the T1-T2 level right below the tracheotomy line in 2 (13, 3%) cases, and 1 (6, 6%) case had stenosis in both the cricoid ring and below the tracheotomy. Myer and Cotton divided tracheal stenoses into four categories based on the degree of obstruction: Grade 1 corresponds to <50%; Grade 2, 50% -70%; Grade 3, 70% -99%; and Grade 4 is total obstruction [6]. A 50% reduction in the airway causes exertion dyspnea and a 75% reduction causes dyspnea at rest.…”

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“…3 In the majority of cases with a Grade I stenosis, conservative management may be all that is required but in Grade II and above, surgical intervention is the preferable treatment. Techniques for repairing the airway consist of two basic modalities: endolaryngeal and external approaches.…”