Subglottic stenosis

Abstract

Subglottic stenosis (SGS) is a congenital or acquired condition characterized by a narrowing of the upper airway extending from just below the vocal folds to the lower border of the cricoid cartilage. With the introduction of prolonged intubation in neonates (mid 1960s), acquired SGS became the most frequent cause of laryngeal stenosis; unlike congenital SGS, it does not improve with time. Laryngeal reconstruction surgery evolved as a consequence of the need to manage these otherwise healthy but tracheotomized children. Ongoing innovations in neonatal care have gradually led to the salvage of premature and medically fragile infants in whom laryngeal pathology is often more severe, and in whom stenosis often involves not only the subglottis, but also the supraglottis or glottis-causing significant morbidity and mortality. The primary objective of intervention in these children is decannulation or preventing the need for tracheotomy. The aim of this article is to present a more detailed description of both congenital and acquired SGS, highlighting the essentials of diagnostic assessment and familiarizing the reader with contemporary management approaches.

Outcome measures for pediatric laryngotracheal reconstruction: International consensus statement

“…The outcomes of many investigations now span decades rather than focusing on early childhood or the postoperative period alone, thus highlighting the changes that occur to our patients throughout their lifetime . In addition, post‐reconstruction voice, swallow function, activity tolerance, and sleep patterns have become common topics of investigation and increasingly important to patients, adding intricacy and breadth to our interpretation of surgical outcomes …”

Anesthesia for shared airway surgery in children

“…Subglottic stenosis is a narrowing of the subglottic tracheal lumen (Figure ). It is defined as a lumen ≤4 mm in a full‐term neonate and a lumen <3 mm in a preterm infant . It may be congenital or acquired, with the acquired form of the disease being more prevalent.…”

“…At presentation, the majority of patients have stridor, often biphasic. There may be other signs of respiratory distress, such as intercostal retractions and a barking cough . The Myer‐Cotton scale can be used to classify the degree of stenosis …”

“…Management is based on the grade at diagnosis, with less severe cases being treated conservatively. More significant stenoses can be managed by endoscopic dilation or with laryngotracheal reconstruction using a costal cartilage graft …”

Post‐intubation subglottic stenosis in children: Analysis of clinical features and risk factors

“…Subglottic stenosis (SGS) is one of the most common causes of upper airway obstruction in childhood. It can be congenital or acquired and has a frequency between 0.6% and 11% …”