Subglottic Stenosis

Marston, Alexander P.; White, David R.

doi:10.1016/j.clp.2018.07.013

Cited by 59 publications

(33 citation statements)

References 43 publications

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“…The laryngeal injuries can be mucosal injuries like vocal cord erythema, edema, granulations or ulcerations to a more permanent sequelae like vocal cord palsy, arytenoids dislocation and subglottic stenosis. 6,11,[16][17][18][19][20][21][22][23][24][25][26][27][28] In addition, the tracheal injuries can be granulations in the initial stages to tracheal stenosis in the later stages. 29 In the present study, LTI observed were subglottic stenosis, granulation tissue in posterior commissure, vocal cord fixation and granulation tissue in the tracheal wall.…”

Section: Discussionmentioning

confidence: 99%

A clinical study on laryngotracheal injuries following endotracheal intubation

Gadag

Sreedevi

Kizhakkilott

et al. 2021

Int J Otorhinolaryngol Head Neck Surg

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Background: Despite major advances in the design of endotracheal tubes and developments in the management of difficult airways, endotracheal intubation remains by far the most common cause of laryngotracheal injuries (LTI). These LTI are challenging to manage and are associated with significant morbidity and mortality. Hence, the present study was done to find out the incidence, types of LTI and to study the factors affecting the same.Methods: A prospective study was conducted on patients who were intubated for more than 48 hours and admitted in medical intensive care units in a tertiary referral hospital, for a period of 1 year. All patients following extubation were evaluated for LTI by x-ray neck (antero-posterior and lateral view), rigid endoscopy and flexible naso-pharyngo-laryngoscopy. Results: Thirty patients were included in the study. Majority of the patients (56.6%) were found normal while 43.2% patients were having LTI following extubation in the form of bilateral vocal cord fixation, subglottic stenosis, granulation tissue in the posterior commissure and in the trachea. Majority of these patients were aged less than 45 years, with duration of intubation for more than 10 days, with tube size more than 7 mm. Organo-phosphourous (OP) poisoning was the etiology for LTI in 69.2% cases.Conclusions: A high incidence of LTI especially in cases of OP poisoning warrants one to be cautious in managing these intubated patients. Those patients requiring prolonged intubation should be considered for other alternative airway managements like tracheostomy in addition to using low pressure, high volume cuffed tubes. Adequate training of the emergency personnel in the intubation technique and its subsequent care is important especially in a tertiary referral center.

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Section: Discussionmentioning

confidence: 99%

A clinical study on laryngotracheal injuries following endotracheal intubation

Gadag

Sreedevi

Kizhakkilott

et al. 2021

Int J Otorhinolaryngol Head Neck Surg

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“…1-4 Neonatal iatrogenic airway injuries have decreased in incidence secondary to improvements in ventilator and endotracheal tube management. 7 Furthermore the posterior larynx is the most common site for iatrogenic laryngeal injuries in the neonate, as the endotracheal tube is gravity dependent at rest. 5 Nevertheless both children had extended and repetitive intubation episodes and neither child had a defect noted on their initial direct laryngoscopy and intubation.…”

Section: Discussionmentioning

confidence: 99%

Neonatal Lateral Epiglottic Defects

Peterson

Goyal

Puricelli

et al. 2020

Ann Otol Rhinol Laryngol

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Introduction: Multiple congenital abnormalities of the epiglottis have been reported and iatrogenic injuries to the larynx and subglottis are well known. We present a new pattern of defect not previously reported in the literature. Methods: Epiglottic abnormalities at two institutions are reviewed. Cases of defects involving the lateral aspect of the epiglottis and aryepiglottic fold are identified. A literature review of known epiglottic defects is performed. Results: Two children possessing lateral notch injuries at the aryepiglottic attachment to the epiglottis are described. Both children have a history of multiple laryngeal instrumentation attempts and prolonged intubation. Both have swallowing difficulties and are gastrostomy dependent. Congenital epiglottic defects include aplasia and midline bifidity, however, no lateral congenital epiglottic defects have been reported. Conclusion: Epiglottic defects, while rare, should be part of the differential for children with aspiration and feeding difficulties. A new pattern of defect is described and iatrogenic etiology proposed.

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“…In children the use of the microcuff tube with a distal low pressure cuff has reduced the incidence of subglottic trauma and stenosis, as discussed in depth in [122]. Early tracheostomy in adult intensive care units thus avoiding prolonged intubation, pressure monitoring and better training have all contributed to reducing the incidence of PI-SGS [123].…”

Section: Using Biological Innovations To Inform Pi-sgs Managementmentioning

confidence: 99%

Post-intubation subglottic stenosis: aetiology at the cellular and molecular level

2021

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Subglottic stenosis (SGS) is a narrowing of the airway just below the vocal cords. This narrowing typically consists of fibrotic scar tissue, which may be due to a variety of diseases. This review focuses on post-intubation (PI) SGS. SGS can result in partial or complete narrowing of the airway. This narrowing is caused by fibrosis and can cause serious breathing difficulties. It can occur in both adults and children. The pathogenesis of post-intubation SGS is not well understood; however, it is considered to be the product of an abnormal healing process. This review discusses how intubation can change the local micro-environment, leading to dysregulated tissue repair. We discuss how mucosal inflammation, local hypoxia and biomechanical stress associated with intubation can promote excess tissue deposition that occurs during the pathological process of SGS.

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Subglottic Stenosis

Cited by 59 publications

References 43 publications

A clinical study on laryngotracheal injuries following endotracheal intubation

A clinical study on laryngotracheal injuries following endotracheal intubation

Neonatal Lateral Epiglottic Defects

Post-intubation subglottic stenosis: aetiology at the cellular and molecular level

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