The surgical treatment of acquired subglottic stenosis in children with double-stage laryngotracheal reconstruction

Carta, Filippo; Piras, Nicoletta; Mariani, Cinzia; Marrosu, Valeria; Tatti, Melania; Chuchueva, Natalia; Bekpanov, Almat; Medeulova, Aigul; Shetty, Sanjana Ashik; Puxeddu, Roberto

doi:10.1016/j.ijporl.2022.111164

Cited by 3 publications

(2 citation statements)

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“…The decannulation rate after dsLTP in the literature ranges from 65% to 89%. [8][9][10][11][12][13] In our study, the overall decannulation rate was 74% with a significantly higher rate in patients with low-grade stenosis after stent removal (84%) compared with those with high-grade stenosis after stent removal (36%). This suggests dsLTP is a frequently successful procedure for pediatric SGS with decannulation outcomes predicted by early endoscopy findings.…”

Section: Discussionmentioning

confidence: 45%

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Surgical Outcomes by Early Airway Endoscopy Findings after Pediatric Staged Laryngotracheoplasty

et al. 2023

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ObjectivesTo determine how initial postoperative airway endoscopy findings after stent removal predict successful decannulation in children undergoing double‐staged laryngotracheoplasty (dsLTP). Secondary objectives assessed timing of decannulation and number of endoscopic interventions needed after dsLTP.MethodsA case series with chart review included children who underwent dsLTP at a tertiary children's hospital between 2008 and 2021. Rates of decannulation, time to decannulation, and number of interventions after dsLTP were recorded for children with high‐ or low‐grade stenosis at the first bronchoscopy after stent removal.ResultsOf the 65 children who were included, 88% had high‐grade stenosis and 98% had a preoperative tracheostomy. Successful decannulation happened in 74% of the children, and 44% of the children were decannulated within 12 months of surgery. For children with low‐grade stenosis at the first endoscopy after stent removal, 84% were successfully decannulated compared with 36% of the children with high‐grade stenosis (p = 0.001). After dsLTP, children with high‐grade stenosis required 7.5 interventions (SD: 3.3) compared with 4.0 interventions (SD: 3.0) for children with low‐grade stenosis (p < 0.001). Decannulated children with high‐grade stenosis necessitated more endoscopic procedures (7.0 vs. 3.7, p = 0.02). Time to decannulation was similar between children with high‐ and low‐grade early postoperative stenosis (21.9 vs. 17.8 months, p = 0.63).ConclusionsHigher grade stenosis identified on the first airway endoscopy after suprastomal stent removal is correlated with lower decannulation rates and more postoperative endoscopic interventions. Although time to decannulation was not impacted by early stenosis grade, surgeons might utilize these early airway findings to counsel families and prognosticate possible surgical success.Level of Evidence4 Laryngoscope, 2023

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Section: Discussionmentioning

confidence: 45%

“…The decannulation rate after dsLTP in the literature ranges from 65% to 89% 8–13 . In our study, the overall decannulation rate was 74% with a significantly higher rate in patients with low‐grade stenosis after stent removal (84%) compared with those with high‐grade stenosis after stent removal (36%).…”

Section: Discussionmentioning

confidence: 46%

Surgical Outcomes by Early Airway Endoscopy Findings after Pediatric Staged Laryngotracheoplasty

et al. 2023

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Decannulation in Trisomy 21 patients undergoing laryngotracheal reconstruction

Blumenthal

Leonard

Habib

et al. 2023

International Journal of Pediatric Otorhinolaryngology

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Chronic congestion with oral feeds in the presence of subglottic stenosis: a case report

Momin,

Nelson,

Hall

et al. 2024

Bull Natl Res Cent

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Background Subglottic stenosis is the narrowing of the airway below the vocal folds. It can present as a congenital or acquired condition. The primary clinical presentation is often noted as noisy breathing, also known as stridor. Diagnosis in the infant pediatric population poses challenges due to age-related factors and symptom variability. This case report highlights a pediatric patient whose predominant symptom was congestion during oral feeds. Case presentation A 3-month-old pre-term male, intubated following an episode of ventricular fibrillation with underlying viral infection, presented with prolonged, persistent congestion with oral feeds. Given persistent congestion, the differential diagnosis included aspiration, recovery from a viral illness, reflux, and an anatomical stricture. A videofluoroscopic swallow study was completed and ruled out oropharyngeal dysphagia from the differential. Despite this exclusion and the patient’s eventual recovery from his viral illness, congestion with oral feeds continued to worsen. A fiberoptic endoscopic evaluation was completed and revealed Grade 2 subglottic stenosis. The patient required immediate intervention via balloon dilation in the operating room. Conclusions Acquired subglottic stenosis is often a consequence of intubation. Symptoms are variable and can be difficult to diagnose in pediatric patients. Timely intervention is essential to prevent life-threatening conditions.

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The surgical treatment of acquired subglottic stenosis in children with double-stage laryngotracheal reconstruction

Cited by 3 publications

References 30 publications

Surgical Outcomes by Early Airway Endoscopy Findings after Pediatric Staged Laryngotracheoplasty

Surgical Outcomes by Early Airway Endoscopy Findings after Pediatric Staged Laryngotracheoplasty

Decannulation in Trisomy 21 patients undergoing laryngotracheal reconstruction

Chronic congestion with oral feeds in the presence of subglottic stenosis: a case report

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