Acquired subglottic stenosis in neonates is related to an inconsistent
cascade of events that causes 1- 8% of infants to develop the condition after
prolonged intubation. The management of subglottic stenosis (SGS) in children
continues to be a challenging problem for the otolaryngologist.
Aim of the study: To present results of the use of balloon catheter
dilatation (BCD) as a method of establishing control of the compromised airway
and as a definitive alternative to open surgery in infants with acquired subglottic
stenosis (SGS).
Patients and methods : A total of 14 patients (6 girls and 8 boys), with a
mean age of 8.78 months (range, 3-18 months). All 14 patients presented with
biphasic stridor, and 8 had significant retractions noted on examination. In all
patients, management of the compromised airway was established with balloon
catheter dilatation (BCD) followed by intubation.
Main Outcome Measures: were defined by postoperative symptomatology,
endoscopic grading of residual SGS, complications, and the need for subsequent
interventions to manage SGS.
Results: Eight patients were completely asymptomatic after the initial
(BCD). An additional 3 patients had recurrent stridor during the postoperative
period and required a second (BCD) before having complete, persistent resolution
of symptoms. (BCD) failed in 3 patients, of whom 2 went on to undergo singlestaged laryngotracheal reconstruction and 1 required a tracheotomy.
Conclusions: Balloon catheter dilatation (BCD) is a safe means of
establishing the airway in infants with obstruction due to acquired SGS. It was an
effective, stand-alone procedure for the management of SGS in 11 of our 14
patients, obviating the need for tracheotomy or cricoid split.
♠Assistant professor ENT Benha faculty of medicine. |
