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Minimally invasive endoscopic management of subglottic stenosis in children: success and failure.
Int J Pediatr Otorhinolaryngol. 2011 May; 75(5):652-6.IJ

Abstract

OBJECTIVE

To assess the efficacy and safety of endoscopic management of subglottic stenosis both as a primary and as an adjunctive treatment in the pediatric population.

METHODS

Retrospective review of pediatric patients with subglottic stenosis undergoing endoscopic airway procedures at a tertiary care pediatric medical center. Outcomes were assessed by systematic review to determine the success and failure of the endoscopic approach.

RESULTS

Forty patients (22 male, 18 female) underwent endoscopic interventions for a diagnosis of subglottic airway stenosis between 2003 and 2006. Age ranged from 22 days old to 20 years old. Recorded degree of subglottic stenosis ranged from 10% to 99%. Fifty-three percent (21/40) had a history of prematurity, and 40% (16/40) had secondary airway diagnoses. Twenty-four patients underwent an endoscopic intervention initially (including laser or dilation, with or without topical mitomycin treatment), including four patients who underwent tracheostomy prior to the first endoscopic intervention. Sixteen underwent laryngotracheoplasty initially, including ten patients who underwent tracheostomy prior to the laryngotracheoplasty. Endoscopic treatment resulted in resolution of symptoms, and/or decannulation, and no further need for an open procedure in 58% of patients. Of the 24 patients undergoing endoscopic interventions initially, 14 patients underwent two or more endoscopic interventions, and 10 patients subsequently required tracheostomy or laryngotracheoplasty. When endoscopic procedures were used as an adjunct to laryngotracheoplasty, 60% (12/20) had resolution of symptoms, underwent decannulation, and did not require tracheostomy or revision laryngotracheoplasty.

CONCLUSIONS

The endoscopic approach can be successful in the management of properly selected patients with subglottic stenosis, either as the initial treatment modality or as an adjunctive treatment in cases of re-stenosis after open airway surgery. The likelihood of success with a minimally invasive procedure as the primary treatment decreases with worsening initial grade of subglottic stenosis.

Authors+Show Affiliations

Department of Otolaryngology and Communication Enhancement, Children's Hospital Boston, Boston, MA, USA; Department of Otology and Laryngology, Harvard Medical School, Boston, MA, USA; Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, MA, USA.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article

Language

eng

PubMed ID

21377219

Citation

Quesnel, Alicia M., et al. "Minimally Invasive Endoscopic Management of Subglottic Stenosis in Children: Success and Failure." International Journal of Pediatric Otorhinolaryngology, vol. 75, no. 5, 2011, pp. 652-6.
Quesnel AM, Lee GS, Nuss RC, et al. Minimally invasive endoscopic management of subglottic stenosis in children: success and failure. Int J Pediatr Otorhinolaryngol. 2011;75(5):652-6.
Quesnel, A. M., Lee, G. S., Nuss, R. C., Volk, M. S., Jones, D. T., & Rahbar, R. (2011). Minimally invasive endoscopic management of subglottic stenosis in children: success and failure. International Journal of Pediatric Otorhinolaryngology, 75(5), 652-6. https://doi.org/10.1016/j.ijporl.2011.02.002
Quesnel AM, et al. Minimally Invasive Endoscopic Management of Subglottic Stenosis in Children: Success and Failure. Int J Pediatr Otorhinolaryngol. 2011;75(5):652-6. PubMed PMID: 21377219.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Minimally invasive endoscopic management of subglottic stenosis in children: success and failure. AU - Quesnel,Alicia M, AU - Lee,Gi Soo, AU - Nuss,Roger C, AU - Volk,Mark S, AU - Jones,Dwight T, AU - Rahbar,Reza, Y1 - 2011/03/05/ PY - 2010/10/10/received PY - 2011/02/01/revised PY - 2011/02/02/accepted PY - 2011/3/8/entrez PY - 2011/3/8/pubmed PY - 2014/4/29/medline SP - 652 EP - 6 JF - International journal of pediatric otorhinolaryngology JO - Int. J. Pediatr. Otorhinolaryngol. VL - 75 IS - 5 N2 - OBJECTIVE: To assess the efficacy and safety of endoscopic management of subglottic stenosis both as a primary and as an adjunctive treatment in the pediatric population. METHODS: Retrospective review of pediatric patients with subglottic stenosis undergoing endoscopic airway procedures at a tertiary care pediatric medical center. Outcomes were assessed by systematic review to determine the success and failure of the endoscopic approach. RESULTS: Forty patients (22 male, 18 female) underwent endoscopic interventions for a diagnosis of subglottic airway stenosis between 2003 and 2006. Age ranged from 22 days old to 20 years old. Recorded degree of subglottic stenosis ranged from 10% to 99%. Fifty-three percent (21/40) had a history of prematurity, and 40% (16/40) had secondary airway diagnoses. Twenty-four patients underwent an endoscopic intervention initially (including laser or dilation, with or without topical mitomycin treatment), including four patients who underwent tracheostomy prior to the first endoscopic intervention. Sixteen underwent laryngotracheoplasty initially, including ten patients who underwent tracheostomy prior to the laryngotracheoplasty. Endoscopic treatment resulted in resolution of symptoms, and/or decannulation, and no further need for an open procedure in 58% of patients. Of the 24 patients undergoing endoscopic interventions initially, 14 patients underwent two or more endoscopic interventions, and 10 patients subsequently required tracheostomy or laryngotracheoplasty. When endoscopic procedures were used as an adjunct to laryngotracheoplasty, 60% (12/20) had resolution of symptoms, underwent decannulation, and did not require tracheostomy or revision laryngotracheoplasty. CONCLUSIONS: The endoscopic approach can be successful in the management of properly selected patients with subglottic stenosis, either as the initial treatment modality or as an adjunctive treatment in cases of re-stenosis after open airway surgery. The likelihood of success with a minimally invasive procedure as the primary treatment decreases with worsening initial grade of subglottic stenosis. SN - 1872-8464 UR - https://www.unboundmedicine.com/medline/citation/21377219/Minimally_invasive_endoscopic_management_of_subglottic_stenosis_in_children:_success_and_failure_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0165-5876(11)00067-X DB - PRIME DP - Unbound Medicine ER -