Minimally invasive endoscopic management of subglottic stenosis in children: Success and failure

Alicia M. Quesnel, Gi Soo Lee, Roger C. Nuss, Mark S. Volk, Dwight T. Jones, Reza Rahbar

Research output: Contribution to journalArticle

17 Citations (Scopus)

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.

Original languageEnglish (US)
Pages (from-to)652-656
Number of pages5
JournalInternational Journal of Pediatric Otorhinolaryngology
Volume75
Issue number5
DOIs
StatePublished - May 1 2011

Fingerprint

Pathologic Constriction
Tracheostomy
Pediatrics
Therapeutics
Safety Management
Mitomycin
Tertiary Healthcare
Dilatation
Lasers
Population

Keywords

  • Airway
  • Endoscopic
  • Laryngotracheal reconstruction
  • Minimally invasive
  • Subglottic stenosis

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Otorhinolaryngology

Cite this

Minimally invasive endoscopic management of subglottic stenosis in children : Success and failure. / Quesnel, Alicia M.; Lee, Gi Soo; Nuss, Roger C.; Volk, Mark S.; Jones, Dwight T.; Rahbar, Reza.

In: International Journal of Pediatric Otorhinolaryngology, Vol. 75, No. 5, 01.05.2011, p. 652-656.

Research output: Contribution to journalArticle

Quesnel, Alicia M. ; Lee, Gi Soo ; Nuss, Roger C. ; Volk, Mark S. ; Jones, Dwight T. ; Rahbar, Reza. / Minimally invasive endoscopic management of subglottic stenosis in children : Success and failure. In: International Journal of Pediatric Otorhinolaryngology. 2011 ; Vol. 75, No. 5. pp. 652-656.
@article{749da28a6acb4a9fa49699a9db910226,
title = "Minimally invasive endoscopic management of subglottic stenosis in children: Success and failure",
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.",
keywords = "Airway, Endoscopic, Laryngotracheal reconstruction, Minimally invasive, Subglottic stenosis",
author = "Quesnel, {Alicia M.} and Lee, {Gi Soo} and Nuss, {Roger C.} and Volk, {Mark S.} and Jones, {Dwight T.} and Reza Rahbar",
year = "2011",
month = "5",
day = "1",
doi = "10.1016/j.ijporl.2011.02.002",
language = "English (US)",
volume = "75",
pages = "652--656",
journal = "International Journal of Pediatric Otorhinolaryngology",
issn = "0165-5876",
publisher = "Elsevier Ireland Ltd",
number = "5",

}

TY - JOUR

T1 - Minimally invasive endoscopic management of subglottic stenosis in children

T2 - 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

PY - 2011/5/1

Y1 - 2011/5/1

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.

AB - 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.

KW - Airway

KW - Endoscopic

KW - Laryngotracheal reconstruction

KW - Minimally invasive

KW - Subglottic stenosis

UR - http://www.scopus.com/inward/record.url?scp=79954633236&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=79954633236&partnerID=8YFLogxK

U2 - 10.1016/j.ijporl.2011.02.002

DO - 10.1016/j.ijporl.2011.02.002

M3 - Article

C2 - 21377219

AN - SCOPUS:79954633236

VL - 75

SP - 652

EP - 656

JO - International Journal of Pediatric Otorhinolaryngology

JF - International Journal of Pediatric Otorhinolaryngology

SN - 0165-5876

IS - 5

ER -