Subglottic stenosis in infants and children

Choo KKM, Tan HKK, Balakrishnan A
Correspondence: A/Prof Henry Tan Kun Kiaang, henry.tan.kk@kkh.com.sg

ABSTRACT
Introduction This study aimed to examine the epidemiology and outcome of subglottic stenosis in infants and children, and to evaluate the current techniques used in its diagnosis and management at the KK Women’s and Children’s Hospital, Singapore.
Methods A retrospective review and long-term follow-up was conducted in all infants and children diagnosed with subglottic stenosis between January 1997 and December 2008.
Results A total of 18 patients (nine male and nine female) with a median age of 7.5 months were identified. Two patients were diagnosed with definite congenital stenosis and 16 patients with acquired stenosis. The majority had Grade I stenosis (55.6 percent), followed by Grade II (27.8 percent) and Grade III (16.7 percent). None had Grade IV stenosis. 17 patients were intubated, and seven underwent tracheostomy. The most common surgical intervention performed was microlaryngoscopy and bronchoscopy with bougie dilation. The other surgical interventions included cricoid split, laryngotracheal reconstruction and cricotracheal resection. As of December 2008, the median duration of treatment was four years, with an overall recovery rate of 66.7 percent. The successful decannulation rate was 57.1 percent. Two mortalities were reported due to reasons unrelated to subglottic stenosis. Two patients were still undergoing treatment at the time of the study, and two were lost to follow-up.
Conclusion Conservative management alone may be required in the majority of Grade I stenosis cases. We observed that the mean number of reconstructive procedures performed per patient increased with the increase in the severity of stenosis. Each laryngeal framework procedure has to be customised to suit the individual.

Keywords: laryngotracheal stenosis, larynx, paediatric, retrospective, subglottic stenosis
Singapore Med J 2010; 51(11): 848-852