Author(s)
NORIKO MORIMOTO, MD, PhD
Affiliation(s)
National Center for Child Health and Development;
Abstract:
Introduction: .
Subglottic stenosis (SGS) is a difficult condition to treat and often requires multiple interventions. We report our experience with pediatric patients with SGS treated with therapeutic interventions over the past 5 years, and examine factors that influence postoperative outcomes.
Methods: .
A retrospective cohort review of treatment outcomes ( decannulation and voice) for pediatric SGS cases treated with endoscopic balloon dilation and/or LTR from 2017 to 2022 was performed. Variables recorded included patient demographics, initial grade and extent of stenosis, comorbidities, and frequency of therapeutic intervention.
Results:
Thirty-six patients (1-20 yrs) were included. The initial grade of stenosis according to the Myer-Cotton classification was grade 2 in 5, grade 3 in 27, and grade 4 in 4. Only 5 patients had stenosis confined to the cricoid cartilage, 19 patients had 2 sites of stenosis beyond the cricoid cartilage, and 12 patients had stenosis extending to 3 or more sites. Twenty-three patients (64%) underwent endoscopic balloon dilation, and decannulation was successfully achieved in 6 patients. Balloon dilation was effective only in patients with stenosis confined to the subglottic area (OR: 35.0, 95% CI 3.13-353.8). Decannulation was successfully achieved in 25 of 29 patients (86%) who underwent LTR. Birth weight, comorbidities, and number of interventions did not have a significant impact on outcomes, although the involvement of three or more stenosis sites and grade 4 stenosis had an impact. Twenty patients (55%) had severe voice disorder or aphonia, which decreased to only 2 (6%) after intervention, while 25 (69%) improved to normal or mild voice.
Conclusions:
Assessing the site of stenosis extension is important to ensure that intervention is minimized and outcomes are maximized when selecting a treatment strategy.