The aim of the study was to examine and analyze the epidemiology and outcome of treatment for paediatric
acquired subglottic stenosis treated with endoscopic bougie dilatation and topical
mitomycin C. There were 15 patients identified from 2008 until 2013. All of them had
acquired subglottic stenosis due to history of intubation. Majority of the patients had grade III
stenosis, with the total of seven. Three patients had grade IV; three were grade II and two were grade I. All of the patients with severe
stenosis (grade III and IV) needed
tracheostomy while only one in mild
stenosis group (grade I and II) required it for prolonged ventilation rather than obstruction due to subglottic
stenosis. All of them underwent direct laryngoscopy under
general anesthesia followed by endoscopic dilatation with bougie and topical
mitomycin C 0.4 mg/ml for 5 min. Aim of success in our study was decannulation of
tracheostomy or absence of symptoms at exertion. We achieved 6 (60 %) successful decannulation out of 10 patients with
tracheostomy (excluded the patient with
tracheostomy in grade I
stenosis due to prolonged ventilation). As for those without
tracheostomy, 3 (75 %) out of 4 patients were asymptomatic even at exertion. Average number of dilatation was 3.1 times, with mean duration of 28 min. No complications were reported in our series. One patient with grade I
stenosis passed away due to severe
pneumonia unrelated to the
stenosis or dilatation, and she did not have any dilatation before she passed away. Multiple related risk factors were identified such as intubation, prematurity, movement of endotracheal tube, respiratory
infection, traumatic intubation and
gastroesophageal reflux disease. Experience of open surgical method was very limited in our centre in Sabah in East Malaysia. Endoscopic technique plays an important role in treatment of subglottic
stenosis with adjunct like
mitomycin C possibly booster the successful rate.