Tertiary Referral Centers, King Abdulaziz Medical City, Riyadh, Saudi Arabia.
PATIENTS AND METHODS: A retrospective case series study was conducted, where the case notes of all pediatric patients who underwent endoscopic management as a primary surgical intervention for
acquired subglottic stenosis (SGS) from 2004 to 2014 were reviewed. All patients who underwent surgical correction with primary open
laryngoplasty for
congenital subglottic stenosis had been excluded.
RESULTS: A total of 60 patients with a workable diagnosis of subglottic
stenosis were reviewed. Forty-five patients were included in the study and 15 patients were excluded because they underwent open
laryngoplasty as a primary treatment modality for
congenital subglottic stenosis. The majority of the patients were males 29 (64%), with 16 (36%) females. The main presentation was
stridor and intercostal recession. Thirty-nine (86%) patients had subglottic
stenosis due to prolonged intubation; 5 (11%) patients were idiopathic and one patient (3%) had inflammatory reasons. The site of
stenosis was isolated SGS in 41 while 4 patients had glottic-subglottic
stenosis (GSGS). In terms of the grade of
stenosis: 13 patients had grade I; 23 had grade II and 9 had grade III. The character of
stenosis was soft except in 5 patients with hard (mature)
scar. The number of dilatation procedures ranged from 1 to 6 with a mean of 2. The endoscopic management was considered to be successful when the patient is completely asymptomatic after the follow up period of one year. No major complications were recorded among the patients. Thirty-seven (82.3%) patients had a benign course post endoscopic intervention without complications and 8 (17.7%) underwent a secondary open surgical management due to re-
stenosis (P value < 0.01).
CONCLUSION: Our study showed that primary endoscopic management was successful in 82.3% of cases of
acquired subglottic stenosis including those with high grade
stenosis and long segment of more than 12 mm in terms of the craniocaudal length.
CO2 laser was an important tool to convert mature hard stenotic segment into a soft one. The latter yielded to the lateral pressure created by balloon dilatation better.