Successful Treatment Of A Child With Severe Congenital Subglottic Stenosis With Balloon Dilatation

Introduction

In adults, the glottis is the narrowest part of the larynx, whereas, in newborns, it is the subglottic region. The subglottic region has a diameter of around 4–5 mm in infants and 3 mm in premature infants. It is crucial to acknowledge that even a 1 mm circumference swelling or edema in the subglottic area of an infant can lead to a substantial 60% obstruction of the airway. Therefore, the treatment of airway issues in pediatric patients may require more immediate and complex interventions compared to adults (Marston AP et al., Clin Perinatol. 2018;45:787–804).

Airway stenosis can be congenital or acquired (intubation for a prolonged period, infection, tumors, etc.) and most commonly occurs within the subglottis (Marston AP et al., Clin Perinatol. 2018;45:787–804). About 5% of subglottic stenosis cases are congenital, making it the third most common cause of congenital airway obstruction. Congenital subglottic stenosis is usually milder than the acquired type and tends to improve as the child grows. The Myer-Cotton rating scale is the most commonly used method for diagnosing subglottic stenosis. It classifies the degree of stenosis based on visual inspection during laryngoscopy. It consists of four grades: Grade I - 0 to 50% decrease in lumen surface; Grade II - 51 to 70% decrease; Grade III - 71 to 99% decrease, and Grade IV - no evidence of a detectable lumen. However, patients with advanced stage (3–4) according to the Myer-Cotton classification of subglottic stenosis may require emergency intervention (Marston AP et al., Subglottic Stenosis. Clin Perinatol. 2018 Dec;45:787–804). While the ultimate therapeutic goal is to provide a stable and safe airway with endoscopic or open surgical methods, the need for tracheotomy may occur in emergencies where surgery is not feasible. Balloon laryngoplasty is a highly effective, low-risk alternative or adjunct to traditional reconstructive procedures in children with subglottic or laryngeal stenosis (Wentzel JL et al., Laryngoscope. 2014;124:1707–12, Wenzel AM et al., Eur Arch Otorhinolaryngol, 2018;275:2325–2331)

We present the management of a 26-month-old patient with stage 3 subglottic stenosis who has developed pectus excavatum and growth retardation due to inspiratory stridor and respiratory distress since birth. This case serves as an educational example for clinicians, as it demonstrates the successful management of a patient despite a late diagnosis and challenging airway.

Publication History

Article published online:
06 February 2024