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Tertiary center experience with primary endoscopic laryngoplasty in pediatric acquired subglottic stenosis and literature review

BACKGROUND AND OBJECTIVES: To share our experience with primary endoscopic laryngoplasty in pediatric acquired subglottic stenosis and critically review the previously published studies. SETTING: Tertiary Referral Centers, King Abdulaziz Medical City, Riyadh, Saudi Arabia. PATIENTS AND METHODS: A re...

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Autores principales: Alshammari, Jaber, Alkhunaizi, Arwa A., Arafat, Abdullah S.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: King Faisal Specialist Hospital and Research Centre 2017
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6372454/
https://www.ncbi.nlm.nih.gov/pubmed/30805497
http://dx.doi.org/10.1016/j.ijpam.2016.11.001
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author Alshammari, Jaber
Alkhunaizi, Arwa A.
Arafat, Abdullah S.
author_facet Alshammari, Jaber
Alkhunaizi, Arwa A.
Arafat, Abdullah S.
author_sort Alshammari, Jaber
collection PubMed
description BACKGROUND AND OBJECTIVES: To share our experience with primary endoscopic laryngoplasty in pediatric acquired subglottic stenosis and critically review the previously published studies. SETTING: 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. CO(2) 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.
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spelling pubmed-63724542019-02-25 Tertiary center experience with primary endoscopic laryngoplasty in pediatric acquired subglottic stenosis and literature review Alshammari, Jaber Alkhunaizi, Arwa A. Arafat, Abdullah S. Int J Pediatr Adolesc Med Original Research Article BACKGROUND AND OBJECTIVES: To share our experience with primary endoscopic laryngoplasty in pediatric acquired subglottic stenosis and critically review the previously published studies. SETTING: 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. CO(2) 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. King Faisal Specialist Hospital and Research Centre 2017-03 2017-02-10 /pmc/articles/PMC6372454/ /pubmed/30805497 http://dx.doi.org/10.1016/j.ijpam.2016.11.001 Text en © 2017 Publishing services provided by Elsevier B.V. on behalf of King Faisal Specialist Hospital & Research Centre (General Organization), Saudi Arabia. http://creativecommons.org/licenses/by-nc-nd/4.0/ This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
spellingShingle Original Research Article
Alshammari, Jaber
Alkhunaizi, Arwa A.
Arafat, Abdullah S.
Tertiary center experience with primary endoscopic laryngoplasty in pediatric acquired subglottic stenosis and literature review
title Tertiary center experience with primary endoscopic laryngoplasty in pediatric acquired subglottic stenosis and literature review
title_full Tertiary center experience with primary endoscopic laryngoplasty in pediatric acquired subglottic stenosis and literature review
title_fullStr Tertiary center experience with primary endoscopic laryngoplasty in pediatric acquired subglottic stenosis and literature review
title_full_unstemmed Tertiary center experience with primary endoscopic laryngoplasty in pediatric acquired subglottic stenosis and literature review
title_short Tertiary center experience with primary endoscopic laryngoplasty in pediatric acquired subglottic stenosis and literature review
title_sort tertiary center experience with primary endoscopic laryngoplasty in pediatric acquired subglottic stenosis and literature review
topic Original Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6372454/
https://www.ncbi.nlm.nih.gov/pubmed/30805497
http://dx.doi.org/10.1016/j.ijpam.2016.11.001
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