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Communication Stations
Published in Adnan Darr, Karan Jolly, Jameel Muzaffar, ENT Vivas, 2023
Wai Sum Cho, Anna Slovick, Jameel Muzaffar, Adnan Darr
Part 2: You diagnosed subglottic stenosis with 60% narrowing of the airway. You decided to perform balloon dilatation to improve the airway. Unfortunately following the procedure, there was significant oedema and the baby had to be kept intubated. Speak to the parents about your diagnosis and further management planPoints to cover: Oedema is expected and likely to be temporaryInform the potential need for further procedures in the futureDiscuss the possibility of requiring tracheostomy or surgical procedure to the airway such as a cricoid split. They may need to be referred to a tertiary centreParental concerns: Parents are worried about the need for a tracheostomy and the long-term care/impact having seen another child requiring one during previous admission
Lower airway bronchoscopic interpretation
Published in Don Hayes, Kara D. Meister, Pediatric Bronchoscopy for Clinicians, 2023
Kimberley R. Kaspy, Sara M. Zak
The subglottis is the uppermost portion of the trachea, just below the vocal cords but above the thoracic inlet. In pediatric patients, the cricoid cartilage is the narrowest portion of the airway compared to the vocal cords of adults.The most common lesion seen in the subglottis is subglottic stenosis (SGS).9 This can be congenital or acquired. The most common cause of acquired subglottic stenosis in pediatric patients is trauma/injury due to prolonged intubation.8,10Subglottic stenosis is graded based on the degree of narrowing in the airway, called the Cotton-Myer grading system.11Grade 1 SGS is less than 50% narrowing of the subglottisGrade 2 SGS is 51%–70% narrowing of the subglottisGrade 3 SGS is 71%–99% narrowing of the subglottis (seen in Figure 5.3a)Grade 4 SGS results when there is no detectable opening into the distal trachea, which is depicted in Figure 5.3b
Otorhinolaryngology
Published in Stephan Strobel, Lewis Spitz, Stephen D. Marks, Great Ormond Street Handbook of Paediatrics, 2019
Chris Jephson, C. Martin Bailey
Subglottic stenosis (SGS) is a narrowing of the airway at the level of the subglottis. SGS is mostly acquired, but can also be congenital. The incidence of SGS is difficult to estimate. Acquired SGS has reduced with increased awareness of the role of intubation: currently about 1–2% of intubated neonates develop an acquired SGS.
The impact of early surgical treatment of tracheal stenosis on neurorehabilitation outcome in patients with severe acquired brain injury
Published in Brain Injury, 2023
R. Formisano, M. D’Ippolito, M. Giustini, C. Della Vedova, L. Laurenza, M. Matteis, C. Menna, E. A. Rendina
It is well known that TS management requires different surgical approaches, which are guided by the site, length and type of stenosis. It is associated with possible complications (34), but mainly with a high success probability, receiving a definitive solution to this severe and life-threatening complication. In particular, no-surgical procedures, incorrectly considered safer options for the treatment of subglottic stenosis following intubation (35), make often wilder, longer or unbearable the way to reach the conclusive recovery. On the other hand, an early surgical resection may have potential disadvantages as well, such as the interruption of the rehabilitation process. However, surgery was performed following the Enhanced Recovery After Surgery (ERAS) recommendations (28) minimally interfering with the rehabilitation process (a mean hospital stay of 7 days in the Thoracic Surgery Unit).
Life-threatening idiopathic subglottic stenosis misdiagnosed as asthma
Published in Acta Oto-Laryngologica Case Reports, 2022
Niloofar Sherazi Dreyer, Kristine Grubbe Gregersen, Kristian Hveysel Bork
Subglottic stenosis is the obstruction of the central airway in the region below the glottis and bounded inferiorly by second tracheal ring. Causes of subglottic stenosis can be congenital, acquired, or idiopathic. The most common causes are trauma following intubation (prolonged/repetitive intubation or excessive endotracheal tube cuff pressure) and tracheostomy. Acquired causes may be external and internal traumas. External are typically trauma to the neck/larynx and internal traumas can include (intubation or tracheotomy) as mentioned earlier. Other acquired causes include infections as bacterial tracheitis, tuberculosis, gastroesophageal reflux disorder (GERD), systemic diseases (amyloidosis, sarcoidosis, polyarteritis, granulomatosis with polypangiitis), radiation therapy, inhalational injury, tracheal malignancy, and foreign body aspiration [1].
The PHACES syndrome: Multiple episodes of reproliferation of subglottic hemangioma
Published in Baylor University Medical Center Proceedings, 2018
Randall W. Holdgraf, Melissa Kress
Infantile hemangiomas are the most common benign tumors of infancy. They are characterized by two distinct phases: proliferation and involution.1 The proliferation phase is characterized by rapid growth for the first 6 to 9 months of life followed by involution over 3 to 7 years.2 Most hemangiomas occur in otherwise healthy infants; however, almost one third of patients with hemangiomas >22 cm2 also have PHACES syndrome, which stands for posterior fossa, hemangioma, arterial anomalies, cardiac defects, eye abnormalities, and sternal cleft.3 PHACES syndrome is diagnosed by the presence of a facial hemangioma >5 cm in diameter plus one major or two minor criteria involving these systems.4 Children with PHACES syndrome can also be afflicted by subglottic hemangiomas, which commonly present with biphasic stridor worsened by crying. Progression of subglottic stenosis can lead to significant airway obstruction necessitating aggressive medical and surgical treatment.5 Treatment of airway hemangiomas with propranolol has been well described and shows promising results; however, there are still cases of either failure to respond to propranolol treatment or recurrence after discontinuing therapy.6,7 Herein, we describe a particularly challenging-to-treat patient with PHACES syndrome and subglottic hemangioma who had multiple recurrences once propranolol treatment was weaned.