Early diagnostic and endoscopic dilatation for the treatment of acquired upper airway stenosis after intubation in children

• Published in: Journal of pediatric surgery Vol. 43; no. 7; pp. 1254 - 1258
• Main Authors: Maksoud-Filho, Joao G, Gonçalves, Manoel Ernesto P, Cardoso, Silvia R, Tannuri, Uenis
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.07.2008
• Subjects: Acquired; Airway Obstruction - therapy; Child, Preschool; Children; Dilatation; Endoscopic dilatation; Endoscopy; Humans; Infant; Infant, Newborn; Intubation, Intratracheal - adverse effects; Pediatrics; Subglottic stenosis; Surgery; Tracheal Stenosis - diagnosis; Tracheal Stenosis - etiology; Tracheal Stenosis - therapy; Children; Acquired; Endoscopic dilatation; Subglottic stenosis; Surgery
• ISSN: 0022-3468; 1531-5037
• DOI: 10.1016/j.jpedsurg.2007.10.057

Abstract Background Upper airway stenosis (UAS) after endotracheal intubation is a common problem in children. Most literature refers to a surgical treatment for these lesions. Laryngotracheal reconstruction and cricotracheal resection are used for low- and high-grade stenosis, but decannulation is not always possible immediately after surgery. Purpose The aim of this study was to verify the feasibility and results of endoscopic dilatations for treatment of subglottic stenosis. Method The study encompassed a 12-year retrospective analysis of patients treated for UAS in a tertiary center. All children were symptomatic at the time of the endoscopic diagnosis. The stenosis was graded according to the Myer-Cotton criteria. Endoscopic dilatation was initiated immediately after the diagnosis. Children with grade IV stenosis underwent surgery. Results Children with tracheal stenosis and no involvement of the subglottic area did not respond to endoscopic dilatations and underwent surgery. There were 45 children with grade I stenosis, 12 with grade II, 7 with grade III, and 4 with grade IV lesions. Patients with grade I, II, and III stenosis were all treated by endoscopic dilatations alone and were decannulated when asymptomatic. The average time for decannulation was 18.90 ± 26.07 months for grade I, 32.5 ± 27.08 months for grade II, and 27.57 ± 20.60 months for grade III stenosis ( P < .01, for grade II vs grade III). Conclusion Grade I, II, and III subglottic stenoses can be safely managed by early endoscopic dilatations with a high rate of success and low rate of morbidity but require a significantly long period of treatment.