Obstructive lesions of the pediatric subglottis

Abstract

Purpose: To compile information regarding obstructive subglottic lesions in children, including anatomy, pathogenesis, prevention, evaluation, and treatment options, required for implementation of a multi-faceted treatment plan.

Method: Review of the literature.

Conclusions: Although they are infrequent, obstructive subglottic lesions pose significant challenges to treating physicians, from airway management and injury prevention to decannulation and voice rehabilitation. Most patients with these lesions require multidisciplinary care and long-term treatment and can nearly always be treated successfully.

Keywords: Airway reconstruction; laryngotracheoplasty; pediatric airway; stridor; subglottic hemangioma; subglottic stenosis; subglottis.

Figure 1. Subglottic hemangioma. Note the smooth, submocusal appearance of this almost completely obstructive mass.

Figure 2. Subglottic hemangioma in Figure 1 several weeks after CO₂ laser therapy.

Figure 3. Cartilaginous congenital subglottic stenosis. The cricoid ring is regularly shaped, but small. Note the normal sized tracheal rings distal to the cricoid cartilage.

Figure 4. This figure shows a Grade III stenosis of about 95%.

Figure 5. This is an example of a Grade I stenosis of about 30%.

Figure 6. Carved costal cartilage ready for placement into the airway.

Figure 7. Costal cartilage graft in place in the reconstructed airway.

Figure 8. Endoscopic views of a subglottic stenosis prior to expansion with an anterior laryngotracheoplasty.

Figure 9. This is the same patient from Figure 8 after anterior LTP. Note how well the perichondrium incorporated into the new mucosa of the newly expanded airway.

Figure 10. A stent attached to a metal tracheostomy tube. The white portion is not hollow superiorly and the top protrudes slightly through the vocal cords.