Idiopathic subglottic stenosis: Two cases report

Abstract

Introduction and importance: Idiopathic subglottic stenosis is a rare condition that primarily affects young women, with an etiology that remains poorly understood.

Case presentation: We report two cases of patients presenting with acute laryngeal dyspnea secondary to idiopathic subglottic stenosis. Clinical and paraclinical evaluations ruled out infectious, immunological, and iatrogenic causes. Treatment consisted of endoscopic procedures, including balloon dilation, CO₂ laser vaporization, and intralesional injections of corticosteroids and 5-fluorouracil. One patient required CO₂ laser incision of the inferior constrictor muscle due to recurrence. After prolonged follow-up, the clinical outcome was favorable, with no significant recurrence.

Clinical discussion: The etiology of idiopathic subglottic stenosis remains uncertain. A plethora of therapeutic alternatives have been proposed; however, none has demonstrated superiority in terms of ease and efficacy. Until more is known about the condition, prolonged postoperative clinical, radiological, and endoscopic monitoring is essential, even in cases where only the slightest recurrence of clinical signs is observed.

Conclusions: The management of this condition relies on a multidisciplinary approach, integrating endoscopic and surgical treatments tailored to the severity of the stenosis.

Keywords: Case report; Corticosteroid therapy; Endoscopic dilation; Idiopathic subglottic stenosis; Surgery.

Fig. 1

Laryngeal CT scan showing subglottic stenosis with the most constricted area measuring 6.9 mm (blue arrow), associated with circumferential narrowing due to mucosal hypertrophy (star). (For interpretation of the references to colour in this figure legend, the reader is referred to the web version of this article.)

Fig. 2

Persistence of mucosal lesions and subglottic stenosis on follow-up CT scan.

Fig. 3

Coronal and sagittal CT scan of the cervicothoracic region showing subglottic laryngeal stenosis extending over 2 cm (red arrow) with a 60 % luminal narrowing, and a tracheostomy cannula in place (A). Direct laryngoscopy showing an inflammatory subglottic stenosis with a mucosal appearance and the result after laser incision (B). (For interpretation of the references to colour in this figure legend, the reader is referred to the web version of this article.)