Subglottic Stenosis

SGS is narrowing of the lumen of the windpipe at its junction with the voicebox. SGS can be acquired after trauma or infection to the airway. Alternatively it may be present since birth (congenital). Congenital subglottic stenosis is the third most common congenital anomaly of the voice box (larynx).

The presentation of subglottic stenosis depends on the age of the child and the severity of the narrowing. Often the stenosis may not be evident until the child develops a routine respiratory infection, which further narrows the airway due to swelling in the lining. The child presents in a manner similar to laryngotracheobronchitis (croup). Noisy breathing (stridor) with respiratory distress is the most common presenting symptom. The child may have a barking cough, but the cry is usually normal.

The paediatric ENT surgeon would need to carry out a laryngoscopy and bronchoscopy under anaesthesia to confirm the diagnosis and to assess the airway for other anomalies. The stenosis is evaluated in terms of its length and diameter.

The treatment of this condition depends on the age of the child and the severity of the stenosis. In some mild cases, continued observation may be adequate and the airway will increase in size as the child grows. At times of upper respiratory infections, oral, intravenous, or inhaled medication may be required.

In other cases, endoscopic laser division and balloon dilatation may be adequate. This procedure may have to be repeated over time.

In patients who have significant airway compromise a tracheostomy may be required to provide a safe airway. Most children who do require tracheostomy can be decannulated later once the subglottic space either widens or is surgically corrected.

In severe cases it may be required to reconstruct the airway surgically repair by performing either a laryngotracheal reconstruction or cricotracheal resection.

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