International Journal of Pediatric Otorhinolaryngology 79 (2015) 2056–2058

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Endoscopic management of congenital anterior glottic stenosis Mi Jin Yoo a,1, Soham Roy b,2, Lee P. Smith c,d,* a

Department of Otolaryngology—Head and Neck Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, 3400 Bainbridge Ave., Medical Arts Pavilion, 3rd Floor, Bronx, NY 10467, USA b Department of Otolaryngology—Head and Neck Surgery, University of Texas Medical School at Houston, Children’s Memorial Hermann Hospital, Houston, TX 77030, USA c Division of Pediatric Otolaryngology, Cohen Children’s Medical Center, New Hyde Park, NY, USA d Department of Otolaryngology—Head and Neck Surgery, Hofstra North Shore-LIJ School of Medicine, Hempstead, NY, USA

A R T I C L E I N F O

A B S T R A C T

Article history: Received 7 July 2015 Received in revised form 9 September 2015 Accepted 13 September 2015 Available online 25 September 2015

Introduction: Congenital anterior glottic stenosis (web) is a rare condition usually presenting with airway obstruction, stridor or dysphonia. Symptomatic infants may require tracheotomy to bridge the neonatal period. Early open surgical reconstruction may have significant risks and failure may still result in tracheotomy. We introduce an endoscopic surgical approach with balloon dilation for primary management of congenital anterior glottic stenosis. Methods: We present three cases of congenital anterior glottic stenosis in children 7, 14, and 90 days old presenting with stridor, dyspnea, and dysphonia. The larynx was exposed by suspension microlaryngoscopy. The glottic stenosis was incised from a posterior to anterior direction using a laryngeal sickle knife. Subsequently, an airway balloon was guided through the stenotic lumen. Once the balloon was inflated, the balloon pressure was maintained for 30 s or until the patient’s oxygen saturation dropped below 92%. The dilation was repeated two or three times. The patients were kept intubated with an uncuffed endotracheal tube and monitored in the pediatric intensive care unit following surgery. Results: All three patients were extubated within 72 h without complications. One patient failed the first extubation attempt and was reintubated and successfully extubated 24 h later. Patients were reevaluated with direct microlaryngoscopy within two weeks. All patients had symptomatic relief and did not require further surgical intervention. Conclusion: Endoscopic balloon dilation laryngoplasty may be a safe and effective primary procedure for pediatric patients with congenital anterior glottic stenosis. It is technically simple and obviates the potential morbidities associated with an open surgical procedure or tracheotomy. ß 2015 Elsevier Ireland Ltd. All rights reserved.

Keywords: Glottic Glottis Stenosis Balloon Dilation Web

1. Introduction Congenital anterior glottic stenosis (web) is a rare condition often presenting with airway obstruction early in life. Based on the severity, patients may present with stridor, dysphonia, or respiratory distress necessitating surgical intervention to relieve the airway obstruction. Glottic stenosis can be classified by the degree of obstruction and degree of extension into the subglottis by Cohen’s classification [1]. * Corresponding author at: Cohen Children’s Medical Center, Department of Otolaryngology—Head and Neck Surgery, Hofstra North Shore-LIJ School of Medicine, New Hyde Park, NY 11042, USA. Tel.: +1 516 470 7550; fax: +1 516 470 4514. E-mail address: [email protected] (L.P. Smith). 1 Tel.: +1 718 920 4267. 2 Tel.: +1 713 500 5410. http://dx.doi.org/10.1016/j.ijporl.2015.09.013 0165-5876/ß 2015 Elsevier Ireland Ltd. All rights reserved.

During the 6th week of embryological life, the developing laryngeal opening is obliterated by actively proliferating epithelial tissue, arising from the two arytenoid swellings and anteriorly by the epiglottic eminence. It is theorized that congenital glottic webs and stenoses result from failure of recanalization of the epithelial lamina [2]. The stenosis may be thin and confined to the glottic larynx, or it may be thick and extend inferiorly into the subglottic airway. Tracheotomy is the gold standard management for infants with airway obstruction such as congenital anterior glottic stenosis. Open airway surgery such as single stage laryngotracheoplasty has been described for managing infants with thick congenital anterior glottic stenosis [3]. However, traditional open surgical procedures are invasive, and may have surgical site and/or donor site morbidity. In addition, children undergoing traditional open surgical procedures for this condition may initially require a tracheotomy with its associated morbidity and potential for mortality.

M.J. Yoo et al. / International Journal of Pediatric Otorhinolaryngology 79 (2015) 2056–2058

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Fig. 1. Endoscopic images of a child with Cohen grade III stenosis. Microlaryngoscopy of the glottis: (A) prior to endoscopic division and balloon dilation and (B) following endoscopic division and balloon dilation. Bronchoscopy of the: (C) subglottis and (D) trachea following dilation.

Endoscopic balloon dilation has recently gained popularity. It is minimally invasive and technically simple. We introduce an endoscopic surgical management technique with endoscopic division and balloon dilation for primary management of congenital anterior glottic stenosis. 2. Methods We present three cases of congenital anterior glottic stenosis in children 7, 14, and 90 days old. The children presented with stridor, dyspnea, and dysphonia requiring urgent intervention. Awake beside fiberoptic laryngoscopy was suspicious for anterior glottic stenosis. One patient had Cohen grade II stenosis, approximately

Endoscopic management of congenital anterior glottic stenosis.

Congenital anterior glottic stenosis (web) is a rare condition usually presenting with airway obstruction, stridor or dysphonia. Symptomatic infants m...
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