Endoscopic management of posttraumatic supraglottic stenosis in the pediatric population

Complete Tracheal Transection in a 3-Year-Old After Blunt Neck Trauma: a Case Report

Pediatric laryngotracheal injuries from blunt force trauma are rare but can lead to significant morbidity and mortality. In pediatric patients with severe laryngotracheal disruption, extracorporeal membrane oxygenation has been used to improve oxygenation and ventilation until definitive repair can be performed. We describe the case of a 3-year-old girl with blunt neck trauma secondary to an all-terrain vehicle accident in which her neck was clotheslined against a fence, leading to a complete tracheal transection at the C7-T1 level. Emergent extracorporeal membrane oxygenation cannulation was initiated. We discuss the evaluation and management of tracheal injuries and the requisite multidisciplinary team approach. Pediatric patients with laryngotracheal trauma require definitive airway management, which should be performed by skilled personnel.

Endoscopic Z-plasty for Treatment of Supraglottic Stenosis: Experience on Nine Patients

OBJECTIVES

Supraglottic stenosis is a rare type of laryngeal stenosis that is caused by congenital laryngotracheal anomalies, iatrogenic instrumentation injuries, autoimmune disorders, infection, irradiation, chemical or thermal burns, and external blunt or penetrating trauma. The author presents his experience on nine patients using this new endoscopic surgical technique for treatment of supraglottic stenosis.

STUDY DESIGN

Individual retrospective cohort study, tertiary referral center, university hospital.

METHODS

All cases of supraglottic laryngeal stenosis treated during a 10-year period at a tertiary academic medical center were reviewed. Nine patients with supraglottic stenosis treated with endoscopic uni- or bilateral z-plasty technique were determined and presented. The etiology of stenosis was iatrogenic surgical trauma in seven patients, laryngeal fracture in one patient, and systemic lupus erythematosus in the other patient. Main outcome measures were respiratory function test results, absence of dyspnea on exertion, and decannulation if tracheotomy was present preoperatively.

RESULTS

Seven patients with tracheotomy were decannulated 1 month after surgery. All nine patients had adequate airway and were dyspnea-free. Their preop respiratory function test results improved significantly postoperatively (P < .05).

CONCLUSION

For supraglottic stenosis endoscopic surgery using mucosal flaps in the form of z-plasty should be considered within the available surgical techniques. Although this type of surgery is highly successful, it is technically difficult to apply.

LEVEL OF EVIDENCE

4 Laryngoscope, 131:E534-E539, 2021.

Management of supraglottic stenosis using a novel stent design

OBJECTIVES

To present a novel design for a stent for management of a traumatic supraglottic web.

METHODS

Case report and literature review (PubMed 1964-2013).

RESULTS

A 48-year-old man was presented after penetrating laryngeal trauma. He had severe dysphonia and was tracheotomy dependent. He had been treated previously with open reduction and fixation of laryngeal fracture. On examination, we identified an avulsed left vocal fold and a supraglottic web. He initially underwent reapproximation of the avulsed left vocal fold, and subsequently, the supraglottic web was treated using a stent designed by the senior author (R.T.S.). In addition, he underwent later resection of scar tissue to improve dysphonia and then he was decanulated.

CONCLUSIONS

There are a few techniques presented in the literature and mostly are adaptations of subglottic stenosis management techniques. Individualized treatment is needed for these difficult cases. We present our experience with supraglottic web treatment to expand the literature on this uncommon disorder.

Supraglottic Stenosis: Etiology and Treatment of a Rare Condition

Objectives:

Although laryngotracheal stenosis is well described in the literature, the vast majority of cases are of stenosis at either the subglottic or glottic level. Supraglottic stenosis is an unusual subset of laryngotracheal stenosis that has distinctly different causes, symptoms, and treatment options.

Methods:

A retrospective chart review was conducted on all adult patients at our institution with a diagnosis of supraglottic stenosis. Clinical records, videolaryngoscopic examinations, and operative and clinic procedure records were reviewed. All patients had a minimum follow-up of 12 months.

Results:

Eight patients with supraglottic stenosis were identified. Five (62.5%) had a history of radiation therapy, and the remaining 3 cases were associated with autoimmune disorders. Our data revealed a frequent association with dysphagia (7 of 8 cases, or 87.5%), including 2 patients with complete pharyngoesophageal stricture and 3 who required a percutaneous gastrostomy tube. All of the patients required more than 1 surgical intervention because of symptomatic recurrent airway stenosis. Three patients underwent successful endoscopic treatment with a carbon dioxide laser in the operating room. One of these patients and 5 additional patients were successfully managed with pulsed KTP laser treatment in the clinic setting without complications. We observed 2 cases of acute intraoperative supraglottic edema in the setting of suspension laryngoscopy and jet ventilation, 1 of which necessitated emergent tracheostomy.

Conclusions:

Supraglottic stenosis is a rare condition that is often associated with external-beam radiation or autoimmune disorders. All of the patients in our series experienced some degree of symptomatic airway obstruction that required management. The majority also had coexisting dysphagia, often associated with pharyngeal or esophageal stricture. Despite the favorable response to endoscopic treatment, all patients eventually required additional procedures because of symptomatic recurrence of their stenosis. Although endoscopic surgical treatment with a carbon dioxide laser in the operating room setting is a viable option, office-based treatment with a pulsed KTP laser appears to be an effective and potentially safer alternative.

Paediatric blunt laryngeal trauma: a review

Paediatric blunt laryngeal trauma is infrequently encountered; however, it can have fatal consequences if managed inappropriately. This paper provides an overview of the relatively limited literature available on the subject and highlights current controversies and recent advances in the management of these injuries.