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Doi Y, Ekuni S. Anesthetic management of inguinal hernia in an ex-premature infant with subglottic stenosis: a case report. JA Clin Rep 2023; 9:60. [PMID: 37700065 PMCID: PMC10497473 DOI: 10.1186/s40981-023-00652-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 08/23/2023] [Accepted: 09/06/2023] [Indexed: 09/14/2023] Open
Abstract
BACKGROUND We report the anesthetic management of inguinal hernia repair for an infant with subglottic stenosis. A previously scheduled operation had been cancelled due to unexpected airway trouble during the induction. CASE PRESENTATION A boy was born at 24 weeks of gestation and his trachea was intubated for 45 days. At 16 months old, surgery for inguinal hernia was planned, but cancelled due to unexpected narrow airway, and subglottic stenosis was first suspected. At 17 months old, he was transferred to us for inguinal hernia surgery. After careful discussion between the surgical team and the anesthesiologists, a strategy to manage this patient was developed. He underwent open hernia surgery under spinal anesthesia and diagnostic rigid bronchoscopy under tubeless general anesthesia separately, which revealed low-grade stenosis and some subglottic cysts. The postoperative course was uneventful. CONCLUSION Interdepartmental discussion weighing risks and benefits may deduce the safest and most appropriate anesthesia method.
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Affiliation(s)
- Yumi Doi
- Department of Anesthesia, Takatsuki General Hospital, 1-3-13 Kosobe-Cho, Takatsuki, Osaka, 5691192, Japan.
- Pediatric Perioperative Center, Takatsuki General Hospital, 1-3-13 Kosobe-Cho, Takatsuki, Osaka, 5691192, Japan.
| | - Satoshi Ekuni
- Department of Anesthesia, Takatsuki General Hospital, 1-3-13 Kosobe-Cho, Takatsuki, Osaka, 5691192, Japan
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Last SP, Patterson HI, Hauser N, Vijayasekaran S. Congenital subglottic cyst: a rare cause for sudden airway compromise in a newborn. BMJ Case Rep 2023; 16:16/2/e253750. [PMID: 36759040 PMCID: PMC9923279 DOI: 10.1136/bcr-2022-253750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/11/2023] Open
Abstract
A full-term infant developed stridor, respiratory distress and hypercarbia shortly after birth requiring urgent airway intervention. The patient underwent urgent intubation via rigid bronchoscopy. The diagnosis of congenital subglottic cyst was made. The cyst was decompressed and the patient was extubated the following day. On repeat laryngoscopy 1 month later, there was no residual disease and the patient remained symptom free. Congenital subglottic cysts are extremely rare and the diagnosis can be either missed or misdiagnosed with more common causes of stridor, such as laryngomalacia. Subglottic cysts may cause total airway obstruction and even death if they are large enough and not treated immediately.
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Affiliation(s)
- Samuel Peter Last
- Otolaryngology-Head and Neck Surgery, Perth Children's Hospital, Nedlands, Western Australia, Australia
| | - Heather Isabel Patterson
- Anaesthesia and Pain Medicine, Perth Children's Hospital, Nedlands, Western Australia, Australia
| | - Neil Hauser
- Anaesthesia and Pain Medicine, Perth Children's Hospital, Nedlands, Western Australia, Australia
| | - Shyan Vijayasekaran
- Otolaryngology—Head and Neck Surgery, Perth Children's Hospital, Nedlands, Western Australia, Australia,Surgery, The University of Western Australia Faculty of Medicine, Dentistry and Health Sciences, Perth, Western Australia, Australia
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Muacevic A, Adler JR, R F, Abu Bakar S. Congenital Laryngeal Cyst as a Rare Cause of Stridor in Infants: Two Case Reports. Cureus 2023; 15:e33867. [PMID: 36819299 PMCID: PMC9933415 DOI: 10.7759/cureus.33867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/17/2023] [Indexed: 01/19/2023] Open
Abstract
Congenital laryngeal cysts are a rare cause of stridor in infants. These cysts may have serious clinical implications if not promptly recognized. A small laryngeal cyst may remain asymptomatic. However, if large, it can block the laryngeal inlet leading to acute airway obstruction, which is potentially life-threatening. In pediatric patients presenting with respiratory distress, prompt diagnosis and surgical management are crucial to avoid infant morbidity and mortality. We describe two cases of laryngeal vallecular cysts in infants and their management in our clinical practice.
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Ünsaler S, Gökler O, Altuntaş O, Meriç Hafiz A, Ünal ÖF. Subglottic cysts in preterm infants: superficially located cysts versus deeply buried cysts in the mucosa. Eur Arch Otorhinolaryngol 2021; 279:1391-1396. [PMID: 34713339 DOI: 10.1007/s00405-021-07142-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Accepted: 10/15/2021] [Indexed: 11/30/2022]
Abstract
PURPOSE To analyze the reason for the diversity of the clinical course of subglottic cysts and discuss their pre- and coexistence with subglottic stenosis. METHODS The medical records of patients who were treated for subglottic cysts between 2003 and 2020 were retrospectively reviewed and direct laryngoscopy videos were analyzed to assess the healing patterns of their disease. RESULTS Of the 15 patients, 10 had a history of intubation in the neonatal period. In 11 patients, the cysts were transparent and well defined, and no recurrence of subglottic cysts occurred after the initial surgery. In four patients, the cysts were located deep in the mucosa and did not have the typical appearance of a cyst, but rather of a stenotic segment; all of them had a history of intubation and three of them required laryngotracheal reconstruction. CONCLUSION Transparent, thin-walled superficial subglottic cysts with healthy surrounding mucosa can easily be treated with endoscopic marsupialization; however, the treatment of deep subglottic cysts can be challenging. The coexistence of subglottic cysts and subglottic stenosis is not rare. We point out the need for considering the possibility of a missed deep submucosal cyst in a seemingly refractory case of pediatric subglottic stenosis with atypical endoscopic findings and with a background history of prior intubation.
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Affiliation(s)
- Selin Ünsaler
- Department of Otolaryngology, Koç University School of Medicine, Koç University Hospital, Davutpaşa Cad. Topkapı, 34010, Istanbul, Turkey.
| | - Ozan Gökler
- Department of Otolaryngology, Koç University School of Medicine, Koç University Hospital, Davutpaşa Cad. Topkapı, 34010, Istanbul, Turkey
| | - Ozan Altuntaş
- Department of Otolaryngology, Koç University School of Medicine, Koç University Hospital, Davutpaşa Cad. Topkapı, 34010, Istanbul, Turkey
| | - Ayşenur Meriç Hafiz
- Department of Otolaryngology, Koç University School of Medicine, Koç University Hospital, Davutpaşa Cad. Topkapı, 34010, Istanbul, Turkey
| | - Ömer Faruk Ünal
- Department of Otolaryngology, Koç University School of Medicine, Koç University Hospital, Davutpaşa Cad. Topkapı, 34010, Istanbul, Turkey
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Soloperto D, Spinnato F, Di Gioia S, Di Maro F, Pinter P, Bisceglia A, Marchioni D. Acquired subglottic cysts in children: A rare and challenging clinical entity. A systematic review. Int J Pediatr Otorhinolaryngol 2021; 140:110523. [PMID: 33261859 DOI: 10.1016/j.ijporl.2020.110523] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Revised: 11/22/2020] [Accepted: 11/23/2020] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Subglottic cysts (SGCs) are a rare cause of laryngeal stenosis that mainly seem to affect preterm infants with an intubation history. PURPOSE To review the related literature and compare different management protocols for patients presenting SGCs, as well as briefly report our clinical case treated at Verona University Hospital by Pediatric Airways Team. METHODS The articles resulting from a PubMed and MEDLINE search were analysed and selected using previously established criteria. A systematic review of the selected papers was conducted following PRISMA guidelines. RESULTS The search yielded 571 related articles; cross-checking of articles led to the identification and exclusion of 239 duplicates. The remaining 332 papers were screened according to previously established eligibility criteria. The final number of selected articles was 13. CONCLUSIONS Well-planned teamwork, with active collaboration between the ENT specialists, pediatricians and anesthesiologists, is the key to achieve multidisciplinary management of patients diagnosed with SGCs. Long-term follow-up is crucial considering the high recurrence rate of this disease.
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Affiliation(s)
- Davide Soloperto
- Otolaryngology-Head and Neck Surgery Department, University Hospital of Verona, Verona, Italy
| | - Federica Spinnato
- Otolaryngology-Head and Neck Surgery Department, University Hospital of Verona, Verona, Italy.
| | - Stefano Di Gioia
- Otolaryngology-Head and Neck Surgery Department, University Hospital of Verona, Verona, Italy
| | - Flavia Di Maro
- Otolaryngology-Head and Neck Surgery Department, University Hospital of Verona, Verona, Italy
| | - Patrick Pinter
- Otolaryngology-Head and Neck Surgery Department, University Hospital of Verona, Verona, Italy
| | - Alfonso Bisceglia
- Department of Anesthesiology, University Hospital of Verona, Verona, Italy
| | - Daniele Marchioni
- Otolaryngology-Head and Neck Surgery Department, University Hospital of Verona, Verona, Italy
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Bowles PFD, Reading J, Albert D, Nash R. Subglottic cysts: The Great Ormond Street experience in 105 patients. Eur Arch Otorhinolaryngol 2020; 278:2137-2141. [PMID: 32875392 DOI: 10.1007/s00405-020-06321-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Accepted: 08/24/2020] [Indexed: 11/24/2022]
Abstract
PURPOSE The aim of the study was to assess the contemporary presentation and management of subglottic cysts and make recommendations on the treatment of these patients. METHODS Retrospective case series of 105 patients between October 1999 and November 2017 from a paediatric teaching hospital. RESULTS Ninety-one percentage (n = 96) had a history of prematurity, with a mean gestation of 27.2 weeks (SD ± 4.1). A history of intubation was found in 99% (n = 104) of cases [median 18 days (range = 1-176)]. Presenting symptoms were: Stridor 57.1%, (n = 60), difficult intubation 14% (n = 15), recurrent croup 11.4% (n = 12), failed extubation 7.6%, (n = 8), hoarseness/weak cry 10.5% (n = 10). Ninety percentage (n = 94) underwent intervention for management of SGCs with 86% (n = 81) treated with cold steel marsupialisation and 14% (n = 13) with CO 2 laser. Recurrent cysts occurred in 56% (n = 53) of cases. Treatment modality did not affect recurrence (p = 0.594 Δ). Sixty-six percentage (n = 69/105) of patients had one or more concurrent airway pathology at MLB. Most frequent was subglottic stenosis 47% (n = 49), with 16% (n = 8) subsequently requiring open reconstructive airway surgery. Mean duration of follow-up was 47.6 months (SD ± 38.3). CONCLUSION SGC are an uncommon, reversible cause of upper airway obstruction and should be considered in the list of differential diagnoses in patients with a history of prematurity and perinatal intubation, presenting with stridor. While concurrent SGS is common, adequate symptom improvement in such cases may be achieved with SGC removal alone. Management is by surgical marsupialisation. Recurrence and additional airway pathologies are common and may necessitate longer-term treatment in centres with paediatric airway expertise.
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Affiliation(s)
- P F D Bowles
- Department of Otolaryngology, Great Ormond Street Hospital for Children, Great Ormond Street, London, WC1N 3JH, UK.
| | - J Reading
- Department of Otolaryngology, Great Ormond Street Hospital for Children, Great Ormond Street, London, WC1N 3JH, UK
| | - D Albert
- Department of Otolaryngology, Great Ormond Street Hospital for Children, Great Ormond Street, London, WC1N 3JH, UK
| | - R Nash
- Department of Otolaryngology, Great Ormond Street Hospital for Children, Great Ormond Street, London, WC1N 3JH, UK
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Miller MR, Vitone SF, Kiell EP, Potisek NM. When Acute Stridor Is More Than Croup. J Pediatr 2019; 214:237-237.e1. [PMID: 31303337 DOI: 10.1016/j.jpeds.2019.06.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Revised: 06/04/2019] [Accepted: 06/06/2019] [Indexed: 11/26/2022]
Affiliation(s)
| | | | | | - Nicholas M Potisek
- Department of Pediatrics, Wake Forest School of Medicine, Winston-Salem, North Carolina
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Weiss M, Dave M, Bailey M, Gysin C, Hoeve H, Hammer J, Nicolai T, Spielmann N, Gerber A. Endoscopic airway findings in children with or without prior endotracheal intubation. Paediatr Anaesth 2013; 23:103-10. [PMID: 23289772 DOI: 10.1111/pan.12102] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/20/2012] [Indexed: 12/01/2022]
Abstract
BACKGROUND Airway alterations found after endotracheal intubation are usually associated with mechanical trauma from the tube. However, no studies are available concerning alterations in airways that have never been intubated before. It was the aim of the study to compare endoscopic findings in the larynx and trachea of children who had undergone prior endotracheal intubation with findings in children who had not been intubated before. METHODS In 1021 children aged from 0 to 6 years, rigid endoscopies were performed before planned elective endotracheal intubation. The anonymized endoscopy videos were reviewed and graded by five international airway experts. Data was compared between the two groups using the chi-square test (P ≤ 0.05). RESULTS Endoscopic records of 971 children (473 with prior intubation; 498 without prior airway intubation) were included in the final calculations. Most patients (93.7%) with prior intubation had been intubated with a cuffed tube. The number of intubations ranged from 1 to 27. The median interval between intubation and endoscopy was 0.53 years (0.003-5.57 years). Abnormal findings were observed in 31.7% and 26.8% of patients with and without prior intubation, respectively (P = 0.063). Glottic granulomas were significantly more common after intubation (3.6% vs 1.4%; P = 0.028). The incidence of other abnormal findings was similar in both groups. CONCLUSION Endoscopic airway alterations can be observed in about one-quarter of children presenting for routine surgery without prior intubation. Except for glottic granulomas, the abnormalities are found with similar frequency in patients with and without prior intubation. No relevant airway damage from short-term endotracheal intubation was found.
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Affiliation(s)
- Markus Weiss
- Department of Anaesthesia, University Children's Hospital, Zurich, Switzerland
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