Acquired subglottic cysts: management and long term outcome

Acquired subglottic cysts in children: A rare and challenging clinical entity. A systematic review

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.

Subglottic cysts: The Great Ormond Street experience in 105 patients

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.

Airway damage of prematurity: The impact of prolonged intubation, ventilation, and chronic lung disease

Over the past four decades, advances in neonatal intensive care have led to the survival of smaller and more immature infants. The improved survival of very low birth weight infants is associated with long term respiratory morbidity, most frequently in the form of bronchopulmonary dysplasia. In this review, we will discuss the pathogenesis, risk factor as well as management of commonly seen acquired airway disorders associated with prematurity, prolonged intubation and ventilation.

Anesthesia for patients with subglottic cysts

Acquired subglottic cysts can cause rapid development of respiratory distress. Subglottic cysts are a disease of premature infants and other pathologies of prematurity should be anticipated. Perioperative success is dependent on communication between surgeon and anesthesiologist. Contingency plans for an emergency surgical airway should be in place in the event of total airway obstruction.