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Alamri AA, Alnefaie MN, Alsulami OA, Tonkal A, Assiry MM, Al-Khatib T. Endoscopic balloon dilatation for pediatric subglottic stenosis: a meta-analysis of successful outcomes. Eur Arch Otorhinolaryngol 2024; 281:3977-3984. [PMID: 38578502 DOI: 10.1007/s00405-024-08582-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Accepted: 02/25/2024] [Indexed: 04/06/2024]
Abstract
OBJECTIVES The primary goal of this study was to systematically identify all relevant published articles on the use of primary endoscopic balloon dilation for the management of pediatric patients with subglottic stenosis, critically assess the technique's success, and determine which patients are the best candidates for the procedure. METHODOLOGY This was a systematic review and meta-analysis that aimed to investigate the use and success rate of EBD for treating pediatric SGS. An electronic systematic literature search of three major databases, PubMed, EBSCO, and Web of Science&MEDLINE through Clarivate, was conducted to include the eligible articles. RESULTS A total of 14 unique studies were included in the final analysis, with 473 cases of pediatric SGS. The pooled success rate of EBD in treatment of pediatric SGS was 76% (k = 14 studies, 95% confidence interval [CI] = 0.65-0.86, P < 0.001, Q test for heterogeneity = 0.03, P < .001, I2 = 91%). CONCLUSIONS We reported a high success rate of EBD in treating pediatric SGS. The reported complications were uncommon, although they can be serious and life threatening. The intensity of SGS may be related to the likelihood of therapy failure.
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Affiliation(s)
| | - Majed N Alnefaie
- Department of Otolaryngology Head and Neck Surgery, King Fahad Armed Forces Hospital, Medical Services of The Armed Forces, Jeddah, Saudi Arabia
| | - Omar A Alsulami
- Otolaryngology-Head and Neck Surgery, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Albaraa Tonkal
- Department of Otolaryngology, Head and Neck Surgery, King Abdulaziz University, Jeddah, Saudi Arabia
| | | | - Talal Al-Khatib
- Department of Otolaryngology, Head and Neck Surgery, King Abdulaziz University, Jeddah, Saudi Arabia
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Hu L, He N, He S, Jiao Y. Endoscopic balloon dilatation in the management of paediatric-acquired subglottic stenosis in children. Auris Nasus Larynx 2024; 51:161-166. [PMID: 37544811 DOI: 10.1016/j.anl.2023.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 07/14/2023] [Accepted: 07/19/2023] [Indexed: 08/08/2023]
Abstract
OBJECTIVE To summarise our experience and the outcomes of endoscopic balloon dilatation (EBD) in the management of paediatric-acquired subglottic stenosis (SGS), and to further explore the influencing factors of successful EBD. METHOD A retrospective case series study was conducted involving 33 paediatric patients diagnosed with acquired SGS who underwent EBD as the primary treatment from January 2012 to December 2021. The collected information included patient demographics, aetiology, time from extubation to operation, initial grade of SGS, descriptions of stenosis tissues, presence of tracheotomy, number of dilatation procedures and co-morbidity. The follow-up results were collected and analysed. RESULT Thirty-three paediatric patients with an average age of 31.0 months who underwent EBD were included in the study. According to the Myers-Cotton classification, four (12.1%) patients had Grade I stenosis, nine (27.3%) had Grade II, 20 (60.6%) had Grade III and none had Grade IV. Of these, 15 (45.5%) exhibited acute lesions and 18 (54.5%) exhibited chronic lesions. The mean number of dilatation procedures per patient was 1.88 ± 1.05, and 19 (57.6%) patients received dilatations more than once. The overall success rate was 72.7%, with 100% for Grade I, 88.9% for Grade II and 60.0% for Grade III. There was a significant difference between the distribution of the stenosis grades in the successful and failed cases (p < 0.05). The mean number of dilatation procedures was 1.47 ± 0.64 and 2.22 ± 1.22 per patient in those with acute lesions and chronic lesions, respectively. The patients with chronic lesions had a significantly higher number of dilatations than those with acute lesions (p < 0.05). The success rate was 86.7% for acute lesions and 61.1% for chronic lesions. The correlation between the type of subglottic lesions and procedural success was not statistically significant (p > 0.05). CONCLUSION Acquired SGS in paediatric patients can be successfully managed using EBD. The dilatation procedures should be performed in a timely manner, early treatment could prevent the need for multiple procedures and smaller stenosis grades could improve the success rate of the surgery.
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Affiliation(s)
- Lanye Hu
- Department of Otolaryngology and Oral and Maxillofacial Surgery, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Ning He
- Department of Otolaryngology Head and Neck Surgery, Maternal and Child Health Hospital of Guangxi Zhuang Autonomous Region, Nanning, China
| | - Shan He
- Department of Otolaryngology and Oral and Maxillofacial Surgery, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Yu Jiao
- Department of Otolaryngology and Oral and Maxillofacial Surgery, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.
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Soldatskiy YL, Nikitina DN, Polunin MM, Edgem SR, Krugovskaya NL, Subbotina AS. [Balloon dilation as an alternative to tracheotomy for acquired subglottic stenosis in children of the first year of life]. Vestn Otorinolaringol 2024; 89:10-15. [PMID: 38506019 DOI: 10.17116/otorino20248901110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/21/2024]
Abstract
OBJECTIVE To study the efficacy and safety of balloon dilation as the first choice method in the treatment of children of the first year of life with acquired subglottic stenosis. MATERIAL AND METHODS A retrospective analysis of the treatment of 25 patients aged 27 days to 11 months of life (average age 5.3±3.76 months) with subglottic stenosis caused by prolonged intubation, in whom balloon dilation was the first method of treatment. Grade III Cotton-Myer stenosis was preoperatively detected in 22 children, the remaining 3 had grade II stenosis. RESULTS The success rate of balloon dilation was 100%; tracheotomy was not required in any case, the absence of stenosis during a follow-up examination in the catamnesis was recorded in 14 (56%) children, the remaining 11 (44%) had grade 0-I stenosis and did not cause respiratory disorders. In 1 child (1.5 years old), a subglottic cyst was removed after balloon dilation. One dilation was required in 18 (72%) children, two - in 5 (20%), three and four - respectively for 1 patient. If additional intervention was necessary, the operation was repeated 10 days - 3 months after the previous one. There were no postoperative complications. CONCLUSION Balloon dilation is a highly effective and safe alternative to traditional surgical interventions for acquired subglottic stenosis in children of the first year of life and can be recommended as a method of first choice.
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Affiliation(s)
- Yu L Soldatskiy
- Morozovskaya Children's City Clinical Hospital, Moscow, Russia
| | - D N Nikitina
- Morozovskaya Children's City Clinical Hospital, Moscow, Russia
| | - M M Polunin
- Morozovskaya Children's City Clinical Hospital, Moscow, Russia
- Pirogov Russian National Research Medical University, Moscow, Russia
| | - S R Edgem
- Morozovskaya Children's City Clinical Hospital, Moscow, Russia
| | - N L Krugovskaya
- Morozovskaya Children's City Clinical Hospital, Moscow, Russia
| | - A S Subbotina
- Pirogov Russian National Research Medical University, Moscow, Russia
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Soloperto D, Sacchetto A, Dallari V, Pinter P, Marchioni D. Endoscopic treatment of paediatric subglottic stenosis and cyst (with video). Am J Otolaryngol 2022; 43:103280. [PMID: 34972003 DOI: 10.1016/j.amjoto.2021.103280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Accepted: 11/21/2021] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The aim of this article is to describe step by step the endoscopic treatment of acquired subglottic stenosis (SGS) in an infant and to show the endoscopic results one month after surgery. STUDY DESIGN Case presentation with instructional video. SETTING University Hospital of Verona, Italy. METHODS We present the case of a 6-month-old ex-26-week preterm female infant who required prolonged intubation in the neonatal period. She referred to our hospital for persistent inspiratory and expiratory stridor, and laboured breathing. The endoscopic dynamic examination of upper airway revealed the presence of type 3 laryngomalacia and subglottic stenosis grade III according to Myers-Cotton classification. An endoscopic balloon laryngoplasty was planned. Two laryngeal dilatations were performed. The endoscopic exploration after the first dilatation showed the presence of a subglottic cyst on the anterior surface of the subglottis. The treatment of subglottic cyst consisted of marsupialization of the cyst with cold microinstruments, and subsequent suction of its content. RESULTS An endoscopic check-up was carried out one month after surgery. The examination of the upper airway under spontaneous respiration didn't show significant subglottic stenosis. A very small subglottic cyst under the anterior commissure was observed. However, no more balloon dilatations or marsupialization of the cyst were performed in order to avoid the formation of synechiae. CONCLUSION Treatment of SGS must be planned according to the extent of the stenosis and the history of the patient. Endoscopic procedures, such as balloon dilatation and cyst marsupialization, are best chosen for patients with isolated SGS without prior treatment failure.
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Affiliation(s)
- Davide Soloperto
- Division of Otorhinolaryngology, Department of Surgery, Dentistry, Gynecology, and Pediatrics, University of Verona, University Hospital of Verona, Piazzale Aristide Stefani, 1, 37126 Verona, Italy
| | - Andrea Sacchetto
- Division of Otorhinolaryngology, Department of Surgery, Dentistry, Gynecology, and Pediatrics, University of Verona, University Hospital of Verona, Piazzale Aristide Stefani, 1, 37126 Verona, Italy.
| | - Virginia Dallari
- Division of Otorhinolaryngology, Department of Surgery, Dentistry, Gynecology, and Pediatrics, University of Verona, University Hospital of Verona, Piazzale Aristide Stefani, 1, 37126 Verona, Italy
| | - Patrick Pinter
- Division of Otorhinolaryngology, Department of Surgery, Dentistry, Gynecology, and Pediatrics, University of Verona, University Hospital of Verona, Piazzale Aristide Stefani, 1, 37126 Verona, Italy
| | - Daniele Marchioni
- Division of Otorhinolaryngology, Department of Surgery, Dentistry, Gynecology, and Pediatrics, University of Verona, University Hospital of Verona, Piazzale Aristide Stefani, 1, 37126 Verona, Italy
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Kadosh OK, Nebor I, Smith MM, Hart CK, Tabangin ME, Burra K, Kasten JL, Sinner DI, de Alarcon A. Establishing an Endoscopic Chronic Subglottic Stenosis Rabbit Model. Laryngoscope 2021; 132:1909-1915. [PMID: 34652827 DOI: 10.1002/lary.29873] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Revised: 09/01/2021] [Accepted: 09/02/2021] [Indexed: 11/08/2022]
Abstract
OBJECTIVES/HYPOTHESIS To develop a reproducible and consistent chronic subglottic stenosis (SGS) in an endoscopic animal model. STUDY DESIGN Prospective study. METHODS We conducted a prospective study using New Zealand white rabbits. Chronic SGS was induced endoscopically by Bugbee electrocautery to 50% to 75% of the subglottic area's circumference, followed by 4-hour endotracheal intubation. The rabbit airways were endoscopically assessed and sized with uncuffed endotracheal tubes (ETTs) before the injury, during follow-up, and at the endpoints. There were four endpoints: 2, 4, 6, and 8 weeks post SGS induction. Animals were humanely euthanized for histopathological examination of the subglottic injury site and microscopic measurement of the cricoid lumen. RESULTS Twenty-two rabbits reached the endpoints, and 18 rabbits developed chronic SGS. ETT size significantly decreased by 0.5 from preinjury to the endpoint in all groups, P < .001. Control median cricoid lumen measurements were 20.48 mm2 , the median cricoid lumen measurement for the 2 weeks endpoint was 14.3 mm2 , 4 weeks 11.69 mm2 , 6 weeks 16.03 mm2 , and 8 weeks endpoint median was 16.33 mm2 . Histopathological examination showed chronic scar tissue and new cartilage formation at the cricoid level, mainly at the posterior subglottic injury site starting from 4 weeks postinjury. Collagen staining revealed substantial amounts of organized collagen and different collagen orientation starting 4 weeks postinjury lasting until 8 weeks postinjury. CONCLUSION We developed an animal model to study chronic SGS. This model will be utilized to compare different endoscopic treatment interventions in acute SGS versus chronic SGS and further define the molecular basis of SGS. LEVEL OF EVIDENCE NA Laryngoscope, 2021.
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Affiliation(s)
- Orna K Kadosh
- Division of Pediatric Otolaryngology-Head and Neck Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.,Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Ivanna Nebor
- Division of Pediatric Otolaryngology-Head and Neck Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.,Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Matthew M Smith
- Division of Pediatric Otolaryngology-Head and Neck Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.,Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Catherine K Hart
- Division of Pediatric Otolaryngology-Head and Neck Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.,Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Meredith E Tabangin
- Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Kaulini Burra
- Division of Neonatology and Pulmonary Biology, Perinatal Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Jennifer L Kasten
- Department of Pathology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Debora I Sinner
- Division of Neonatology and Pulmonary Biology, Perinatal Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Alessandro de Alarcon
- Division of Pediatric Otolaryngology-Head and Neck Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.,Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
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