Surgery of subglottic stenosis in neonates and children

The excellent management of patients in the different Intensive Care Units has decreased mortality but, as a side effect, we have to treat an increasi ng number of patients with airway problems secondary to prolonged intubatio n. The clinical records of patients diagnosed of acquired or congenital sub glottic stenosis (SE) between 1990 and 1995 were retrospectively reviewed. Types of treatment included conservative, endoscopic, and open surgery: ant erior cricoid split (ACS), anterior laryngotracheoplasty (ALTP) and anterop osterior laryngotracheoplasty (APLTP). 46 patients had SE: 7 congenital and 39 acquired. According to Cotton's classification 13 had grade I, 16 grade II, 12 grade III and none grade IV. Eleven of twelve cases treated conserv atively did well (92%); one out of six patients managed endoscopically requ ired further surgery (7%); good results were obtained in 5 of 7 cases treat ed by ACS (71%); 8 out of 9 patients treated by ALTP did well (89%) and 7 o ut of 8 managed by APLTP had good results (87.5%). One iatrogenic suture de hiscence required further surgery. There is no statistical difference in th e complication rate between patients treated conservatively and those treat ed by open surgery, while the mean hospital stay was higher in the latter ( p < 0.05). An appropriate surgical technique should be offered to those pat ients with SE who do not do well with conservative management, since these techniques have yielded good results with a low rate of complications. Long -term follow-up shows the absence of recurrence.