Glottic and Subglottic Stenosis

Review the cotton stenosis grading system. What is the typical diameter of a normal subglottis in a neonate and what is considered narrowed?

Compare and contrast pediatric vs. adult laryngeal anatomy.

Review the histopathologic classification of congenital subglottic stenosis.

List the etiologies of acquired laryngeal stenosis.

Discuss how intubation causes subglottic stenosis.

Reference(s):

Manica, D., Schweiger, C., Marostica, P. J. C., Kuhl, G., & Carvalho, P. R. A. (2013). Association between length of intubation and subglottic stenosis in children. The Laryngoscope, 123(4), 1049–1054.

List important factors in the prevention of laryngotracheal stenosis.

Discuss the different types of laryngeal stenosis.  How is posterior glottic stenosis classified and what are the treatment options? Describe the open surgical management of posterior glottic stenosis in children.

Are there any syndromes that place a child at greater risk for a narrowed airway?

Discuss the endoscopic management of glottic and subglottic stenosis. What are the contraindications to endoscopic management.

You are consulted on a difficult to extubate a neonate with subglottic stenosis. The family refuses a tracheostomy because they have heard of the high incidence of M&M in this population. What other options do they have (medical and surgical)?

When and how do you do a cricoid split? List the criteria for cricoid split.

Discuss the proper assessment for decannulation in the pediatric population. Discuss the pros and cons of single stage laryngotracheal reconstruction.

Reference(s):

Gustafson, L. M., Hartley, B. E., Liu, J. H., Link, D. T., Chadwell, J., Koebbe, C., … Cotton, R. T. (2000). Single-stage laryngotracheal reconstruction in children: a review of 200 cases. Otolaryngology–Head and Neck Surgery : Official Journal of American Academy of Otolaryngology-Head and Neck Surgery, 123(4), 430–434.

Discuss how you would decide if a patient needs an open surgery for subglottic stenosis or if endoscopic management can be attempted.

Reference(s):

Maresh, A., Preciado, D. A., O’Connell, A. P., & Zalzal, G. H. (2014). A comparative analysis of open surgery vs endoscopic balloon dilation for pediatric subglottic stenosis. JAMA Otolaryngology– Head & Neck Surgery, 140(10), 901–905.

What is the data on Mitomycin C and prevention of restenosis?

Reference(s):

Perepelitsyn, I., & Shapshay, S. M. (2004). Endoscopic treatment of laryngeal and tracheal stenosis-has mitomycin C improved  the outcome? Otolaryngology–Head and Neck Surgery : Official Journal of American Academy of Otolaryngology-Head and Neck Surgery, 131(1), 16–20.

Discuss the different types of stents, timing of stent removal and in what circumstances stents may be unnecessary.

Discuss post-operative care of patients after a laryngotracheal reconstruction.

Reference(s):

Kozin, E. D., Cummings, B. M., Rogers, D. J., Lin, B., Sethi, R., Noviski, N., & Hartnick, C. J. (2015). Systemwide change of sedation wean protocol following pediatric laryngotracheal reconstruction. JAMA Otolaryngology– Head & Neck Surgery, 141(1), 27–33.

Discuss the proper antimicrobial coverage in laryngotracheal stents.

Reference(s):

Nouraei, S. A. R., Petrou, M. A., Randhawa, P. S., Singh, A., Howard, D. J., & Sandhu, G. S. (2006). Bacterial colonization of airway stents: a promoter of granulation tissue formation following laryngotracheal reconstruction. Archives of Otolaryngology–Head & Neck Surgery, 132(10), 1086–1090.

Discuss the role of cricotracheal resection and slide tracheoplasty in patients with subglottic stenosis.

Reference(s):

de Alarcon, A., & Rutter, M. J. (2012). Cervical slide tracheoplasty. Archives of Otolaryngology–Head & Neck Surgery, 138(9), 812–816.

Discuss long-term voice outcomes of patients after laryngotracheal reconstruction.

Reference(s):

Tirado, Y., Chadha, N. K., Allegro, J., Forte, V., & Campisi, P. (2011). Quality of life and voice outcomes after thyroid ala graft laryngotracheal reconstruction in young children. Otolaryngology–Head and Neck Surgery : Official Journal of American Academy of Otolaryngology-Head and Neck Surgery, 144(5), 770–777.