Subglottic Stenosis
Subglottic stenosis is graded by % of occlusion
Grade 1 obstruction in less than 70% occluded Grade 2 is 70 - 90% occluded
Grade 3 is greater that 90% occluded
Grade 4 is a complete occlusion
Using this grading system, Bens subglottic stenosis was a Grade 3. In some mild cases of subglottic stenosis, the child may not need any surgical intervention.
Subglottic stenosis is an abnormal narrowing of the trachea below the glottis (vocal cords). Children with subglottic stenosis often suffer from neonatal stridor, which is a harsh, high-pitched respiratory sound due to obstruction of the airway, especially during inhalation. Subglottic stenosis may be associated with laryngotracheitis, or inflammation of the larynx and trachea. Such defects may require tracheotomy or a reconstructive procedure, but they can resolve with age and growth of the larynx.
Subglottic stenosis may also be acquired through repeated intubation of the throat, as may be performed in premature babies.
Stridor is usually more severe when it is acquired than when it is congenital. Croup is the most common cause of acute stridor, and laryngomalacia (congenital floppiness of the epiglottis and aryepiglottic folds) is the most common cause of chronic stridor in children under two years. Laryngomalacia is twice as common in boys than in girls.
Surgeons carefully evaluate children with stridor and all other airway problems. It is important to differentiate between congenital and acquired stenosis, in order to determine the most appropriate treatment. Rigid endoscopy is used to diagnose the cause of stridor and degree of subglottic stenosis when present.
Treating Subglottic Stenosis and Stridor
Surgical procedures vary widely depending on the nature, location, and extent of the problem. In cases of severe respiratory distress or acute obstruction, intubation is performed first. If necessary, tracheostomy may also be done. In this procedure, an opening is created in the trachea and a tube inserted to facilitate air exchange. Any other surgical procedures will address the underlying cause of the airway problems and will be tailored to your child’s specific anatomy.
