Treatment of Severe Subglottic Stenosis without Tracheotomy

Abstract

Subglottic stenosis in neonates, infants and children is one of the most challenging problems confronting the pediatric otolaryngologist today. Small patients with congenital or acquired stenosis severe enough to require tracheotomy must undergo repeated endoscopic procedures or laryngotracheal reconstruction; weeks, months, or years may be required to attain a lumen large enough to permit decannulation. During 1981, six infants and children with severe subglottic stenosis were managed without tracheotomy. The surgical technique employed involves endoscopic excision of the offending subglottic tissue using the CO2 laser and suspension microlaryngoscopy. Intraoperative intubation is avoided by using an insufflation technique for general anesthesia which permits unobstructed visualization of the larynx, thereby avoiding laryngeal trauma and edema.