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Abstract
Laryngeal stenosis may occur in the supraglottis, glottis, or subglottis.
Clinically subglottic stenosis (SGS) is by far the most common problem
requiring intervention. The cricoid ring surrounds the subglottic airway
circumferentially. In the paediatric patient, subglottic airway is the narrowest’
portion of the airway. SGS may be congenital [primary] or acquired [secondary],
in addition to a third type called idiopathic SGS. Common causes of acquired
SGS are failed treatment or non-recognition of acute trauma, but stenosis is also
seen as a complication of tracheotomy and intubation. In Egypt and Middle East,
scleroma is probably the most common cause of laryngeal stenosis.
Many methods of measuring the subglottic region have been proposed
including radiography, CT, MRI, and computed cinetomography (cine-CT).
These imaging modalities all have disadvantages and limitations in assessing the
airway size of the paediatric patient. Diagnostic ultrasonic instruments have been
available in the medical field for the past 4 decades in a noninvasive, rapid,
painless, safe, atraumatic, inexpensive, and dynamic fashion. Multidetector CT
(MDCT) has revolutionized noninvasive, anatomic, and functional imaging of the
central airway. Currently, the application of optical coherence tomography
(OCT) on the submucosal lesions in the subglottis is of value in diagnosis and
differentiation between oedema, granulation tissue, scar tissue, and neocartilage
formation. Rigid endoscopy, remains the gold standard and the most effective
method for evaluating the relative dimensions of the subglottic airway.
Treatment of SGS must include prevention. Efficient and appropriate
management of infectious or inflammatory disorders, thermal or chemical injury,
and GERD can diminish the chance of laryngeal stenosis. Endoscopic treatment is indicated if the stenosis does not involve scarring wider than 1 cm vertically.
Circumferential scarring can only be treated in this way if the cartilage
framework remains intact. Endoscopic laser management of SGS is successful in most cases involving grade I or II stenosis, if there are no factors predisposing to
failure. It is used for removal of cicatricial tissues, so it is limited to fibrotic
scarring involving short segments and not involving the airway skeleton. It has had success rates between 66% to 80%. Laryngotracheoplasty (L TP) was
reversed to limited grade II or grade HI stenosis limited to the subglottic area and not extending above the glottic plane or under the second tracheal ring.
Grad IV SGS, usually requires a staged procedure with prolonged stenting,
tracheotomy, or cricotracheal Resection (CTR”
Key word:- subglottic stenosis (SGS), computed cinetomography (cine-CT),
multidetector CT (MDCT), optical coherence tomography (OCT),
laryngotracheoplasty (L TP), and cricotracheal Resection (CTR).