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Subglottic and Tracheal Stenosis

Subglottic stenosis is a condition in which a child’s airway is obstructed due to congenital (present at birth) narrowing of the airway in this region, or from scarring just below the vocal cords. The scar typically develops early in childhood, often because the child was born premature and needed a breathing tube for awhile as their lungs developed. This breating tube, though life-saving, can result in a scar and subglottic stenosis.

Subglottic stenosis causes breathing difficulties for the child. These difficulties can be mild or severe (the narrower the airway, the more difficulty the child will experience when breathing).

normal and elliptical

The image on the left shows cricoid cartilage of the neck that is normal in shape and therefore allows for normal breathing through the airway. The image on the right shows cricoid cartilage of the neck that is elliptical in shape, indicating subglottic stenosis.

subglottic stenosis
The image above shows a popularized grading system for classifying the degree of severity of subglottic and tracheal stenosis.

Treatment

Significant subglottic stenosis may require placement of a tracheostomy tube to bypass the narrow part of the airway. The tracheostomy is generally placed to allow the child to breathe, feed, and grow until they become healthy and stable enough for further surgical interventions to then allow the tracheostomy eventually to be removed. Pediatric airway reconstruction in the form of either laryngotracheal reconstruction or cricotracheal resections is designed to rebuild the airways and to allow the tracheostomies to be eventually removed (see pictures and videos). For a child without major heart, lung, or other medical issues, airway reconstruction has approximately a 90-95% success in allowing the tracheostomy tube eventually to be removed.

Photos

subglottic stenosis
Subglottic Stenosis: The above photograph is from an endoscopic exam of a child with subglottic stenosis.

tracheal stenosis
Tracheal Stenosis: The above photograph is from an endoscopic exam of a child with tracheal stenosis.