Subglottic tracheal stenosis.

Abstract

In dealing with subglottic stenosis in small children, meticulous and gentle techniques will yield the best results. It is easier to prevent than to treat subglottic stenosis. The use of endotracheal tubes of proper size (Fig 10) and meticulous management of the tube combined with careful extubation techniques may prevent progression of injury. If stenosis does develop, the lesions should be carefully assessed and described. Care must be taken in diagnostic procedures so that a rigid scope is not forced through an area of narrowing, thereby producing further injury. The old technique of rigid dilators may produce a shearing injury to the tracheal mucosa that is manifested by blood on the dilators. Intralesional injection of steroids also may be more injurious than helpful. The use of balloons with radial dilation has been more satisfactory. When granulation tissue is extensive, removal can be accomplished either with cup biopsy forceps or with the KTP laser. Minimizing iatrogenic injury by using the lowest possible wattage produces better results. When tracheoplasty is necessary, careful attention to technical details is essential. These details are described under the section on cartilage tracheoplasty. With difficult stenotic lesions, many techniques have been proposed, indicating that no one technique is universally successful. Thus, it is important to make careful assessment and description of the lesion along with an individualized approach following generally accepted guidelines.