Subglottic and Tracheal Stenosis

Abstract

1. Subglottic Stenosis Although laryngotracheal stenosis is a rare disorder, it can cause life-threatening conditions if not properly recognized and treated. The anatomy and embryology of the larynx and trachea should be well understood in order to provide an accurate diagnosis of this disease. The subglottis is the anatomical region between the vocal cords and the lower edge of the cricoid cartilage. In this period, the diameter of the subglottis was 4.5–7 mm. A diameter of 4 mm is regarded as the lower limit of normal in a full-term infant and 3 mm in premature infants. Subglottic stenosis is a condition that can be congenital or acquired. Patients with mild to moderate stenosis are often asymptomatic for a long time until an infection causes edema, which narrows the airway and causes respiratory discomfort. Intercostal and suprasternal retraction, trouble breathing, biphasic stridor, and dyspnea are all symptoms of subglottic stenosis. Endoscopic examination is the gold standard for assessment of the airway and is a prerequisite for the effective treatment of subglottic stenosis. Radiology aids the surgeon in diagnosing the location and amount of stenosis. A thorough swallowing evaluation is highly advised for patients who are suspected to have aspiration. A tracheotomy is required in moderate or severe cases of laryngeal stenosis to secure the airway. The choice of the surgical technique is dependent on pathologic findings, patient age, the degree and texture (hard or soft) of stenosis, as well as the patient’s general health. Endoscopic techniques mainly involve balloon dilation, laser excision, and topical application of mitomycin C. Open surgical techniques include expansion and resection surgery. 2. Tracheal Stenosis Congenital or acquired tracheal stenosis are both possible. Symptoms may vary based on the extent of stenosis. Respiratory distress, stridor, cyanosis, and barking cough may be observed in patients with severe tracheal stenosis, while minor symptoms (i.e., occasional wheezing, stridor, exercise intolerance) occur in mild cases. Chest radiographs and fluoroscopy help demonstrate the narrowing of the trachea. The location and severity of the stenosis are determined using CT or MRI. Bronchoscopy is required to confirm the diagnosis. Treatment is influenced by the length and extent of the stenosis, as well as its location. Children with minimal symptoms may be followed with serial bronchoscopies or high-resolution imaging. Endoscopic techniques are essential in both the follow-up and management of acquired tracheal stenosis. Open surgery should be considered if conservative treatment or endoscopic management has failed or is not recommended. © Springer Nature Switzerland AG 2023.