What is subglottic stenosis?
Subglottic stenosis is a narrowing of the airway below the vocal cords and above the trachea. This disorder involves the narrowing of the cricoid — the only complete ring of cartilage in the airway. Scarring in the larynx just below the vocal cords often causes this narrowing. Subglottic stenosis may also involve the vocal cords and affect your child’s voice.
Subglottic Stenosis | Symptoms & Causes
What are the symptoms of subglottic stenosis?
Symptoms of subglottic stenosis include:
- noisy breathing (stridor)
- respiratory distress
- poor weight gain
- blue spells (cyanotic episodes)
- recurrent croup or lung infections
What causes subglottic stenosis?
Subglottic stenosis can be present at birth (congenital) or acquired. The cause of congenital subglottic stenosis is unknown.
Acquired subglottic stenosis can develop when scar tissue forms in the trachea due to prolonged intubation, previous airway surgery, or both. Intubation occurs when a tube is inserted into the trachea to help maintain breathing during a medical or surgical procedure.
Boys and girls of all ethnic backgrounds are equally at risk for subglottic stenosis.
Subglottic Stenosis | Diagnosis & Treatments
How is subglottic stenosis diagnosed?
Children with subglottic stenosis are usually not diagnosed at birth, but more often when they are a few months old, usually if a cold or other virus causes stress to their airway.
Clinicians diagnose subglottic stenosis through a comprehensive aero-digestive evaluation that may include one or more of the following tests:
- imaging (chest x-ray, neck x-ray, airway fluoroscopy)
What are the treatment options for subglottic stenosis?
Treatment depends on the severity of your child's stenosis. Your child may outgrow the problem without intervention or, if the problem is severe, surgery may be required. Your child’s treatment plan may include:
Our doctors use minimally invasive techniques whenever possible to treat subglottic stenosis. In some cases, the airway may be dilated (opened) with a balloon. Lasers can be used to remove segmental portions of scar tissue.
Our surgeons are experts at open surgery to treat subglottic stenosis. The two most common surgical procedures to treat this condition are:
- Laryngotracheoplasty: Surgical repair of the stenosis, during which the narrowed diameter of the windpipe (trachea) is enlarged by inserting an elliptical piece of cartilage (taken from the child’s rib or ear, depending on the amount of cartilage needed).
- Cricotracheal resection: A procedure in which the scar tissue and most of the ring-shaped cartilage of the larynx is cut out and the normal trachea is brought up to replace it.
How we care for subglottic stenosis
Subglottic stenosis is one of the most common abnormalities requiring tracheostomy in children younger than one year of age. However, the clinicians at Boston Children’s Hospital perform this procedure only as a last resort. Instead, our Center for Airway Disorders provides the most advanced minimally-invasive and open-airway procedures available for this condition. Our team approach includes the expertise of specialists from various fields who provide comprehensive assessment, treatment, and follow-up care.