Balloon dilation in the management of severe airway stenosis in children and adolescents.
OBJECTIVE
Children and adolescents with airway stenosis pose a clinical challenge. Recently, balloon dilation has been described, primarily for the treatment of early, immature, less severe airway stenosis. We describe our experience with 8 children and adolescents managed with balloon dilation, including severe, mature subglottic and tracheal stenosis.


METHODS
This is a case series of 8 children and adolescents with acquired subglottic and tracheal stenosis treated by the primary author with balloon dilation between August 2006 and April 2010 at an academic tertiary care center. In the four patients who were tracheotomy-dependent at the time of presentation, suprastomal stents or Montgomery T-tubes were used. In 1 patient with 99% subglottic stenosis (SGS), balloon dilation and stenting were used to create a lumen prior to laryngotracheal reconstruction (LTR).


RESULTS
All 4 patients with tracheotomy were decannulated. The remaining 4 patients were successfully managed without tracheotomy.


CONCLUSIONS
Mature, severe laryngeal and tracheal stenosis in pediatric patients can be successfully managed with balloon dilation. In the most severe cases with prior tracheotomy, stenting is necessary. Balloon dilation with stenting can also facilitate LTR. In patients without prior tracheotomy, tracheotomy and stenting can often be safely avoided with appropriate postoperative management.
Department of Otolaryngology-Head and Neck Surgery, Ochsner Clinic Foundation, New Orleans, LA 70121, USA. lguarisco@ochsner.org
J Lindhe
JL
Guarisco
Christina J
CJ
Yang
D000293:Adolescent; D019072:Antibiotic Prophylaxis; D002056:Burns / Q000150:complications; D002648:Child; D002675:Child, Preschool; D003646:Debridement; D004106:Dilatation / Q000295:instrumentation / Q000379:methods*; D004724:Endoscopy / Q000379:methods; D005260:Female; D005764:Gastroesophageal Reflux / Q000517:prevention & control; D006801:Humans; D007223:Infant; D007828:Laryngoscopy / Q000379:methods; D007829:Laryngostenosis / Q000601:surgery / Q000628:therapy*; D008297:Male; D016685:Mitomycin / Q000008:administration & dosage / Q000627:therapeutic use; D011183:Postoperative Complications / Q000517:prevention & control; D011239:Prednisolone / Q000627:therapeutic use; D054328:Proton Pump Inhibitors / Q000627:therapeutic use; D019651:Plastic Surgery Procedures; D012189:Retrospective Studies; D015607:Stents; D014135:Tracheal Stenosis / Q000209:etiology / Q000601:surgery / Q000628:therapy*; D014140:Tracheotomy; D016896:Treatment Outcome
D054328:Proton Pump Inhibitors; D016685:Mitomycin; D011239:Prednisolone
Balloon dilation; Subglottic stenosis; Tracheal stenosis