title: Paediatric subglottic stenosis - Have things changed? Our experience from a developing tertiary referral centre.
abstract: BACKGROUND
  Paediatric airway disorders are common, particularly in the context of improved ventilation methods for neonates in intensive care units. Management is not standardised.
  
  
  OBJECTIVE
  To assess the number, severity, management and outcomes of all patients diagnosed with subglottic stenosis at a developing tertiary referral centre.
  
  
  METHODS
  19 month prospective longitudinal study.
  
  
  METHODS
  All patients who underwent microlaryngobronchoscopy (MLB) were included. Subglottic stenosis (SGS) was graded intraoperatively using the Myer-Cotton classification.
  
  
  RESULTS
  102 patients underwent MLB during this period. 33 of 102 patients (32.4%) were diagnosed with SGS+/-other co-pathologies. Mean and median age at diagnostic procedure were 24.7 months (SD 23.5) and 18 months, respectively. At their first MLB, 22 of 33 patients (66.7%) were found to have a Grade 1 SGS, 7 of 33 (21.2%) were Grade 2 and the remaining 4 of 33 (12.1%) were Grade 3. We had no patients with Grade 4 SGS. During this period, these patients with SGS underwent 73 MLBs+/-interventions (2.21 per patient) such as incision and balloon dilatation, tracheostomy (2 of 33) or ultimately, laryngotracheal reconstruction (LTR) (2 of 33). A further 3 patients have since undergone LTR. No significant unexpected events occurred.
  
  
  CONCLUSIONS
  These findings suggest that subglottic stenosis may be evolving in terms of its presentation and management. Management can more often be endoscopic and perhaps avoid tracheostomy or laryngotracheal reconstruction. Further long term prospective studies are required.
authors.affiliation: ENT Department, Barts Children's and the Royal London Hospital, United Kingdom. Electronic address: r.talwar@nhs.net.
authors.forename: Rishi
authors.initials: R
authors.lastname: Talwar
authors.affiliation: ENT Department, Barts Children's and the Royal London Hospital, United Kingdom.
authors.forename: Jagdeep Singh
authors.initials: JS
authors.lastname: Virk
authors.affiliation: ENT Department, Barts Children's and the Royal London Hospital, United Kingdom.
authors.forename: Yogesh
authors.initials: Y
authors.lastname: Bajaj
mesh_terms: D001999:Bronchoscopy; D002648:Child; D002675:Child, Preschool; D003251:Constriction, Pathologic / Q000601:surgery; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007828:Laryngoscopy; D007829:Laryngostenosis / Q000175:diagnosis* / Q000601:surgery; D008137:Longitudinal Studies; D008297:Male; D011446:Prospective Studies; D062606:Tertiary Care Centers; D014139:Tracheostomy
keywords: Endoscope; Laryngotracheal reconstruction; Paediatric; Stridor; Subglottic stenosis