title: Endoscopic management of congenital anterior glottic stenosis.
abstract: BACKGROUND
  Congenital anterior glottic stenosis (web) is a rare condition usually presenting with airway obstruction, stridor or dysphonia. Symptomatic infants may require tracheotomy to bridge the neonatal period. Early open surgical reconstruction may have significant risks and failure may still result in tracheotomy. We introduce an endoscopic surgical approach with balloon dilation for primary management of congenital anterior glottic stenosis.
  
  
  METHODS
  We present three cases of congenital anterior glottic stenosis in children 7, 14, and 90 days old presenting with stridor, dyspnea, and dysphonia. The larynx was exposed by suspension microlaryngoscopy. The glottic stenosis was incised from a posterior to anterior direction using a laryngeal sickle knife. Subsequently, an airway balloon was guided through the stenotic lumen. Once the balloon was inflated, the balloon pressure was maintained for 30s or until the patient's oxygen saturation dropped below 92%. The dilation was repeated two or three times. The patients were kept intubated with an uncuffed endotracheal tube and monitored in the pediatric intensive care unit following surgery.
  
  
  RESULTS
  All three patients were extubated within 72h without complications. One patient failed the first extubation attempt and was reintubated and successfully extubated 24h later. Patients were re-evaluated with direct microlaryngoscopy within two weeks. All patients had symptomatic relief and did not require further surgical intervention.
  
  
  CONCLUSIONS
  Endoscopic balloon dilation laryngoplasty may be a safe and effective primary procedure for pediatric patients with congenital anterior glottic stenosis. It is technically simple and obviates the potential morbidities associated with an open surgical procedure or tracheotomy.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, 3400 Bainbridge Ave., Medical Arts Pavilion, 3rd Floor, Bronx, NY 10467, USA.
authors.forename: Mi Jin
authors.initials: MJ
authors.lastname: Yoo
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, University of Texas Medical School at Houston, Children's Memorial Hermann Hospital, Houston, TX 77030, USA.
authors.forename: Soham
authors.initials: S
authors.lastname: Roy
authors.affiliation: Division of Pediatric Otolaryngology, Cohen Children's Medical Center, New Hyde Park, NY, USA; Department of Otolaryngology-Head and Neck Surgery, Hofstra North Shore-LIJ School of Medicine, Hempstead, NY, USA. Electronic address: lsmith8@nshs.edu.
authors.forename: Lee P
authors.initials: LP
authors.lastname: Smith
mesh_terms: D060666:Airway Extubation; D003251:Constriction, Pathologic / Q000601:surgery; D055154:Dysphonia / Q000209:etiology; D004724:Endoscopy; D005931:Glottis / Q000002:abnormalities* / Q000601:surgery*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007442:Intubation, Intratracheal; D019651:Plastic Surgery Procedures; D012135:Respiratory Sounds / Q000209:etiology; D014140:Tracheotomy
keywords: Balloon; Dilation; Glottic; Glottis; Stenosis; Web