Management specificities of congenital laryngeal stenosis: external and endoscopic approaches

Laryngoscope. 2014 Apr;124(4):1013-8. doi: 10.1002/lary.24373. Epub 2013 Oct 5.

Abstract

Objectives/hypothesis: This study aimed to report our experience in the management of congenital laryngeal stenosis and to compare our series and results to published data in the literature.

Study design: Retrospective case series. Tertiary referral center for rare pediatric head and neck malformations.

Methods: Medical charts of patients diagnosed with congenital laryngeal stenosis in our institution were reviewed over a 15-year period, from 1996 to 2011. Surgical treatment consisted of an endoscopic procedure, open laryngeal surgery (OLS), or a combination of both.

Results: Sixteen patients met the inclusion criteria for the study and were divided in two groups: the endoscopic laryngoplasty (EL) group, with patients who underwent the endoscopic procedure as first-line treatment, and the OLS group, whose patients underwent open laryngoplasty with cartilage graft as first-line treatment. Each group contained eight patients with grade II to IV congenital stenosis. All patients, except one in the EL group, achieved a good result (<50% residual stenosis) at the end of the follow-up.

Conclusions: This case series suggests that EL, with incision of the subglottic laryngeal cartilages with cold steel instruments and balloon dilation, is a safe and effective treatment for congenital laryngeal stenosis grade II to IV. This procedure could be considered as an alternative option to OLS, even as a first-line procedure. An endoscopic procedure does not preclude the possibility for an open laryngeal procedure in case of failure. A prolonged follow-up is mandatory.

Level of evidence: 4.

Keywords: Larynx; balloon dilation; congenital laryngeal stenosis; cricoid split; endoscopic procedure.

MeSH terms

  • Child, Preschool
  • Female
  • Follow-Up Studies
  • Humans
  • Infant
  • Infant, Newborn
  • Laryngoplasty / methods*
  • Laryngoscopy / methods*
  • Laryngostenosis / congenital
  • Laryngostenosis / diagnosis
  • Laryngostenosis / therapy*
  • Larynx / abnormalities*
  • Larynx / surgery
  • Male
  • Retrospective Studies
  • Treatment Outcome