Efficacy of Cricotracheal Stenosis Resection (CTSR) Among Children with Congenital vs. Acquired Sub-glottic Stenosis

Jaber Alshammari; Mohammed Halawani; Abdullah Arafat; Abdullah Alkhaldi; Nazish Masud

doi:10.1007/s12070-023-03731-3

Efficacy of Cricotracheal Stenosis Resection (CTSR) Among Children with Congenital vs. Acquired Sub-glottic Stenosis

Indian J Otolaryngol Head Neck Surg. 2023 Sep;75(3):1755-1761. doi: 10.1007/s12070-023-03731-3. Epub 2023 Apr 3.

Authors

Jaber Alshammari^{1

2}, Mohammed Halawani^{1

2}, Abdullah Arafat^{1

2}, Abdullah Alkhaldi^{1

2}, Nazish Masud^{2

3}

Affiliations

¹ Division of Otolaryngology Head & Neck Surgery, King Abdulaziz Medical City (KAMC), King Abdullah Specialized Children Hospital (KASCH), National Guard Health Affairs (NGHA), Riyadh, Saudi Arabia.
² King Abdullah International Medical Research Center Riyadh (KAIMRC), Riyadh, Saudi Arabia.
³ Research unit, College of medicine, King Saud bin Abdulaziz University for Health Sciences Riyadh, Riyadh, Saudi Arabia.

PMID: 37636724
PMCID: PMC10447872 (available on 2024-09-01)
DOI: 10.1007/s12070-023-03731-3

Abstract

Sub-glottic Stenosis (SGS) treatment in children is challenging because there is no standard algorithm to follow; however, the use of endoscopic techniques in SGS treatment has emerged over the last decades and has advanced. The aim of this study was to assess the efficacy of Cricotracheal Stenosis Resection (CTSR) among children with congenital vs. acquired SGS. In this retrospective study, we reviewed the charts of 22 patients who underwent endoscopic intervention as the primary modality of treatment for SGS at King Abdulaziz Medical City from January 1, 2011 to October 31, 2019. Successful treatment was defined as: resolution of symptoms, restoration of a normal patent airway with no stenosis, and decannulation. Out of 22 patients, 14 cases were acquired and 8 were congenital SGS. Most of the patients had grade 3 stenosis before surgery 15 (68%), followed by grade 1 stenosis among 4 (18.2%) and grade 2 stenosis was present in 3 (13.6%) patients. Postoperatively, 17 (77.3%) patients improved to grade zero, whereas grade 3 stenosis was not reported in any patient. The Mc-Nemar's test showed significant improvement between pre- and post-operative stenosis grade with test value = 22, and P value = 0.003. This technique was successful among 18 (82%) patients with P value ≤ 0.01. Irrespective of the differences in the age of patients, length, and character of stenosis among congenital and acquired groups, the endoscopic CTSR technique proved to be successful in both groups. We achieved a success rate of 86% in the acquired series, and 75% in the congenital series, which is a very promising result.

Keywords: Acquired subglottic stenosis; Airway surgery; Congenital subglottic stenosis; Pediatric airway; Subglottic stenosis.

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