Andréia Melchiors Wenzel1, Cláudia Schweiger2,3, Denise Manica2,3, Leo Sekine4, Isabel Cristina Schütz Ferreira2,5, Gabriel Kuhl3, Paulo José Cauduro Marostica2,6. 1. Programa de Pós-Graduação em Saúde da Criança e do Adolescente, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil. deiawenzel@gmail.com. 2. Programa de Pós-Graduação em Saúde da Criança e do Adolescente, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil. 3. Otolaryngology and Head and Neck Surgery Department, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil. 4. Programa de Pós-Graduação em Epidemiologia, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil. 5. Pediatric Department, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil. 6. Pediatric Pulmonology Department, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil.
Abstract
PURPOSE: To assess the impact of balloon laryngoplasty on clinical and surgical outcomes in pediatric patients with acute subglottic stenosis. METHODS: Two case series were included and compared. The first group included patients treated initially either with tracheostomy (if severe symptoms) or with close follow-up (if mild symptoms). Those children underwent re-evaluation and specific treatment of their stenosis with laser incisions or open surgeries some weeks later. The other group included children treated initially with balloon laryngoplasty, reflecting a shift in surgical practice after 2009. Data as success of the procedure, mean hospital stay, mean pediatric intensive care unit (PICU) stay, post-procedure fever, need of antibiotics, procedure-related complications, and deaths were assessed and compared between both cohorts. RESULTS: The sample comprised 38 pediatric patients aged 0-5 years. Fifteen children were treated before 2009, of who 10 (66.7%) required tracheostomy soon after the diagnosis. Ultimately, 13 (86.6%) underwent laryngotracheal reconstruction. Twenty-three children were treated after 2009 and the success rate in these patients treated primarily with balloon laryngoplasty was 82.6%. Of these, only 3 (13%) required tracheostomy and 1 (4.3%) required further open laryngotracheal reconstruction. Patients treated by balloon laryngoplasty underwent fewer procedures under general anesthesia and had a lower burden of treatment-related morbidity, as denoted by shorter PICU stay, less antibiotic use, earlier postoperative resumption of oral feeding, and a lower incidence of postoperative complications and fever. CONCLUSION: When used for management of acute laryngeal stenosis, balloon laryngoplasty is associated with a high success rate, presenting lower morbidity than open surgery.
PURPOSE: To assess the impact of balloon laryngoplasty on clinical and surgical outcomes in pediatric patients with acute subglottic stenosis. METHODS: Two case series were included and compared. The first group included patients treated initially either with tracheostomy (if severe symptoms) or with close follow-up (if mild symptoms). Those children underwent re-evaluation and specific treatment of their stenosis with laser incisions or open surgeries some weeks later. The other group included children treated initially with balloon laryngoplasty, reflecting a shift in surgical practice after 2009. Data as success of the procedure, mean hospital stay, mean pediatric intensive care unit (PICU) stay, post-procedure fever, need of antibiotics, procedure-related complications, and deaths were assessed and compared between both cohorts. RESULTS: The sample comprised 38 pediatric patients aged 0-5 years. Fifteen children were treated before 2009, of who 10 (66.7%) required tracheostomy soon after the diagnosis. Ultimately, 13 (86.6%) underwent laryngotracheal reconstruction. Twenty-three children were treated after 2009 and the success rate in these patients treated primarily with balloon laryngoplasty was 82.6%. Of these, only 3 (13%) required tracheostomy and 1 (4.3%) required further open laryngotracheal reconstruction. Patients treated by balloon laryngoplasty underwent fewer procedures under general anesthesia and had a lower burden of treatment-related morbidity, as denoted by shorter PICU stay, less antibiotic use, earlier postoperative resumption of oral feeding, and a lower incidence of postoperative complications and fever. CONCLUSION: When used for management of acute laryngeal stenosis, balloon laryngoplasty is associated with a high success rate, presenting lower morbidity than open surgery.
Authors: L M Gustafson; B E Hartley; J H Liu; D T Link; J Chadwell; C Koebbe; C M Myer; R T Cotton Journal: Otolaryngol Head Neck Surg Date: 2000-10 Impact factor: 3.497
Authors: C Schweiger; P J Cauduro Marostica; M M Smith; D Manica; P R Antonacci Carvalho; G Kuhl Journal: J Laryngol Otol Date: 2013-02-28 Impact factor: 1.469
Authors: Alison Maresh; Diego A Preciado; Ashley P O'Connell; George H Zalzal Journal: JAMA Otolaryngol Head Neck Surg Date: 2014-10 Impact factor: 6.223
Authors: Mariana Magnus Smith; Gabriel Kuhl; Paulo Roberto Antonacci Carvalho; Paulo José Cauduro Marostica Journal: Int J Pediatr Otorhinolaryngol Date: 2007-06-27 Impact factor: 1.675