J Korean Soc Laryngol Phoniatr Logoped.  2020 Jun;31(1):19-26. 10.22469/jkslp.2020.31.1.19.

Risk Factor Analysis of Endoscopic Dilation Procedure for the Management of Subglottic Stenosis in Pediatric Patients

• Park MH
• Choi N
• Song BH
• Jeong HS
• Son YI
• Chung MK

• KMID: 2505862
• DOI: http://doi.org/10.22469/jkslp.2020.31.1.19

Abstract

Background and Objective
Endoscopic airway dilation is the primary treatment for pediatric subglottic stenosis (SGS) due to its feasibility and non-invasiveness. The aim of this study is to evaluate the risk factors for the failure of endoscopic airway dilation in pediatric patients with SGS.

Materials and Methods
This study reviewed medical records of 38 pediatric patients had endoscopic dilation from a single and tertiary referral center, retrospectively. The success of the endoscopic dilation procedure was defined as no dyspneic symptom without tracheostomy or laryngotracheal reconstruction. Demographic profiles, underlying disease, and Myer-Cotton SGS severity grade were recorded. Success rates and risk factors for the failure of treatment were analyzed.

Results
The SGS patients with severity grade I was most common. After mean 1.8 numbers of procedures, there were 23 patients (60.5%) in the success group and 15 patients (39.5%) in the failure group. Age, sex, underlying diseases, and SGS severity grade were not significantly different between two groups. In patients who had multiple endoscopic procedures, the failure group showed SGS deteriorated after procedures in 66.7%, compared to 11.1% of the success group. In multivariable analysis, a long-term intubation (≥1 month) was identified as an independent risk factor for failure of endoscopic dilation procedure.

Conclusion
Although endoscopic dilation procedure is safe and effective for the management, repetitive endoscopic dilation may not give clinical benefit in patient with long-term intubation. Other airway procedures must be considered in those group of patients.

Keyword

Laryngeal stenosis; Subglottic stenosis; Dilation; Endoscopic surgery; 기도 협착; 성문하 협착; 확장술; 내시경 수술