8.7 Subglottic Stenosis
Key Features
The subglottis is the narrowest part of the infant airway.
Acquired subglottic stenosis is most commonly found; the most common related factor is intubation.
Subglottic stenosis of 70% or more of the lumen is associated with daily symptoms.
The subglottis, the narrowest part of the pediatric airway, is composed of a complete cartilaginous ring, the cricoid, and loose submucosa that swells when irritated (as in, for example, croup). It is the region most likely to be affected by pressure from a too-large or frequently moving endotracheal tube. Congenital subglottic stenosis most commonly results from an abnormally shaped cricoid, with intraluminal lateral shelves, resulting in an oval shape to the lumen. Intervention is individualized to the patient: sometimes a watch-and-wait approach works; other children benefit from some type of surgery.
Epidemiology
Incidence is ~ 1.5 cases per million, but it occurs in 1 to 8% of neonates requiring intubation.
Clinical
An abnormal, narrow airway causes stridor. It is, therefore, worth reviewing the typical dimensions of the “normal” airway ( Table 8.2 ).
Signs
The signs include stridor, respiratory distress, and typically a normal voice.
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