Posterior subglottic cyst

Evaluation of pediatric subglottic cysts

INTRODUCTION

Subglottic cysts (SGCs) are increasingly recognized as a cause of upper airway obstruction in previously intubated infants. Endoscopic marsupialization with cold steel instruments or CO(2) laser has been reported to be the standardised treatment method for SGCs. SGC case series of 9 patients who were treated with endoscopic marsupialization with cold steel instruments or CO(2) laser and mechanical decompression with balloon dilatation are presented.

PATIENTS AND METHODS

Retrospective study of 9 cases of subglottic cysts treated between 2003 and 2010 was done. Diagnoses were made by performing flexible nasopharyngolaryngoscopy and surgical treatment was done through endoscopic marsupialization with cold steel instruments or CO(2) laser.

RESULTS

The age range of SGC patients were between 3 months and 36 months (average 12, 11 months). Two of the patients were female (2/9), 7 of them were male (7/9). SGC diagnoses were made by flexible nasopharyngolaryngoscopy. History of intubation was noted in 3 of the patients (3/9). Duration of intubation was 28 days, 6 days, and 8 days respectively. Cysts were multiple in all cases, and located posteriorly and laterally at the subglottic area and upper trachea. The patients presented with were stridor, fail to thrive, and recurrent croup attacks. Treatment methods preferred for these patients were endoscopic marsupialization with cold steel instruments or CO(2) laser and mechanical decompression with balloon dilatation. The follow-up period after treatment ranged between 8 months and 3 years. Recurrence of the SGCs did not happen and re-evaluation under general anesthesia was reserved for the symptomatic patients.

CONCLUSION

Diagnostic laryngoscopy and bronchoscopy are important in diagnosing SGC. History of premature birth and intubation are not 'sine qua non' of SGC as SGC may be congenital as well. Symptoms of SGCs may mimic the characteristic features of chronic obstructive lung disease, so evaluation of the airway should be considered in such infants if they have stridor or hoarseness not responding to routine treatment. Laryngoscopy and bronchoscopy are routinely indicated for airway evaluation in at-risk infants.

Subglottic cysts in children: a 10-year review

Subglottic cysts are associated with prematurity and periods of early neonatal intubation and are a rare cause of infant stridor. In this study we analyse our experience of this rare but important problem. We discuss the aetiology, diagnosis and management of subglottic cysts. We carried out a retrospective review of all cases of subglottic cysts presenting to the otorhinolaryngology department at the Leeds teaching hospitals trust during the period between 1995 and 2005. In total seven patients were identified. A retrospective review of the case notes of all patients proven to have subglottic cysts at direct laryngoscopy and bronchoscopy was undertaken. Seven patients were identified, four males and three females. Five were born premature (24-31 weeks). All were intubated with average intubation period of 20.6 days. Six of our patients' underwent endoscopic marsupialisation using cup forceps and one with a contact diode laser. Two patients had recurrence of the cyst and had a repeat of endoscopic marsupialisation. This study highlights the associated risk of neonatal intubation with the risk of formation of subglottic cysts, and the need for early diagnosis and appropriate treatment to avoid unnecessary morbidity.

Subglottic ductal cysts in the preterm infant: association with laryngeal intubation trauma

Acquired subglottic ductal cysts following prolonged intubation in preterm infants have been reported with increasing frequency during the past two decades. This paper reviews the subglottic ductal cysts diagnosed in 15 pediatric patients between 1989 and 1993--the largest such review. Eighty percent were observed in preterm low-birth weight infants following prolonged intubation, and all but 3 of the patients had major intubation trauma of the larynx--an association not previously reported. The cysts were usually multiple and arose in the posterolateral subglottis. Most were small and did not cause significant airway obstruction, but associated intubation changes were sufficiently severe to necessitate tracheotomy in 10 patients. The cysts observed in our study did not enlarge and in 4 patients were observed to spontaneously resolve or shrink in size--trends not previously reported. Subglottic ductal cysts noted in preterm infants after prolonged intubation most commonly occur in association with laryngeal intubation trauma and are likely a component of intubation trauma. Although these cysts may resolve without therapy, careful follow-up and treatment of potentially obstructing subglottic ductal cysts is recommended.

Subglottic cyst in a newborn

Subglottic laryngeal cysts in the newborn are extremely rare. It is difficult to establish if the cyst is acquired or congenital because respiratory distress requires intubation in the I.C.U. generally without prior endoscopy. A case report is presented, followed by a discussion of possible aetiology and management protocol; the advantages of the CO2 laser make excision of the cystic sac possible without tracheotomy.