A respiratory physician's view of acquired subglottic stenosis

Extract

Apart from the neonatal period acquired subglottic stenosis is most often seen in infancy and early childhood. It remains the commonest indication for tracheostomy in the paediatric age group, (Jennings, 1987). The aetiology is usually multiple and may include major contributory factors from the airway itself, the presence of an intercurrent illness and the complications of intubation (Table I). The airway may be intrinsically normal or abnormal at birth but may subsequently be stressed by various events such as infection either in the neonatal period or in the first few months of life. Extrinsic compressions of the airway, for example by a vascular ring (Westaby et al., 1984) may produce tracheomalacia so increasing the risks of respiratory obstruction during intercurrent infection. Intubation is the preferred method of airway support for those with associated severe respiratory failure but brings with it a number of potential complications which may eventually lead to significant subglottic narrowing.