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Published in: Pediatric Surgery International 10/2018

01-10-2018 | Original Article

Serial intralesional triamcinolone acetonide injections for acquired subglottic stenosis in premature infants

Authors: Akinori Sekioka, Koji Fukumoto, Masaya Yamoto, Toshiaki Takahashi, Kengo Nakaya, Akiyoshi Nomura, Yutaka Yamada, Naoto Urushihara

Published in: Pediatric Surgery International | Issue 10/2018

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Abstract

Purpose

Long-term intubation of premature infants sometimes induces acquired subglottic stenosis (SGS), causing glottic or supraglottic problems. These kinds of SGS often require tracheostomy and subsequently make decannulation difficult. The aim of our study was to clarify the efficacy of repeated intralesional steroid injections to the stenosis.

Methods

Six children with acquired SGS, who were treated with triamcinolone acetonide injections to the subglottic space just below the vocal folds between September 2015 and December 2017 were retrospectively reviewed.

Results

The patients’ mean age was 4.3 (range 1.3–4.4) years, the mean gestational age at birth was 25 (23–28) weeks, and the mean birth weight was 591 (456–734) g. The degree of SGS was grade II in one patient and III in five patients, with both tracheostoma and glottic or supraglottic abnormalities. They generally underwent ten procedures, every 3–4 weeks. In most cases, the patency of the injected space improved by 25–220%, and the symptoms were relieved. One patient achieved decannulation, and another one underwent laryngotracheal reconstruction and decannulation. Two patients started using a speech cannula. There were no severe complications.

Conclusion

Serial intralesional steroid injections are likely to be effective in improving the patency of acquired SGS.
Literature
1.
go back to reference Yamamoto K, Jaquet Y, Ikonomidis C et al (2015) Partial cricotracheal resection for paediatric subglottic stenosis: Update of the lausanne experience with 129 cases. Eur J Cardio Thoracic Surg 47:876–882CrossRef Yamamoto K, Jaquet Y, Ikonomidis C et al (2015) Partial cricotracheal resection for paediatric subglottic stenosis: Update of the lausanne experience with 129 cases. Eur J Cardio Thoracic Surg 47:876–882CrossRef
2.
go back to reference George M, Jaquet Y, Ikonomidis C et al (2010) Management of severe pediatric subglottic stenosis with glottic involvement. J Thorac Cardiovasc Surg 139:411–417CrossRefPubMed George M, Jaquet Y, Ikonomidis C et al (2010) Management of severe pediatric subglottic stenosis with glottic involvement. J Thorac Cardiovasc Surg 139:411–417CrossRefPubMed
3.
go back to reference Raman T, Chatterjee K, Alzghoul BN et al (2017) A bronchoscopic approach to benign subglottic stenosis. SAGE Open Med Case Rep 1:2050313 × 13496507 Raman T, Chatterjee K, Alzghoul BN et al (2017) A bronchoscopic approach to benign subglottic stenosis. SAGE Open Med Case Rep 1:2050313 × 13496507
5.
go back to reference Hoffman MR, Coughlin AR, Dailey SH (2017) Serial office-based steroid injections for treatment of idiopathic subglottic stenosis. Laryngoscope 127:2475–2481CrossRefPubMed Hoffman MR, Coughlin AR, Dailey SH (2017) Serial office-based steroid injections for treatment of idiopathic subglottic stenosis. Laryngoscope 127:2475–2481CrossRefPubMed
6.
go back to reference Edmondson NE, Bent J (2010) Serial intralesional steroid injection combined with balloon dilation as an alternative to open repair of subglottic stenosis. Int J Pediatr Otorhinolaryngol 74:1078–1081CrossRefPubMed Edmondson NE, Bent J (2010) Serial intralesional steroid injection combined with balloon dilation as an alternative to open repair of subglottic stenosis. Int J Pediatr Otorhinolaryngol 74:1078–1081CrossRefPubMed
7.
go back to reference Willis EB, Folk D, Bent JP (2013) Adjunctive procedures after pediatric single-stage laryngotracheoplasty. Ann Otol Rhinol Laryngol 122:330–334CrossRefPubMed Willis EB, Folk D, Bent JP (2013) Adjunctive procedures after pediatric single-stage laryngotracheoplasty. Ann Otol Rhinol Laryngol 122:330–334CrossRefPubMed
8.
go back to reference Gnanapragasam A (1979) Intralesional steroids in conservative management of subglottic stenosis of the larynx. Int Surg 64:63–67PubMed Gnanapragasam A (1979) Intralesional steroids in conservative management of subglottic stenosis of the larynx. Int Surg 64:63–67PubMed
9.
go back to reference Guarisco JL, Yang CJ (2013) Balloon dilation in the management of severe airway stenosis in children and adolescents. J Pediatr Surg 48:1676–1681CrossRefPubMed Guarisco JL, Yang CJ (2013) Balloon dilation in the management of severe airway stenosis in children and adolescents. J Pediatr Surg 48:1676–1681CrossRefPubMed
10.
go back to reference Myer CM III, O’Connor DM, Cotton RT (1994) Proposed grading system for subglottic stenosis based on endotracheal tube sizes. Ann Otol Rhinol Laryngol 103:319–323CrossRefPubMed Myer CM III, O’Connor DM, Cotton RT (1994) Proposed grading system for subglottic stenosis based on endotracheal tube sizes. Ann Otol Rhinol Laryngol 103:319–323CrossRefPubMed
11.
12.
go back to reference Morita K, Yokoi A, Bitoh Y et al (2015) Severe acquired subglottic stenosis in children: analysis of clinical features and surgical outcomes based on the range of stenosis. Pediatr Surg Int 31:943–947CrossRefPubMed Morita K, Yokoi A, Bitoh Y et al (2015) Severe acquired subglottic stenosis in children: analysis of clinical features and surgical outcomes based on the range of stenosis. Pediatr Surg Int 31:943–947CrossRefPubMed
13.
go back to reference Ikonomidis C, George M, Jaquet Y et al (2009) Partial cricotracheal resection in children weighing less than 10 kilograms. Otolaryngol Head Neck Surg 142:41–47. 14CrossRef Ikonomidis C, George M, Jaquet Y et al (2009) Partial cricotracheal resection in children weighing less than 10 kilograms. Otolaryngol Head Neck Surg 142:41–47. 14CrossRef
14.
go back to reference Johnson RF, Rutter M, Cotton R et al (2008) Cricotracheal resection in children 2 years of age and younger. Ann Otol Rhinol Laryngol 117:110–112CrossRefPubMed Johnson RF, Rutter M, Cotton R et al (2008) Cricotracheal resection in children 2 years of age and younger. Ann Otol Rhinol Laryngol 117:110–112CrossRefPubMed
15.
go back to reference Brown SB, Hedlund GL, Glasier CM et al (1987) Tracheobronchial stenosis in infants: successful balloon dilation therapy. Radiology 164:475–478CrossRefPubMed Brown SB, Hedlund GL, Glasier CM et al (1987) Tracheobronchial stenosis in infants: successful balloon dilation therapy. Radiology 164:475–478CrossRefPubMed
16.
go back to reference Finken MJJ, Mul D (2010) Cushing’s syndrome and adrenal insufficiency after intradermal triamcinolone acetonide for keloid scars. Eur J Pediatr 169:1147–1149CrossRefPubMed Finken MJJ, Mul D (2010) Cushing’s syndrome and adrenal insufficiency after intradermal triamcinolone acetonide for keloid scars. Eur J Pediatr 169:1147–1149CrossRefPubMed
17.
go back to reference Gondwe JS, Davidson JE, Deeley S et al (2005) Secondary Cushing’s syndrome in children with juvenile idiopathic arthritis following intra-articular triamcinolone acetonide administration. Rheumatology 44:1457–1458CrossRefPubMed Gondwe JS, Davidson JE, Deeley S et al (2005) Secondary Cushing’s syndrome in children with juvenile idiopathic arthritis following intra-articular triamcinolone acetonide administration. Rheumatology 44:1457–1458CrossRefPubMed
18.
go back to reference Kumar S, Singh RJ, Reed AM et al (2004) Cushing’s syndrome after intra-articular and intradermal administration of triamcinolone acetonide in three pediatric patients. Pediatrics 113:1820–1824CrossRefPubMed Kumar S, Singh RJ, Reed AM et al (2004) Cushing’s syndrome after intra-articular and intradermal administration of triamcinolone acetonide in three pediatric patients. Pediatrics 113:1820–1824CrossRefPubMed
19.
go back to reference Teelucksingh S, Balkaran B, Ganeshmoorthi A et al (2002) Prolonged childhood Cushing’s syndrome secondary to intralesional triamcinolone acetonide. Ann Trop Paediatr 22:89–91CrossRefPubMed Teelucksingh S, Balkaran B, Ganeshmoorthi A et al (2002) Prolonged childhood Cushing’s syndrome secondary to intralesional triamcinolone acetonide. Ann Trop Paediatr 22:89–91CrossRefPubMed
Metadata
Title
Serial intralesional triamcinolone acetonide injections for acquired subglottic stenosis in premature infants
Authors
Akinori Sekioka
Koji Fukumoto
Masaya Yamoto
Toshiaki Takahashi
Kengo Nakaya
Akiyoshi Nomura
Yutaka Yamada
Naoto Urushihara
Publication date
01-10-2018
Publisher
Springer Berlin Heidelberg
Published in
Pediatric Surgery International / Issue 10/2018
Print ISSN: 0179-0358
Electronic ISSN: 1437-9813
DOI
https://doi.org/10.1007/s00383-018-4312-7

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