eMedicine Specialties > Pediatrics: Surgery > Otolaryngology
Subglottic Stenosis: Multimedia
Updated: Oct 24, 2008
Multimedia
 | Media file 1: Intraoperative endoscopic view of a normal subglottis. |
 | Media file 2: A glottic and subglottic view of a grade III subglottic stenosis in an 18-year-old patient following a motor vehicle accident. The true vocal cords are seen in the foreground. Subglottic stenosis is seen in the center of the picture. |
 | Media file 3: Endoscopic view of the true vocal cords in the foreground and the elliptical congenital subglottic stenosis (SGS) in the center of the picture. A close-up view is seen in Media file 5. |
 | Media file 4: Subglottic view of very mild congenital subglottic stenosis. Laterally, the area looks only slightly narrow. When endotracheal tubes were used to determine its size, it was found to be 30% narrowed. |
 | Media file 5: Endoscopic subglottic view of congenital elliptical subglottic stenosis, a close-up of subglottic stenosis in Media file 3. See progression of treatment with an anterior graft in Media file 11, Media file 17, Media file 19, Media file 20, and Media file 34. |
 | Media file 6: An intraoperative view of granular subglottic stenosis in a 3-month-old infant that was born premature, weighing 800 g. The area is still granular following cricoid split. This patient required tracheotomy and eventual reconstruction at age 3 years. True vocal cords are shown in the foreground (slightly blurry). |
 | Media file 7: Intraoperative laryngeal view of the true vocal cords of a 9-year-old boy. Under the vocal cords, a spiraling subglottic stenosis can be seen. A close-up view of the stenosis can be seen in Media file 8, and treatment can be seen in Media files 9-10. |
 | Media file 8: A close-up view of the stenosis seen in Media file 7. This spiraling subglottic stenosis is not complete circumferentially. Laser therapy was the treatment choice and was successful after 2 laser treatments. Treatment can be seen in Media files 9-10. |
 | Media file 9: Continued lasering of the subglottic stenosis seen in Media files 7-8. The reflected red light is the aiming beam for the CO2 laser. |
 | Media file 10: Endoscopic view of patient in Media files 7-9 two months postoperative. Some mild residual posterior subglottic stenosis remains, but the child is asymptomatic and the airway is open overall. |
 | Media file 11: An intraoperative view of a split cricoid in a patient with elliptical congenital subglottic stenosis (Media file 3, Media file 5). The open airway can be seen in the center of the picture. The wound extends to the inferior one third of the thyroid cartilage. The first 2 tracheal rings also are divided. The graft and its placement are seen in Media file 17, Media file 19, Media file 20, and Media file 34. |
 | Media file 12: Preoperative view of a 4-month-old infant with acquired grade III subglottic stenosis from intubation. Vocal cords are in the foreground. A close-up view of the stenosis can be seen in Media file 13, and treatment can be seen in Media files 14-16. |
 | Media file 13: An endoscopic subglottic view of a 4-month-old with grade III subglottic stenosis (close-up view of the patient in Media file 12) born premature at 26 weeks' gestation and intubated for 3 months. Treatment can be seen in Media files 14-16. |
 | Media file 14: Postoperative view of the patient in Media files 12-13. Following cricoid split, the patient had been intubated for 1 week and extubated for 1 week. Continued treatment can be seen in Media files 15-16. |
 | Media file 15: A subglottic view of patient in Media file 14 following dilation with an endotracheal tube to lyse the thin web of scar and a short course (5-day) treatment with oral steroids. Final result can be seen in Media file 16. |
 | Media file 16: Postoperative view of a 4-month-old infant with subglottic stenosis following cricoid split (patient seen in Media files 12-15). This picture is 2 weeks after lysis of scar and steroids. Notice very mild recurrence of scaring at the site of previous scar. Overall, the airway is open and patent. The anterior superior area can be seen, with a small area of fibrosis where the cricoid split previously healed. |
 | Media file 17: Rib graft for reconstruction of subglottic stenosis carved in boat type anterior graft. The diamond-shaped internal intraluminal component with perichondrium still present is seen on the top section of the rib and the shape of the rib is seen on the backside of the carved out diamond shape. See placement of graft in Media file 19. |
 | Media file 18: Anterior rib graft with a diamond shape. Note it measures approximately 1.7 mm in length. Intraluminal site is facing up. Flanges of rib are carved to remain on the outside of the trachea to prevent prolapse into the trachea. |
 | Media file 19: An intraoperative aerial view of an anterior cartilage graft in place over the wound. Note external component of the graft still looks like a portion of the rib. The internal component has been carved in a diamond shape. This is an intraoperative photo of the patient seen in Media file 3 and Media file 5. The cartilage graft in Media file 17 was used in this patient for reconstruction. A postoperative photo is seen in Media file 34. |
 | Media file 20: An intraoperative side view of the neck with cartilage graft to be placed into the posterior cricoid suspended and having all sutures in position, ready to be tied. All the sutures are placed prior to lowering the graft into position. Then, the sutures are tied. Another view of the graft is seen in Media file 19. |
 | Media file 21: Representative (noninclusive) sample of varying sizes of Aboulker stents (range of 3-15 mm). These stents are hollow and coated in Teflon. |
 | Media file 22: A glottic endoscopic view of the top of Aboulker stent in the larynx protruding through and above the true and false vocal cords. The arytenoids and epiglottic folds are seen. |
 | Media file 23: Diagram of a long Aboulker stent wired to a metal Jackson tracheotomy tube. |
 | Media file 24: A Jackson tracheotomy tube wired to a long Aboulker stent. |
 | Media file 25: A 7-mm Montgomery tracheotomy tube with caps |
 | Media file 26: A subglottic endoscopic view of granulation tissue (superior center portion of the picture) that occurred at the graft site 10 days following a laryngotracheal reconstruction performed with an anterior graft. Granulation tissue is at the superior center portion of the picture. Treatment can be seen in Media files 27-28. |
 | Media file 27: Intraoperative suspended view through a subglottoscope of the subglottis of patient in Media file 26, showing the granulation tissue just prior to removal with cup forceps and laser. The postexcision view is seen in Media file 28. |
 | Media file 28: Postexcision view of granulation tissue seen in Media files 26-27 through the subglottoscope. |
 | Media file 29: Preoperative view of glottic stenosis and small glottic chink in a 2-year-old child who underwent anterior and posterior grafting. The child's glottic narrowing is tight, and scarring of the right arytenoid has occurred. A close-up of this patient's subglottic stenosis can be seen in Media file 30. Treatment can be seen in Media files 31-33. |
 | Media file 30: Preoperative endoscopic subglottic view of a 2-year-old patient with congenital and acquired vertical subglottic stenosis. Treatment can be seen in Media files 31-33. |
 | Media file 31: Postoperative view of the glottic larynx in a child who underwent anterior and posterior grafting for subglottic stenosis (see Media files 29-30). The child had glottic narrowing that is more open and in neutral position after the surgery. The scarring of the right true vocal cord appears improved, and her voice is more normal. Continued treatment can be seen in Media file 32-33. |
 | Media file 32: Postoperative close up view of the true vocal cords in the patient seen in Media file 31. |
 | Media file 33: A 3-month postoperative subglottic view of patient (seen in Media files 29-32) who underwent anterior and posterior costal cartilage grafting with successful decannulation showing open subglottis with some very mild damage to the anterior wall and the suprastomal area where the tracheostomy tube had been placed. |
 | Media file 34: A 1-week postoperative subglottic view of the surgical repair with an anterior graft of a congential elliptical subglottic stenosis. The white areas to the left and right are the true vocal cords. The graft is seen at the superior and mid area. This is a postoperative photo of the patient seen in Media file 3 and Media file 5. The graft and its placement are seen in Media file 11, Media file 17, Media file 19, and Media file 20. |
 | Media file 35: End view of an Aboulker stent showing the central opening. These stents are hollow and coated in Teflon. |
More on Subglottic Stenosis |
| Overview: Subglottic Stenosis |
| Differential Diagnoses & Workup: Subglottic Stenosis |
| Treatment & Medication: Subglottic Stenosis |
| Follow-up: Subglottic Stenosis |
 Multimedia: Subglottic Stenosis |
| References |
| « Previous Page |
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Further Reading
Keywords
subglottic stenosis, laryngeal stenosis, SGS, cricoid ring, acquired SGS, acquired subglottic stenosis, syphilis, tuberculosis, typhoid fever, diphtheria, endotracheal intubation, pressure necrosis, exercise intolerance, prematurity, airway obstruction, inspiratory stridor, biphasic stridor, gastroesophageal reflux disease, GERD, bronchopulmonary dysplasia, cleft palate, choanal atresia, retrognathia, subglottic tumor, subglottic hemangioma, glottic stenosis, tracheal stenosis, edema, gastroesophageal reflux, GER, acute infection, croup
